Filed under: blister care, Foot Care, Foot Care Products, Footcare, Health, Sports
Last weekend I worked foot care at the Western States 100 Mile Endurance Run. We had a fairly dry winter with not much snow in the high country and I had heard runners talk of the dust on the trail. Based on that, I did not expect to see high number of runner’s having foot trouble because of maceration.
Working Michigan Bluff aid station, at 55.7 miles, I was surprised by the runners coming in with wet feet, and varying degrees of maceration. For some, it was minor skin softening and maybe a few surface creases. Others had more severe maceration, with creases that were deeper over widespread areas on the bottom of their feet. A few were really bad – deep creases and skin folding over on itself. In extreme cases, the folded skin can split open.
While maceration is commonly caused by stream and river crossings, it also happens when runners pour water over their heads and body and it runs down into their shoes. Feet also sweat a lot, some people’s more than others, and this also can lead to maceration.
I also worked the finish line. There I saw even worst cases of maceration.
Severe maceration can manifest itself as a burning sensation, and the feeling of large blisters all over the bottom of their feet. Taking off the runner’s shoes and socks, we found virtually all of these complaints to be degrees of maceration. Two facts are evident. First, as might be expected, the longer a runner is on the course, the worse the feet can become. Secondly, not changing one’s shoes and socks during the race can magnify the effects of maceration.
The photos here are of one runner. My recollection is this runner finished the 100 miles in about 29 hours. She came into the podiatrity area of the medical tent and could barely walk. This is not uncommon. Runners dig deep and finish on adrenalin and then once they stop, the extent of the injuries to their feet hits them.
Photo 1 shows the bottom of the right foot – it’s worst than the left. You can see the white of the skin, and the creases running over much of the foot. The creases extend down to the mid-foot. Notice the white skin flap on the tip of the little toe.
Photo 2 is a close up if the toes. You can see the large skin flap on the little toe. This flap of skin was very white and looked as if the skin on the tip of the toes had been pulled outward and pinched. It was about ¼ inch in length. It runs from the toenail to the bottom of the toe.
Photo 3 shows the side of the forefoot. You can see the large fold of skin of the inside of the ball of the foot. This can be very painful and can split open under pressure.
Unfortunately, there is no quick fix for maceration. Typical treatments include warming the feet, moisture-absorbing powder, dry socks, allowing the feet exposure to air to dry, and time. In talking to this runner, she did not change her shoes nor socks during the 100 miles. I don’t recall the type of shoe, but my guess is that it did not allow water to drain.
There are several ways to manage possible maceration. Several years ago I watched as an adventure racer coated the bottom of his feet with Hipoglos, a European version of zinc oxide. The compound helps control moisture on the skin, whether zinc oxide or Desitin or a similar product. RunGoo, Century Riding Cream, and Blue Steel Sports Anti-Chafe Cream are similar products. I may have another product to announce early next month.
Another helpful tip is to make sure your shoes drain well. Whether that means mesh uppers, mesh or a draining material down to the shoes upper sole, or making drain holes with a heated nail, draining water out of the shoe is important. Then of course, changing your shoes and socks is also important. Most 100’s have aid stations with drop bags and it’s easy to put a pair of shoes in one or two drop bags, or have your crew have them ready.
Maceration can be cruel. It ruins the race for some runners. It’s painful. It can take days to heal fully. But there are ways to minimize its effects. If you are running a 100 or a multi-day race, and there is a chance of water on the course, plan accordingly.
Years ago, back in the late 80′s, I has the good fortune to run the Western States 100 Endurance Run four times. While I never earned the silver buckle, I had respectable times: 26:32, 26:00, and 24:32. The fourth time, I pulled myself at Rucky Chucky. I always did my training in the Ohlone Wilderness, Lake Chabot, and Mt. Diablo.
My third time, when I missed the silver buckle by 32 minutes, I never should have finished. My training for the six months before the race was only 750 miles! I was 250th into Robinson Flat and 100th at the finish line. Between the two, no one passed me and I passed everyone I could. My pacer and I had a great night run, picking people off as we ran. I thought I had a shot at 24 hours, but when I got to Highway 49, I knew I would fall short.
So it is with those memories that I wish everyone at Western States the best of luck for a safe and fun run.
I’ll be doing foot care at Michigan Bluff and then Sunday morning at the finish line. I hope some of you crewing will have the opportunity to stop by medical at Michigan Bluff and say hi. If you are running the race, I hope you can run past with great looking feet.
But if you need help with blisters or any foot related care, I’ll be there.
Several weeks ago I was interviewed by Gabriella Boston, a reporter for The Washington Post. She emailed me asking whether I was available and when could we talk. When she called we talked for about an hour. She asked all kinds of questions about foot care based on my experiences for runners.
The article came out on the 17th and is worth reading. The title is How Runners Can Keep Their Feet Happy. Sections include, run training, proper footwear, cross training, and foot care. Gabriella interviewed two podiatrists, a physical therapist, and me. Fixing Your Feet is also mentioned in the article. Click on the link in the paragraph above to read the full article. My bet is that you’ll learn something new.
I’ve been on vacation much of the past two weeks and given my time away, have turned to a good friend, Alene Nitzky, an experienced and well qualified ultra runner who wrote an article published at the Coloradoan website. You have heard me go on and on about the importance of god foot care. Here’s another slant, from an ultra runner who has run Badwater and many other ultras.
Runners spend all kinds of money on entry fees, clothing, travel to races, nutritional supplements and race foods. They spend all kinds of time on training, body work, stretching, weight training or cross training.
They worry about their weight, hydration, nutrition, sleep, and preparing for race-day conditions. And most of all, they obsess about finding the right shoe.
But in all this obsession, the two things they forget are the most essential tools they have to carry them from start to finish and go into those expensive running shoes.
Your feet are your base of support. They are the vehicle that carries you forward and through the distance. You can’t run without them. So why do so many runners neglect them?
You can do all the right training and preparation, wear the right shoes and gear, but if your feet fail you, it can ruin months of hard work.
The problem is lack of foot care. Blisters are just a symptom of the problem. Friction and moisture are the two culprits in creating blisters. Improper hydration plays an important role, too.
Blisters are caused by layers of skin and fabric or debris trapped inside the shoe or sock, combined with friction from running motion. Creases in socks, rough edges inside shoes, and dirt contribute to these rough spots. Calluses that are allowed to develop on feet and are not removed can lead to deep, painful blisters. Rough or jagged toenails can catch on socks, causing the fabric to bunch and rub against the toes.
The role of hydration, especially too little sodium relative to fluid intake, also contributes to blistering. Fluid travels out of the blood vessels into the tissues and separates layers of skin, making shoes tight and contributing to more friction. Check your hands while running. If your hands are swollen, your feet are swollen, too. Popular sports drinks often don’t have enough sodium to replace what is lost during long, hot weather events.
Regular pedicures are helpful. If you don’t want nail polish and all the extras, you can do much of it yourself. Softening and removing calluses over time reduces the likelihood of blisters under these trouble spots. Soften rough, dry spots with lotion when you’re not out running. Keep your toenails trimmed and filed. Underneath the ball of the foot, most people don’t realize they have callouses, and these are a common trouble spot.
Moisture is another problem, even in our dry climate. If you are running trails with stream crossings or crossing snow banks at high altitude, you are also at risk for developing blisters. But even without water crossings, your feet sweat, and moisture in socks and shoes can become a problem.
Keeping your feet as dry as possible helps. If you have a dry pair of shoes and socks to change into after the stream crossings are behind you, that will help.
Use a good sock that wicks moisture away. There are many different brands at specialty running stores. Keep your shoes and socks clean. If you’re running a road marathon, don’t race in shoes or socks you wore on trails. The dirt will stay inside and cause friction.
A foot kit should be part of every runner’s supplies. You can learn how to give yourself a pedicure, how to stock a foot kit and tips for avoiding blisters and other foot problems by doing some research.
Band-Aids are fine for knees and hands, or even on feet that aren’t being used, but they are not meant for use on feet while running. They don’t hold up to friction, moisture and shearing. The Band-Aid will soon bunch up and crease, and any dirt in your shoes and socks will stick to them, causing more friction.
Two excellent resources for learning how to take care of your feet are John Vonhof’s book, Fixing Your Feet, 5th Edition, Wilderness Press, 2011, and website fixingyourfeet.com. You can also get a free subscription to his fixing your feet blog with helpful tips.
I encourage you to check out Alene’s websites. She’s a great person with a big heart.
Filed under: blister care, Foot Care, Footcare, Health, Sports
Last weekend I worked the finish line at the Ohlone 50KM Trail Run in San Francisco’s East Bay hills. This is a tough trail, very exposed to the day’s sun, and every step is either up or down. Some people say, and I believe that if you finish Ohlone, you have a great chance of finishing Western States.
One runner who I admire and consider a close friend is Catra Corbet. She has proven herself as the “owner” of this trail. Many years she will run an Ohlone 100 or more just because she loves the trail so much. This year, Catra did 200 miles on the trail!
In talking to Catra after she completed the 200 miles, she mentioned that she had no blisters. I remember years ago taking a picture of her taping her toes. She used to tape every toe. I have a photo of her with a heel blister too. Now though, Catra runs blister free. What’s the difference?
I believe Catra’s success with blister free feet came through the miles of running she puts on her feet. She doesn’t run short runs, she doesn’t run a couple of times a week – she runs a lot. Many of you know Catra, or have heard of her – and know how much she runs. She also has found the right shoes for her feet – Hokas. She also wears Drymax socks – a favorite of mine.
But it’s not just Catra. I have worked medical and provided foot care at hundreds of ultramarathons, adventure races, walks, and multi-day races and have seen the same thing.
At the Western States 100 at 55.7 miles, for example, the top 20 to 30 runners come through Michigan Bluff without needing any type of foot care. There may be one of two that get some type of foot care from their crew down the road, but if so, is generally pretty minor. Most often, if anything, they just change socks or shoes.
As the race progresses and more runners come through, we begin to see runners needing help with foot care. The farther back the runners are, the more foot care they need. Not every runner, but many of them. And many of them have multiple issues. Not just one blister, but quite a few. The more problems that have, the more complex the repair, and the longer it takes to complete the fix. This becomes a huge issue if they are trying to stay ahead of the cutoffs at each aid station. I remember a runner several years ago that we patched up. At the next aid station, she need more care and wanted to get out of the aid station quickly to avoid the cutoff. That meant not doing a quality patch job –and she came back to the aid station after going a bit down the road. She knew her race was over.
So the point here is that you need to put lots of miles on your feet in order to train them for long conditions. You can run 10 miles a day, day after day, and then try and do a 50 miler, and odds are – you will have problems. You have 10-15 mile feet – not 50 mile feet.
This applies to walking, running, adventure racing, hiking, – any activity where you use your feet.
It all boils down to how many miles you are putting on your feet.
We all can’t be the top runners. Many runners don’t have unlimited time to train. So what can the rest of us do? Make sure you get some long runs, especially closer to your race. Make sure you have the best possible fit in your shoes. Make sure you wear quality socks. Reduce your calluses. Learn proper toenail care. Change your socks and shoes as necessary for the conditions of your run or race.
Over the years, I have talked to too many runners who think blisters are naturally a part of running and racing. They don’t have to be. Make smart choices and put miles on your feet, and your feet can be blister free.
Filed under: blister care, Foot Care, Foot Care Products, Footcare, Footwear, Footwear Products
Vicky Kypta is the Medical Team Manager for the Jungle Marathon, which starts October 6 in the Amazon in Brazil. Last year she did an informal survey of the participants and the results are interesting. The race lasts seven days and goes through the jungle on pre-existing paths, trails, and tracks with natural obstacles to pass including streams and shallow rivers. This leads to feet that are constantly wet.
This is the race that I will be at in a few days.
Vicky shared the results of the questionnaire and commented it was quite interesting, although the sample group was quite small. There were about 30 participants.
Here are some of the findings:
- 77% of the respondents wore Injinji socks
- 100% of those NOT wearing Injinji sock got blisters
- 46% of those wearing Injinji sock got blisters: out of those 50% were on the balls of the foot and 50% were on the toes. Those who had blisters on their toes all wore shoes in their normal size.
Out of those with no blisters:
- 100% wore Injinji socks
- 100% wore shoes one size larger
- 75% applied some form of anti-friction compound to their feet; i.e. Body Glide, 2nd Skin or Zinc Oxide cream
- 75% pre-taped problem areas or hotspots
I find this interesting and wonder what we will find with the 78 participants next week. The Jungle Marathons are well run and the staff tells runners to train with wet feet. They have found this results in less foot problems.
The results are striking in several areas (remember this is a seven day stage race):
- All the runners who did not get blisters wore Injinji socks and shoes a full size larger than their normal shoes
- All the runners who did not wear Injinji socks got blisters
- Runners wearing their normal size shoes all got toe blisters
- The majority of blisters were on the forefoot and toes
Over the past 17 years, I have worked a lot of ultramarathons and multi-day stage races. I can honestly say that overall, feet have improved. More runners are prepared and know how to manage their feet.
When I return, I will share what we found at this year’s Amazon Jungle Marathon.
Filed under: blister care, Foot Care, Foot Care Products, Footcare
Over my years of taping feet, I have seen techniques improve to where pre-taping is more helpful then ever before.
Often times, in the middle of a race, one cannot take the time necessary to do a high-quality tape job. Things may be rushed. The runner may be in a huge hurry to make a cut-off. The feet and skin may be wet. Conditions may be less than ideal – lightening, set-up, workable access/angle to the feet, supplies, etc.
However, before a race, a hike, or run, there is more time to do a high quality pre-tape job. It’s also the time to practice your skills and learn how to do a really good tape job. The first photo here shows a pretty poor tape job on toes. In this photo, the tape will probably peel off from sock changes and general wear. If any one of the pieces comes off, the now untapped toe will be subject to the roughness of the tape on the neighboring toe. It looks like Leukotape, which sticks well, but does not conform to the curves of toes and other places on the foot. It is possible to do a great tape job on toes with Leukotape – but it take time and practice. I must admit I like Leukotape for certain conditions and tape jobs.
A good, high-quality pre-tape job should hold up well, for several days if necessary, and cared for. In this next photo, you can see the right foot of Bogie Dumitrescu after finishing a solo, self-supported crossing of Death Valley followed by up and down to Mt Whitney. You can see how the tape has held for 157 miles in the extremes of Death Valley. It’s hot on the valley floor, but there are two long uphill’s climbs followed by long downhill’s over two passes. An 11-mile trail hike follows that up to and another 11 back down Whitney. The tape job held for 157 miles! In fact it looks perfect.
The tape is Kenesio-Tex on the heels, balls of the feet and big toes. Hypafix tape is used in a figure eight cut to anchor the tape at the forward edge of the ball of the foot, between the toes, and anchored again on top of the foot. This prevents the forward edge of the tape from rolling.
The next photo shows Bogie’s two feet after the tape was removed. No blisters. One of the reasons the tape held is that Bogie managed his feet well. He kept them as dry as possible. This is important in Death Valley where often Badwater runners get their feet wet when they are sprayed or doused with water in an effort to cool them.
Bogie was fortunate to have his feet taped by Denise Jones, the Badwater Blister Queen. Denise is a master at taping feet and does a precision tape job. This is not a 30-minute tape job. It takes as long as it takes to do it right. Denise and I tape almost identically. If we apply a piece of tape and it looks or feels wrong, we remove it and retape. Our aim is to get the runners on the course and able to finish with good feet.
The point of this blog post is to show a good tape job that can hold up over multiple days. The final photo shows Danny Westergaard’s feet that Denise taped for Badwater three weeks ago. Danny’s feet are taped perfectly. You can see the small strip of Hypafix that Denise wrapped around Danny’s big toes to further secure the tape edges.
I commend Bogie and Danny for their runs. Bogie completed his solo self-supported Badwater crossing the week before the official Badwater ultramarathon. Danny completed his 7th Badwater, went to the summit of Whitney and then reversed direction and went back to the start for his 7th Badwater Double.
And I commend Denise Jones for her care of runner’s feet. She’s a class act. Thanks Denise.
Kinesio, Leukotape and Hypafix tapes, as well as Compound Tincture of Benzoin and other foot care supplies are available at Zombierunner.com.
Disclosure: When you purchase through this link, I make an affiliate small amount of each sale.
The Barkley Marathon is considered one of the toughest 100-mile races in the world. It has 59,100 feet of climb (and 59,100 feet of descent), more than any other 100-mile race. Since the race began in 1986, only 13 runners out of about 900 have finished within the 60-hour cutoff.
The Barkley consists of 5 20-mile loops with no aid except for water at two points. The cutoffs for the 100 mile race are 12 hours per loop. The 60 mile “fun run” has a cutoff of 40 hours, or 13:20 per loop. To prove you completed each loop, you must find 9 to 11 books (varies) at various points along the course and return a page from each book.
I read a few of the reports of this year’s race held on March 31 and I looked through hundreds of race photos taken by Geoff Baker. Geoff was kind enough to send me a few photos of feet – and legs from Barkleys. Here is Geoff’s contact information. Geoffrey Baker Photography. and a page from his website showing the competitors - ‘Out There’ at the Barkley: Portraits From the Edge of Endurance.
Thanks Geoff. And now, here are a few photos.
Filed under: blister care, Foot Care, Foot Care Products, Footcare
Several weeks ago I provided foot care at the Gold Rush Adventure Race. Last week I wrote of a tape job I observed, and whether is would work of not. Today I’ll share an observation on one racer’s choice of a lube.
The images show two stages of the process. The first image shows our racer cleaning his feet with a wet-wipe. You can see the creases (folds) on the bottom of his feet. These are typical when the feet have been wet for extended periods. Over time, these creases can become painful and if the skin stays wet, can lead to skin separation and splitting.
In this race, the athletes started with a short run, followed with a bike, and then a swim/paddle across a lake. After that, the teams embarked on a long trek fire roads and trails. The problem, as I was told, was the trek started with a river crossing that was also very muddy. This got everyone’s feet wet to start with.
So, fast-forward to the first major checkpoint. The teams came in and transitioned from feet to bike. At this transition area, each racer changes clothes and footwear for the new discipline.
So cleaning one’s feet between disciplines is necessary and always wise. The more you can remove dirt and grit off the feet, and keep them healthy, the better your chances of long term success. Wet wipes are great for this type of cleaning. Tops, bottoms, sides and toes are all important. With clean feet, we are ready for the next step.
In this case, the racer applied a generous coating of Hipoglos. According to Google, this is a Portuguese product has been in Brazil for 70 years. Its common use is for baby’s bottoms to prevent chafing.
The second photo shows its application on the racer’s feet. Squeeze some on and rub it all over. He made sure it gets between the toes and coats every crease in the bottom of the feet. Nothing gets wiped off. Socks go on right over the Hipoglos.
I saw the racer at the next transition area, almost 18 hours later and his feet looked good. He repeated the process again before heading out on the next leg of the race.
Hipoglos is similar to zinc oxide and Desitin Maximum Strength Diaper Rash Paste. In events where there is extended exposure to water, and when one’s shoes and socks cannot be changed, these are good choices. They are great at controlling moisture. They are equally good at controlling maceration. And of course, better to do good foot care early, as was done by this racer, then to try and catch-up after problems have developed.
Zinc oxide is what I use over blisters to control moisture and dry the skin. I have even injected it into blisters to do the same. Lube is good, but many do not protect the skin from excess moisture as well as products designed for diaper rash.
Give it a try.
I received a comment on a recent blog post about runners wearing Vibram FiveFingers. Debra Martin, MSPT, CLT, sent me a link to an article on “Injury Report from the Sump Jump.”
“It was thrilling to see almost 800 people run off from the starting line at this year’s Stump Jump 50Km event. Overall the injuries were few, considering the number of people out there. But there were a few patterns that were noteworthy, so here is a summary for you to learn from in preparing for your next trail race!
We actually had a line waiting for wound care after the 11 mile race due to the scraped up knees, with a few palm and finger cuts for good measure – just a matter of going fast on a technical trail here. I was very pleased that there were few twisted ankles throughout the day! I hope that was the result of trail runners working on their balance and ankle strength over the past few months and not just plain luck.
The toe injuries I saw came from people wearing – can you guess? Vibram FiveFingers shoes during the race. One person jammed their toe against a rock, twice, and has a possible fracture at the base of his toe. The other either dislocated or fractured his little toe when it split on the other side of a bush/tree.
You can find my notes on barefoot running/wearing Vibrams on the wall of this Facebook page. Yes, wearing these shoes can build strength in your ankle and foot. However, racing in them on technical trails… well, these injuries can happen. The bad part is that you will need to keep moving with a toe swelling up in it’s little compartment, and it will be used to help you push off and “grab” the terrain for the rest of the race. Just something to keep in mind when choosing footwear for your next race!”
I suspect this is a foretelling of injuries to come. Sure, runners get injured all the time. But when one changes their footwear to Vibrams, they need to be aware of the trail even more than other runners wearing shoes.
Barefoot and Minimalist Footwear Advice
Take the time to learn how to “read” the trail. Learn how to react to rocks and roots and other common obstacles. Learn how to change your stride mid-stride to avoid turning an ankle. Learn to be patient and don’t do too much too soon.
When venturing barefoot onto trails or even on pavement, you should take a few precautions. Start slowly with short barefoot excursions to give your feet time to adjust. Your feet are used to the support and cushioning of shoes, and going without will make a sudden change. Be attentive to the conditions of the path underfoot. Your feet can be cut or punctured by debris on the road or trail. If you want to run barefoot, start by walking.
Walking and running barefoot can be an excellent way to condition your feet in order to prevent blisters when you do wear boots or shoes. Your skin will be tougher and you may develop calluses. Yet, be forewarned: this is no guarantee that you will not get blisters. Remember that when it is raining, the moisture will soften the skin on your feet. That’s a good time to switch to one of the minimalist shoes.
Aside from the possibility of cutting your feet on glass or metal, if you have any cuts or open skin on your feet you run the risk of picking up an infection. Another concern is skin that calluses over. These calluses can split into fissures, or cracks in the skin. This opens the inner layers of skin to a greater risk of infection. If you step on something sharp and get a puncture wound, seek medical care. Puncture wounds typically close up and this seals any debris, germs, or contaminants inside the wound. If you choose to go barefoot it’s smart to take care of your feet. There is no point in getting an infection through carelessness.
After reading about all the possible injuries from going barefoot, you may be worried. Going barefoot may be the goal of many athletes, but in reality, wearing minimalist shoes will provide protection and enhance the “barefoot” experience. Tellman Knudson likes FiveFingers, especially for people who:
- Don’t want to deal with the pain of running barefoot
- Want to minimize the risk of stepping on something that could hurt them
- Run on hot surfaces where their feet would roast without protection
- Are in the process of transitioning from running in “normal shoes” to running barefoot
Remember that switching to barefoot running or minimalist footwear does not mean you can’t ever run in shoes again. Many athletes employ a combination of barefoot or minimalist and shoes. Running minimalist helps focus on good form, and for many, will reduce injuries. If you want or need something more substantial than FiveFingers, consider using one of the minimalist shoes such as Inov-8, Nike Free, Newton, New Balance 800, or Terra Plana. These replicate the free and natural flexible motions of your feet better than the usual running shoe.
The above advice is part of the new chapter on barefoot running in the January release of the fifth edition of Fixing Your Feet.