Filed under: blister care, Books, Foot Care, Foot Care Products, Footcare, Footwear, Footwear Products, Health, Sports
After 14 months of revising and updating, editing and then editing again, and issues with the cover, the 6th edition of Fixing Your Feet is available.
While it has been available for pre-order in Amazon, they now have the print version in stock and ready to ship. Amazon currently has the 6th edition priced at $13.64, well below the retail price of $19.95 – a great buy. Here’s a link if you want to order a copy.
The Kindle ebook version will be released in about two weeks.
As I meet runners and crews at races, I find many have an older edition. I encourage you to bite the bullet and get the 6th edition. It’s well worth it.
Every new edition has all products and URLs verified. In addition, the text has been tightened up to eliminate redundancy of topics, and remove out-dated information. Many topics have expanded and new information. Every chapter has been reviewed and some degree of change made.
The chapter on Extreme Conditions and Multiday Events includes new information on the growing problem with maceration, as well as new information on trench foot, chilblains, and frostbite, all possible in the adventures we participate in.
A new chapter is Blister Prevention – The New Paradigm. The chapter revises the thinking that moisture, friction, and heat are the causes of blisters. After much study by experts in the field, I introduce the concept of shear as the underlying cause of blister formation. Several charts show the relationship of moisture, friction, and heat to shear, and how new things like bone movement, skin resilience, and pressure; along with the usual things like fit, socks, insoles, lubricants, and more, influence blister formation. The chapter also stresses the value of ENGO Blister Prevention Patches.
I would be remiss if I didn’t comment on the new cover. The first cover mock-up had an image of an athlete trying to patch her feet, but it did not capture my view of doing foot care and blister patching well. I arranged a photo shoot with a local photographer and Tonya Olson, a physical therapist and well-trained foot-patching expert as our model. Thanks Tonya. I’ll let you be the judge, but I like the cover and the design.
If you have an older edition, you will benefit from the new edition. Even if you have the 5th edition, you’ll find value in the new 6th edition. Order the 6th edition through Amazon.
Once you have the new edition, I’d be appreciative of a review in Amazon when you have time. Reviews are important and help other buyers make informed decisions.
Note: The links above are my Amazon affiliate link.
Filed under: blister care, Foot Care, Footcare, Footwear, Health, Sports
Over the next few days, over 90 ultra runners will test themselves at the Badwater Ultramarathon in California’s Death Vally. 135 miles. Extreme heat, scorching roads, sand, wind, hot winds, and then at the finish line – much colder temperatures. I’ll be there to help with runner’s foot care issues, working with Denise Jones.
I decided to rerun this blog post from 2010. It describes an issue that can harm a runner, and can happen when time is not taken to repair small blisters before they become large, and then huge.
Here’s the post from July 2010.
This was a good week. Badwater in Death Valley always is. Fit runners, great crews, fantastic scenery through the harsh reality of Death Valley – and for me, lots of feet needing care.
For the most part, things were pretty normal. Blisters and more blisters. A great case of severe capillaritis (heat rash) on one runner’s ankles. Ugly toenails. Stinky feet. And more. Lots to like for someone who does foot care.
At the closing ceremony, I noticed Monica, a runner from Brazil, was favoring her right heel. I had met her several years earlier at a previous Badwater when I patched her feet at the 40-mile mark. This year, she finished her 2nd Badwater and that was important. However, she had not come in for help.
She should have.
After the awards ceremony, Denise Jones came and told me I had to see this blister. She talked as if it was really a great find. Denise, as the Badwater Blister Queen, has seen everything and it takes quite a bit to faze her. This blister did. And yes, it was good.
What started as a small blister, one that could have been treated to prevent it from getting bigger, was now an enormous blood blister. The image shows you the size.
There were several issues we had to consider. First and foremost, Monica is a diabetic. This makes foot care a huge issue because any foot infection suddenly becomes a huge health issue. Secondly, the size of this blister, filled with blood, would make it difficult to patch. As always, blood-filled blisters must be managed with care.
We debated the issues and gave Monica advice on how to take care of the blister for her trip home. We advised frequent soaks in warm/hot water with Epson salts and sticking to sandals or other open heel footwear.
What I want to emphasize here is that this never should have reached the size it was and worse yet, filled with blood. For those wondering, a blood blister is bad because, once opened or torn, it can introduce infection into the circularity system if not kept clean.
I wish Monica had taken care of this earlier. She may have never mentioned it to her crew. At any rate, what could have been easily treated now became a huge issue.
It’s a good lesson on not allowing small problems to become large problems. In other words, “Don’t do this to your feet.”
Filed under: blister care, Foot Care, Foot Care Products, Footwear, toenails
Next week is the Western States 100 Mile Endurance Run and all the fun and hoopla that goes with it. I ran the race from 1985 – 1989 with a best time of 24:32. It was a challenge but I had fun every year. Ever since then I have been associated with the run in some capacity and for the last 16 or so years have provided foot care help at an aid station or two and the finish line. In that time I have seen a lot of runners come through aid stations needing foot care.
This year I decided to make a list of my top 12 foot care tips for success at 100’s – whether Western States or any other 100-mile run. You don’t want feet like in this picture.
- Make sure your shoes fit. That means a bit of room in the toe box and good grip in the heel. It also means that the shoes are in good shape.
- Make sure you wear good socks. That means no cotton, but only moisture wicking or water-hating socks. If you are prone to toe blisters, consider Injinji toe socks.
- Trim your toenails short and then file them smooth so when you run your finger over the tip of the toe, you don’t feel any rough edges or points. This goes for thick toenails too – file them down.
- Reduce your calluses with a callus file and moisture creams. Trust me, you don’t want blisters under calluses.
- Wear gaiters over the top of your socks and shoes. This keeps dust and grip from going down inside the shoes and inside your socks. Understand though that the mesh in today’s trail shoes does allow dirt and grits inside the toe box, even with gaiters.
- Use a high-quality lubricant like SportsShield, Sportslick, RunGoo, Trail Toes, or ChafeX. Do not use Vaseline.
- Know how to treat a hot spot and blister between aid stations – and carry a small kit in your hydration pack. Early care is better than waiting until a blister has formed or until the blister has popped and its roof torn off.
- Just as you have trained by running and conditioning, you need to know what your feet need to stay healthy and blister-free during the race. Just as you have learned what foods you can tolerate during a race and during the heat, you need to be prepared for foot care problems. Your feet are your responsibility.
- Make sure you have a well-stocked foot care kit(s) with your crew and they know, in advance, how to care for your feet. Trailside, at an aid station, is not the time to learn or to train them what you like done.
- When you pour water over your head and body to cool off, lean forward to avoid water running down your legs and in your shoes. Getting wet feet or waterlogged socks can lead to maceration very fast.
- Consider using RunGoo or Desitin Maximum Strength Original Paste liberally on your feet and toes to control moisture from excessive sweat, stream crossings, snow melt, and water poured over your head that runs down into your shoes. Reapply at aid stations. Maceration can quickly lead to skin folds, tender feet, skin tears, and blisters.
- Finally, DO NOT assume that every aid station has people trained in foot care or have the supplies necessary to treat your feet. If you have a crew, have them work on your feet. Many times the medical personnel are backed up or dealing with more serious medical emergencies. And, truth be told, blister are not a medical emergency. Heat stroke, heat exhaustion, dehydration, and the like are more serious than blisters.
Every year I am amazed at the number of runners who are ill prepared. They put extra socks in their drop bags – that have holes in them. The have open Athletes foot sores between their toes. Their shoes are shot and should have been replaced. They have not done good toenail care. They have thick calluses. They start the race with old unhealed blisters. Their shoes don’t fit. They wear full-length compression socks and then are amazed when we can’t get them off at the aid station to work on their feet. Tight fitting compression socks may feel good but are almost impossible to get off and even worse to get back on over patched feet.
While medical people will always try to help you, we can’t work miracles with your feet when you have neglected caring for them from the start. Again, your feet are your responsibility.
Filed under: blister care, Foot Care, Foot Care Products, Footcare, Footwear, Footwear Products, Health, Sports
A while back I was interviewed about foot care by Shawn Bearden of Science of Ultra website and podcast. Here’s the link to the Science of Ultra website.
Shawn asked great questions and got deeper into foot care than any other interview I have done. We talked about the essential components of good foot care, from shoe fitting to blister care. Then we wrap it up by defining the essential features of a good minimalist foot care kit for your next run or adventure. The whole episode is about an hour and 22 minutes.
I encourage you to listen to the interview on the Science of Ultra website and then check out his website and other interviews. Podcasts can be subscribed to in iTunes and Stitcher Radio. By subscribing, you’ll received shows on your device (smart phone or tablet) as they are released.
We can learn a lot from shoe reviews. Whether the reviews are in magazines or websites, or posted in online forums and blogs, they can be helpful to hear what others have to say about shoes you are considering. RunRepeat.com is a website that features running shoe comparisons. In late 2015 they ran the numbers from 134,867 customer reviews of 391 running shoes from 24 brands. Shoes were ranked from one to five stars based on satisfaction. Interestingly, their conclusion was that expensive shoes are not any better than more moderately priced shoes. This means inexpensive running shoes are often better rated then expensive ones. They pointed out that perceived shoe quality is very subjective and the study was not a scientifically based. One possible finding from the comparison is that runners who buy more expensive shoes likely have higher expectations, and are more critical in their reviews.
Many shoe and boot companies suggest specific models that are best for certain types of activities and sports, and for certain types of feet. They do this because many shoes are made for a specific type of foot—and many people have feet that will work better with one type of shoe than another. Look for the buyer’s guides in the magazines of your sport. Runners can find shoe reviews in Runner’s World, Trail Runner, and UltraRunning. Backpackers and hikers can check out Backpacker magazine’s reviews, and Outside magazine’s Buyer’s Guide for helpful information.4 Wear Tested Gear Reviews (weartested.org) is another good site with reviews. Many online shoe retailers also offer phone advice support or online guides. For information on shoe reviews and gear review sources, see page xref in the appendix. Other sport-specific magazines may offer similar reviews. Many websites are now posting reviews, and some offer reader comments or reviews.
The September 2015 Runner’s World Shoe Finder asked up front if readers knew the type of shoe that worked best for them. If so, they were guided to a four-section grid based on more shoe, less shoe, and more cushioning, less cushioning. Each box of the grid contained shoes they recommended for that more/less choice. Other readers were asked questions about BMI, running mileage, and injury experience, after which they too were directed to one of the four boxes to find their recommended shoes. Each shoe reviewed was also rated for heel cushioning, forefoot cushioning, and flexibility; and the shoe’s weight and heel and forefoot heights were given. Unfortunately, these guides of suggested shoes usually only include 12-18 shoe models.
It’s a good starting point, but I would use the guides as a reference point to shop at my local running store and get their personal insights.
Even after buying shoes that fit well, be alert to changes inside your shoes as you walk, run, and hike. Jason Pawelsky, with Tamarack, the maker of the popular ENGO Blister Prevention Patches reminds, “We all know that changing conditions (terrain, temperature, distance, etc) can make even the best fitting pair of shoes feel and perform differently so there is no perfect fit 100% of the time. The challenge is to get runners, hikers and team sports players to not only recognize that, but to react proactively.”
This past week I read about two new high technology running shoes. They are very different from what we have seen in the past. The shoes show how far researchers and athletic industry innovators are going in the search to find the perfect running shoe. When I first started running, in the late 80’s, there were about nine shoe companies. Today there are more than 30 and the list is growing.
I’d be willing to try both of these shows – given the opportunity. They peak my interest. We need to be open minded about new shoes coming into the shoe marketplace, because we all remember what people first thought about the Vibram Five-Finger shoes, the minimalist shoes, the maximum cushioned Hokas, and more.
The Enko Running Shoe
The first shoe I saw was simply called Enko Running. It comes in five colors. You select your size and a body weight range. It is the most futuristic shoe I have seen in years. You can see the shoe in the image. The forefoot is fixed while the back heel and mid-foot parts of the shoe are controlled by a platform with springs running from mid-shoe to under the heel. The “studs” in the outersole are replaceable. The springs act as shock absorbers, and are delivered to you based on your weight. Enko claims impact is deadened, your stride is smooth and their system conserves all the energy stored in each stride. The springs are interchangeable.
The Enko Running shoe won a CES Innovation Award in 2016. The shoe is in a fundraising campaign at IndiGoGo.com where you can fund a pair for $330, $60 off the advertised price on their website. They are 153% funded.
The Ampla Fly Running Shoe
The second shoe I saw was the Ampla Fly from AmplaSport.com. Ampla is founded by a “world-renowned sports scientist and athletic industry innovators.” Dr. Marcus Elliott has trained elite athletes through his P3 Sports Science Institute in California.
The Ampla Fly shoe is unique with its split outersole, as you can see in the image. It claims to “… empower the efficient use of force. Encourage better mechanics, which provides a platform to help you run faster, run farther…” Their carbon fiber powerforce plate “… glides the foot to a better ground contact position, gather force at mid-stance, and maximizes force application at big toe push-off.” Two videos on the website shows the technology in action. My guess is that the split outersole, with the gap in the forefoot mid-foot, acts as a flex point with the carbon fiber powerforce plate. The shoes come in two colors, in both men’s and women’s sizes. The advertised price is $180.
What do you think about these two new shoe? Does the design intrigue you enough to plunk down your cold hard cash?
Filed under: blister care, Foot Care, Foot Care Products, Footwear, Footwear Products, Health
This second version of a toe separator is a more complicated to make and apply. It uses a large or small ENGO oval, depending on the size of the toes. The idea is to pinch the patch into an upside down T where the base of the T goes between the two problem toes. The patch is stuck to your insole in a position where it keeps the two toes apart. The slippery surface of the ENGO patch will prevent rubbing and the upward base of the upside down T will keep one toe from going under the other toe.
How to Make Your Own Toe Separator # 2
Using a utility knife, score two cuts, about one inch apart on the backside of the patch. Make them only deep enough to cut through the paper backing – do not cut through the patch itself. Try to have the one-inch wide space in the middle of the patch. Make the width of the cuts wide enough so the folded separator will be tall enough to match the height of the toes it will go between. This is important – a separator used between middle toes will have to be taller than ones used for pinky toes. Men’s toes may also require taller separators. Using the tip of the knife, remove the one-inch strip. Fold the patch in half so the sticky sides match to each other. The two end of the cut backing should meet in the middle. You can now open the two ends and cut the patch into the needed shape based on where the patch will go on the insole and the length of your toes.
Separator # 2 Height and Length
Separators for pinky toes need to be shorter in height and length than ones for the middle toes. You may have to make more than one separator based on the size you need to find the right fit.
How to Use the Separator # 2
To use the separator in your shoe, remove the insole for the foot with the overlapping toes. The smoother the insole the better the patch will stick. Clean the surface of the insole of all lint, dust or other things that could interfere with the patch adhering. Make sure the insoles are dry. Put the insole on the floor and stand on it so your foot falls into any indentations. Usually, an insole will have indentations under the heel, ball of the foot, and some of the toes. Using a pen, make a mark between the two affected toes. Put on a pair of Injinji socks and make sure the marking is still in the right place.
Once the placement has been confirmed, with sock on, place the separator between the two toes to make sure it fits. The best way to do this is with your foot on the insole. The height should come up to the top of the toes with sock on. If the height is too high, trim it with a scissors. If it’s too low, make another separator where the pinched section is higher.
The length needs to be long enough to cover the body of the toe – without hitting the crease between the toes. If the separator touches the crease, it could rub and cause problems, especially if the foot moves forward in the shoe. If it’s too long, trim it with a scissors.
Once the fit has been checked, you can place the separator on the insole. Line it up so the upward part is in the correct place. Then remove the protective backing to expose the adhesive and place the patch on the insole with the upward part over the line on the insole. Rub the separator to make sure it is firmly secured to the insole. Use a scissors to trim any part that extends over the sides of the insole. Use a blow dryer for a few
If the patch does not stick, you probably have an insole with a surface that is not smooth enough or too soft with too much fabric that does not allow the adhesive to hold. In this case, you may want to try another insole with a better surface. They can be peeled off the insole if they are placed wrong, but will probably not stick as well if you try to reattach them. The patches will not stick to a wet insole. For easier removal, use a blow dryer or heat gun to heat the patch.
If the Separator # 2 is Too Weak
It’s possible that the pinched section of the ENGO patch will be too weak or thin to keep the toe from going under the next toe. If you can tell the toe is going under, here’s an idea to make it stronger. Take another ENGO Patch and cut a strip the width of the top of the separator, remove the adhesive backing, and pinch it over the existing separator so it reinforces the upward part of the separator and extends onto the base. This will strengthen the part between the toes and make it stiffer and better able to keep one toe from going under the other.
Filed under: blister care, Foot Care, Foot Care Products, Footwear, Health
This is part one of a two-part blog post.
Over the past few years, I have seen many athletes with a common toe problem – overlapping toes. Some people may call then underlapping toes or call them some other name. When a pinky toe goes under the 4th toe, both toes can be negatively affected. Skin is pinched. Hot spots and then blisters form. Often callus develops as the skin is constantly under pressure from the overlapping toe.
While most common to the 4th toe and pinky toe, overlapping toes can affect any two toes. This is not necessarily a problem limited to running shoes or hiking footwear. It can happen in everyday footwear too. The cause of over-lapping is unknown. Many experts suspect that they are caused by an imbalance in the small muscles of the foot.
There are some easy solutions, which may or may not help, because toes are different. You can switch to Injinji toe socks, giving each toe it’s own little sock and some degree of protection. You can cut out a portion of the insole under the toe that goes under the other toe, giving the toe some extra space. Another option is to tape around the toe or toes to give some protection too.
This is an idea to help runners, adventure racers, and hikers with the problem of overlapping toes. You will need Injinji toe socks, ENGO Blister Prevention Patches (large ovals), and removable insoles. There are two types of separators you can make. This post will cover the first of the two.
Toe Separator Number 1
I use an ENGO Blister Prevention Patch as the toe separators. They make a small and large oval, but I like the large because of its size.
The first toe separator is easy to make and use – and it uses one large ENGO patch. Take a scissors and cut a long oval into a strip, about ¾ inch wide and 1¾ inches long. If you are cutting this for a middle toe or for large toes, it may have to be 1 to 1 ¼ inches wide and a bit longer. Round all corners. Cut one of the remaining sections into a small strip, ¼ inch wide and 1¼ inch long. Take the large oval and remove half the backing from one end. Wearing Injinji socks, put the large oval between the two affected toes. Put the end of the large oval with the exposed adhesive over the toe next to the toe that goes under it. The blue side will go from the top of one toe, run between the toes, and under the toe that normally goes under the other one. What you have is an S shaped patch from the top of one toe, between them, and then under the next toe. Take the small strip and remove the backing, and put one end of the adhesive on the white backing that is underneath the toe at the bottom of the S. The other end of the strip can be stuck onto the top of that toes sock. The small strip is needed to hold the bottom of the S under the toe when you put your foot in your shoe. The S shaped patch will keep the toes apart. Obviously, these are single use. If the patch seems too weak, use two strips to make the S patch stronger.
ICESPIKES have been around for a while and have proven themselves to be a reliable tool for those wanting to run, walk, and hike in winter conditions.
It doesn’t take much in bad conditions to take a nasty fall. Landing on hard ice, a rocky trail, or rocks hidden under snow can ruin your day. Protecting your tailbone, hands and wrists, knees, hips, and ankles, and your back is key to staying active. This is where ICESPIKES come in.
ICESPIKES are a traction system of 32 spikes that are applied directly into the sole of your shoes or boots. Their cold-rolled, tool quality steel will maintain hardness and grip 10 times longer than other systems. The spikes are self-cleaning, while their patented design provided great penetration and stability. They should last up to 500 miles.
ICESPIKES allow you to run, walk, and hike through the winter with the anti-slip spikes
ICESPIKES can also be used in water, mud and muck conditions, on slick rocks and gravel, uneven and root-bound terrain; and in mossy and slick leaf conditions.
For a limited time, use the coupon code “stockingstuffer” for 20% off your purchase.
ICESPIKES are packaged in a kit of 32 spikes and an installation tool and in packages of 32 spikes.
Filed under: blister care, Foot Care, Foot Care Products, Footwear, Footwear Products
Today’s post will cover a great way to prevent blisters using ENGO Blister Prevention Patches. It’s a repeat of a post from mid-2013.
Tamarack Habilitation Technologies is well known for providing healthcare professionals and clients with innovative, value-added orthotic-prosthetic componentry and materials. Their ShearBan product is similar to the ENGO Blister Prevention Patches reviewed in this article. ShearBan is used in the orthopaedic and prosthetic industry on prostheses at amputation stump sites to reduce the incidence of skin breakdown.
ENGO in Footwear
Introduced in 2004, ENGO Blister Prevention Patches have radically redefined the way hot spots, blisters and calluses are treated. As a preventative measure, ENGO patches provide peace-of-mind that blisters won’t become a painful, debilitating problem. If a blister has already formed, applying patches to footwear, corresponding to the blistered area eliminates painful irritation and further skin damage, allowing continued activity. Friction forces are reduced by more than 50% when you apply an ENGO Patch to your footwear.
The patches are made from an ultra-thin Polytetrafluoroethylene (PTFE) film and are 0.015 inches total thickness – a very slippery surface. They are very durable, lasting four to six weeks in most applications. The aggressively sticky patch peels away from the backing and is applied to dry shoes or boots. The PTFE ENGO Patch reduces the ‘stickiness’ between the shoe and sock so they can glide over one another. The foot, inside the sock, glides over the patch shear distortion and friction are reduced, and blisters can be averted, in spite of pressure.
Avid runners, hikers and sports players rely on their feet to reach performance goals; from day hikes to ultra marathons. But quality footwear and socks alone don’t eliminate the skin trauma your feet can experience from repetitive rubbing — building friction forces to levels that cause hot spots, blisters and calluses. While I use these patches in runners’ footwear at races, they can also be used in ordinary every day shoes to reduce calluses.
Similar to Tamarack’s ShearBan material, ENGO patches are applied directly to footwear and equipment, not to the skin. Outcomes of this unique application include ease of use, long-lasting and guaranteed friction relief.
ENGO Patches are made in several sizes and types:
- A large oval – 2 ¾ x 1 ¾
- A small oval – 2 x 1 ½
- A rectangle – 3 ¾ x 2 ¾
- Back of the heel patch – 3 ¾ x 1 ¾
- A cushion heel wrap – 3 ¾ x 1 ½
When I work a race I always have a bag with different sizes of ENGO patches. I have applied the ovals and rectangles and the back of the heel patches. The patches are applied to the shoes and insoles – not to your skin. This means wherever you are going to apply a patch has to be dry. My advice is to apply patches before your race when your shoes are dry. I have used them inside the shoes in the sides, in the heels, and on the insoles.
Typical problem areas in footwear are under the heel and forefoot, and at the side of the heel. An oval patch can be applied to overlap the side of the heel counter and the insole as seen is the photo. I often use a rectangle or large oval under the ball of the foot or an oval under the heel – applied directly to the insole. The patches are useful over stitching or seams in footwear that are rubbing the wearer. If necessary, a patch can be cut to shape for where it will be applied.
The patches will reduce shear and friction; provide relief from hot spot and blister pain, and can be used in any type of insole or orthotic and footwear, from sandals to running shoes, and any type of hiking or ski boot.
I like ENGO patches because they work. The patch is thin and does not alter the fit of the shoe. When properly applied to dry footwear, they stick.
Rebecca Rushton, a podiatrist in Australia, strongly recommends ENGO Patches. She discovered the patches after getting blisters herself and now represents ENGO in Australia. She has written several free reports on blister prevention available on her website, Blister Prevention.
If you are unclear about shear and blister formation, here’s a link to my article An Introduction to Shear and Blister Formation.
The Technical Stuff
JM Carlson, in a 2009 report wrote, “The measurement of friction is the ‘coefficient of friction’. The coefficient of friction (COF) is a number that represents this slipperiness or stickiness between two surfaces and is generally below 1.0. Within the shoe, the COF between the foot, socks and insole can range from 0.5 – 0.9. In contrast the COF between a sock and a polished floor is around 0.2.” Tests have shown PTFE patches to reduce the coefficient of friction (COF) in the shoe by up to 80%. The COF is in approximately 0.16, which is significantly lower than all other in-shoe materials. Importantly, the low COF is maintained even in most and wet conditions inside the shoe.
Check out GoEngo.com for more information about ENGO Blister Prevention Patches. They also offer a money-back guarantee.