Providing foot care for athletes at ultramarathons and multi-day events is a huge responsibility. Their feet are what keep them going, and if you are known for providing foot care, the athletes will be appreciative of whatever you can do. If you are simply helping one runner, you might be a bit more casual. But if you will be part of a foot-care team, you need to be prepared.
In 2015 race directors of several multi-day ultramarathons in Europe were overwhelmed by shear volume of runners seeking medical attention for blisters. They said it took upwards of 30 minutes per foot to treat most of the runners, which caused a significant drain on the ability of the medical team to look after more serious problems. Beginning in 2016, these races are introducing a triage system for medical care. Patients will be assessed prior to treatment with the most needy being treated first, regardless of how long others have been waiting. If the assessment indicates “minor” blisters, advice will be given and runners will be expected to treat their own feet. All runners must have their own blister treatment kit as part of their mandatory gear kit. They candidly state that foot care is easily divided into several phases, what they call the 6Ps: “Proper Preparation Prevents Piss-Poor Performance” and provide a thorough list of preparation, prevention, assessment, and treatment suggestions. “Proper Prevention” means in the months before the event, “Prevents” means during the race, and “Piss-Poor Performance” is what happens if you fail to follow the first three Ps.
Rebecca Rushton, an Australian podiatrist and owner of blisterprevention.com.au, and I agree that foot care at multiday events is vital. I consider a 100-mile ultramarathon a multi-day event. The problem is that many runners have become dependent and expectant that events will have medical personnel providing even the most basic foot care. Participants have come to treat foot care services at events as a perk of the event. While it’s nice to have, it’s not practical and sustainable long term. Race directors need volunteers with the time and expertise in foot care techniques, and the budget for supplies and equipment. The larger and longer the event, the more volunteers are needed and the more costly it becomes.
I wrote in a blog post that, “… at some events participants will move along the trail from aid station to aid station, and at each one, require some degree of foot care. What was patched at an earlier aid station didn’t work or didn’t hold up and they want someone at the next aid station to redo their feet. That’s a lot of work and supplies.” Many athletes also fail to take care of their feet and fail to plan, and in many cases fail to take common sense action (reduce calluses, trim toenails, do self-care, etc) that could have prevented or reduced the problem. Rebecca and I support what we call assisted self-management. In the aid station, provide a table and a few chairs, and basic foot care supplies. Medical personnel will be available to give advice and tend to more serious treatment. It could even be that runners are shown how to patch the first blister and then they manage the rest. It’s a workable model and builds on today’s popular DIY (do-it-yourself) method of learning new skills.
This leads to a new mindset among many medical professionals that manage medical direction at races and multiday events that is worth considering. An article in the April 2014 Sports Medicine summarized it well. “Although participants in ultra-endurance events should be educated and prepared to prevent and treat their own blisters and chafing, blister care will likely be the most frequent use of medical resources during ultra-endurance foot races.” The mindset is that participants need to shoulder some of the responsibility for managing their feet. Medical staff at aid stations can quickly become overwhelmed even to the point of running out of supplies. We can help promote and support this new mindset in several ways:
- Give participants tips to prepare their feet in advance of the event. (Refer to “Foot Care in Multiday Events” in chapter 16.)
- Give participants tips on the best footwear selections for the event (types of shoes, gaiters, oversocks, camp shoes, and so on).
- Give participants a list of foot-care gear they must carry. A section on mandatory foot-care gear can be found at the end of this chapter. Even runners in a 100-mile race can carry a small Zip-lok bag pinned to their bib number or in their hydration pack.
- Advise participants whether or not foot care services will be provided and if so, to what degree. This includes no foot care and supplies, limited self-management, or full service.
- Provide a self-service table of supplies for runners to use in DIY patching of their feet. This can speed up their in and out times at aid stations.
- Stress the importance of knowing how to work on one’s feet (by reading this book or through other sources, or workshops).
- Stress the importance of runner’s having crews knowledgeable in foot-care work and prepared with a well-stocked foot-care kit.
How you implement the principles of self-management or whether you decide to provide full service foot care services depends on several factors: The number of participants, the difficulty, the remoteness, the number of medical volunteers, the availability of supplies (and being able to absorb the cost) and the number of aid stations and how far apart they are. It should be a well-thought out and joint decision between the race director and the event’s medical director.
Please comment how you feel about foot care services at the races you run or help with, or as a race director. We’d love to hear your thoughts.
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.
Never ignore an injury. Pushing through an injury or returning to your sport too soon after being injured can lead to additional injuries. You do not want to turn a temporary injury into a permanent disability. Too often athletes rely on self-diagnosis rather than consulting with a medical specialist. If during or after running or hiking you have persistent foot problems or recurring pain that you cannot resolve, seek medical treatment from a medical specialist who can provide his or her medical expertise for your problem.
Primary Medical Specialists for Feet
Orthopedists are orthopedic surgeons, experts of the joints, muscles, and bones. This includes upper and lower extremities and the spine. Look for an orthopedist that specializes in the foot and ankle. The American Academy of Orthopaedic Surgeons and the American Orthopaedic Foot and Ankle Society can provide referrals. There are also Orthopedic Clinical Specialists (OCS).
Podiatrists are doctors of podiatric medicine (DPM) that work on the feet up to and including the ankles. They specialize in human movement, and medical and surgical problems including foot diseases, deformities, and injuries, such as nail, skin, bone, tendon, and diabetic disorders. Podiatrists treat such disorders with surgery, custom-made orthotics (shoe inserts), physical therapy, injections, casting and braces, prescription medication, and medicated creams and ointments. The American Podiatric Medical Association and the American Academy of Podiatric Sports Medicine can provide referrals.
If you have chronic foot problems, or you are uncertain what your feet are trying to tell you through their pain, consider consulting a podiatrist or orthopedic surgeon. Listen to your whole body and especially your feet. Be attentive to when the pain begins and what makes it hurt more or less. Then be prepared to tell the specialist about the problem, its history, what you have done to correct it, and whether it worked or got worse.
There is a wide range of skill overlap between orthopedists and podiatrists. Each can treat most of the same foot problems. When searching for a medical specialist for your feet, talk to doctors about their training, experience, and whether they have a specialty field. Each of the two specialist fields has doctors who specialize in sports medicine, and these would be my first choice. Weigh this information when making a decision about who to turn to for help. Additionally, a variety of other specialists can provide assistance in strengthening, alignment, rehabilitation, and footwear design and fit.
Pedorthists work with the design, manufacture, fit, and modification of shoes, boots, and other footwear. Pedorthists are board certified (C.Ped) to provide prescription footwear and related devices. They will evaluate, fit, and modify all types of footwear. A C. Ped. can help find a shoe built on a last (the form over which a shoe is constructed) that best matches a person’s feet, and then construct a custom orthotic that meets his or her particular biomechanical needs and interfaces with the shoe in a way that improves its fit and performance. The American Orthotics and Prosthetics Association and the Pedorthic Footwear Association can provide information and referrals.
Sports Medicine Doctors specialize in sports-related injuries. They are typically doctors of internal medicine with additional training in sports medicine. When treating athletes with lower-extremity injuries that do not improve with their initial treatment, they may refer the athlete to a podiatrist or orthopedist. Most are members of the American College of Sports Medicine (which does not provide referral services).
Physical therapists (PT) are licensed to help with restoring function after illness and injury. Most work closely with medical specialists. Physical therapists use a variety of rehabilitation methods to restore function and relieve pain: massage, cold and heat therapy, ultrasound and electrical stimulation, and stretching and strengthening exercises.There are also Masters of Physical Therapy (MPT) and Doctor of Physical Therapy (DPT). The American Physical Therapy Association can provide referrals.
Athletic trainers are licensed to work specifically on sports-related injuries. Rehabilitation methods may be similar to physical therapy but can additionally focus on maintaining cardiovascular fitness while injuries heal. The National Athletic Trainers’ Association can provide referrals.
Massage therapists work with athletes in reducing pain and tightness in muscles, tendons, and ligaments—the body’s soft tissues. The American Massage Therapy Association can provide referrals. Look for either Licensed Massage Therapists (LMT) or Board Certified in Therapeutic Massage and Bodywork (BCTMB).
Chiropractors are doctors of chiropractic (DC) medicine who specialize in the alignment of the body’s musculoskeletal system. Pelvis, back, and neck pain and muscle imbalances are often treated by a chiropractor. Some may specialize in sports injuries. There are also Certified Chiropractic Sports Physicians CCSP). Two organizations, the American Chiropractors Association and the International Chiropractic Association, can provide referrals.
When the time comes to seek medical attention, ask others in your sport for referrals, ask at your local running or outdoors store, look in the Yellow Pages, or search online. If you have a choice, choose a sports medicine specialist over a general doctor.
Filed under: blister care, Books, Foot Care, Foot Care Products, Health, Sports, Travel
I have known Terri Schneider for a long time. She did triathlons, moved up to focus on Ironman’s, then discovered adventure racing. When I heard about her new book, I knew I had to interview her. Her just released book, Dirty Inspirations, tells the stories of her “lessons from the trenches of extreme endurance sports” – the subtitle of the book.
From the back cover, we read, “By choosing to walk the path of more resistance, we come to a better understanding of ourselves and our potential for physical, mental, and emotional growth. And nowhere is this better represented than in the crucible of extreme endurance sports, where athletes are truly pushed beyond the bounds of what seems possible. Seen through the eyes of one of the most diversely experienced female athletes on the planet, the stories in Dirty Inspirations showcase discomfort as virtue, and demonstrate the truly indomitable nature of the human spirit.”
Chapters in Dirty Inspirations take readers into Ironman and adventure races and ultramarathons in Utah, Australia, California, Costa Rica, Malaysia, Tibet and Nepal, New Zealand, Egypt, China, Argentina, Alaska, and Ecuador. Terri raced in many countries, with huge awe-inspiring challenges, and unforgettable memories.
Along the way, she also learned a lot about her feet and how to do foot care. In this unique audio interview, I talk to Terri about the races, foot care secrets, and a lot more. It’s about 23 minutes in length.
Along the way, Terri learned a lot about herself as an athlete and a person. You and I may not have the opportunities to do the races she did, but we can live them through her stories.
For an in-depth interview with Terri about the book and how she wrote it, check out my Writers & Authors on Fire podcast where I interview her for an hour about the writing process.
If you run in the dark, whether roads or trails, the Night Runner 270 Degree Shoe Lights might be perfect for you. The lights are designed by athletes.
The lights attach to the shoelaces with multi-position adjustable brackets and weigh only 1.5 ounces. The lights give off a combined total of 150 lumens to light up the road, sidewalk, or trail in front of you. With white LEDs pointing forward and a red LED on the outside facing backwards, you are covered with 270 degrees of visibility – and you get 30+ meters in beam distance. The units are made with high-impact water-resistant casings for durability. The lights are powered by rechargeable Li-ion batteries with 4-8 hours of battery light. A supplied micro-port USB cable with a Y connection charges both units at the same time. A pair of lights sells for $59.95 and a two pair set for $109.95.
If you have carried hand-held lights or a headlamp, the Night Runner 270 Degree Shoe Lights are worth considering. They could also be used for cycling. The Night Runner lights started as a Kickstarter project.
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.
Feet are a big part of my life. For the past 19 years, Fixing Your Feet has introduced me to great people. I have enjoyed helping runners at events like Western States; Badwater in Death Valley; Primal Quest in Colorado, California and Washington; Raid the North Extreme in BC Canada; the TransRockies in Colorado; Racing the Planet Atacama in Chile; the Coastal Challenge in Costa Rica; the Avon Walk; the Susan G. Komen 3-Day Breast Cancer Walk; The Amazon Jungle Marathon, and others. In all these events, I’ve worked on thousands of feet. In addition, I’ve responded to an uncounted number of emails from folks asking for foot care advice.
The best part has been the people I have met. Runners, hikers, adventure racers, walkers, and their crews. Athletes walking a fine line between making a cutoff in a race, front runners, back of the pack runners, short and long distance hikers, solo and in groups – all ages. Athletes with a simple blister and others with blisters all over. Athletes in pain, and those wanting to quit.
I can recall many of these people. I remember their stories. Some of you are in my stories. I have learned a lot from each person whose feet I have patched. I don’t pretend to know everything about feet. Together we have learned a lot. I thank each of you for what you have contributed to the Fixing Your Feet story.
I wish all my readers a fun, bright, delicious, warm and cozy, and loving Merry Christmas. I hope you can spend time with family and friends – and maybe give your feet some nice soft socks.
Filed under: blister care, Foot Care, Foot Care Products, Footcare, Health
After years without an expedition length adventure race in northern California, the Primal Quest Adventure Race returned this past August. Even though there were openings for 20 four-person teams, only 11 teams toed the starting line in South Lake Tahoe.
For those unfamiliar with adventure racing, races generally consist of a mix of disciplines: trekking, mountain biking, orienteering, white waters, rafting, kayaking, and ascending and rappelling. Some events have caving and other exotic disciplines.
This year’s race stated with a downhill run to kayaks on the shore of Lake Tahoe, after which they paddled north, and then took off on mountain bikes for a long ride. Unfortunately, much of the 80+ miles turned into a hike-a-bike. Then at Kirkwood, they took off on foot for a long trek / orienteering section. For some teams, this section took hours longer then expected.
I was at TA3 (transition area) and we expected the first team early Friday morning, but in fact they arrived almost 24 hours behind schedule. The rest of the teams were spacer further and further apart as time progressed.
My point is that many of the racers had been on their feet for more than two and three days by the time they reached us. Then teams went back on their bikes, into kayaks, and into another long trek. Some teams were short-coursed – taken ahead on the course
Fast forward to TA6, a day and a half later and teams are still racing. Some of the racer who have done the full course to this point have had little time to rest and their feet are extremely sore to the point of being very painful. They may also have some degree of maceration going on too.
One such racer, Thomas, asked me to look at his feet. There were no blisters on the balls of his feet, just very soft and tender skin – very sore with some maceration. I told him I could help.
I cleaned his feet and allowed them to air dry. I applied Tincture of Benzoin Compound to the skin from mid-foot upwards to the base of the toes. Over this I place a piece of soft, 1/8 inch thick Hapla Fleecy Web (adhesive felt), cut to follow the shape of foot at the base of the toes, square at the bottom, and curving up a bit on each side of the foot. At the base of the felt, mid-foot, I placed a strip of Leukotape to help hold down the bottom edge of the felt. Benzoin was used under the tape and edges were rounded. The last touch was two figure 8’s, cut from HypaFix cotton tape, placed between the 1st and 2nd toes and the 3rd and 4th toes, with the bottom of the 8 under the foot and the top of the 8 on top of the foot. This anchors the forward edge of the felt against the skin and keeps it from rolling, especially on downhills. Each figure 8 is about three to four inches in length and the tape is two inches in width.
I received a report later in the race that the patch job had held. After the race ended, Thomas let me know the patch had helped his race.
The adhesive felt helps pad the forefoot and provide cushioning to the sensitive tissues, and can help relieve pain and discomfort from maceration. This is not moleskin, or a version of moleskin. It’s a thicker product and much softer. The felt can be found in 1/8 and 1/4 inch thicknesses. In the Amazon we used fleecy web that is 1/8 inches thick. In the Amazon Jungle Marathon I used the patch job many times on macerated feet – after drying the skin as much as possible.
Medco Athletics sells adhesive felt in a variety if thickness and lengths. You can search on “adhesive felt” or for a specific product I have used, “Fleecy Web.” To give you an estimate on pricing, four Hapla Fleecy Web 9” x 16”, x 1/8 thick sheets sells at Medco for about $26.00. The Hapla Feecy Web is 100% cotton and is latex free.
It also works well for padding around blisters, bunions, heel bumps, and more. Because it is thicker than tape, I would use Benzoin to help it stick better and consider adding extra tape as I described above.