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.
My October issue of Backpacker magazine featured an article about Bil Vandergraff, a Search and Rescue (SAR) Ranger. He served as a ranger for 25 years in the Grand Canyon backcountry. In the article he shared tips on surviving in the backcountry – especially in the harsh and unforgiving Grand Canyon with its heat and extreme elevation changes.
His tips on dealing with the heat are right on: wear the right clothes, embrace the sweat, go slow, stick to mornings and evenings, and know when to stop.
He stresses the importance of helping yourself and to study up – studying the route and conditions.
The one line that struck me was this:
“I don’t take care of blisters. I refuse to. If you can’t take care of your own blisters then you don’t belong in the canyon.”
Wow. I like that.
That same philosophy could be applied to runners, adventure racers, hikers – in short, anyone venturing into the outdoors on their own. Badly blistered feet can stop you in your tracks, can make it hard to climb out of the Grand Canyon, or off a mountain or out of any trail.
Can we apply that to races too? That’s a hard question. A huge question!
If a race has crew access, should the crews be responsible for foot care? Some races don’t provide specific foot care. Others have it in limited form based on whatever foot care knowledge any aid station volunteers or medical personnel may have and based on whatever supplies they have.
I know that at some ultras and adventure races 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 a lot of supplies.
What compounds this question is that many athletes fail to do what SAR ranger Vandergraff stressed, helping yourself and study up. Anyone who has worked an aid station knows full well that many of the participants fail to take care of their feet to start with, fail to trim toenails, fail to reduce calluses, fail to wear the right socks, fail to wear gaiters, fail to replace worn shoes, insoles and socks, fail to learn how to do self-care, fail to educate their crew on good foot care techniques, and fail to have adequate foot care supplies. So then, when they run into problems, they want help. Their failure to plan, and in many cases, take common sense action that could have prevented or reduced the problem, then creates work and expense by others.
I remember an old quote by Benjamin Franklin, “If you fail to plan, you are planning to fail.”
Many events would see their finishing rate drop dramatically if they eliminated foot care. There is a definite need for medical care to ensure that participants don’t get into trouble that could cause them serious injury or bodily system failure – but is foot care one of those?
I’ll repeat Vandergraff’s statement. “I don’t take care of blisters. I refuse to. If you can’t take care of your own blisters then you don’t belong in the canyon.”
Again, can we apply that to races too? That’s a hard question. A huge question!
Filed under: blister care, Foot Care, Foot Care Products, Footcare, Footwear, Footwear Products, Health, Sports, toenails
The seven tips below are written for the Primal Quest Expedition Adventure Race starting next week. They are also applicable to any race you may have coming up.
Primal Quest is less than two weeks away and here are seven things you can do to improve your chances of finishing with healthy feet.
1. Wear the best fitting shoes you can. Have a bit of space in front of your longest toe and enough height in the shoe’s toe box to avoid squishing the toes from the top.
2. Bad toenail care can result in toe blisters and black toenails, where fluid or blood is under the nail. Trim your toenails short and then use a nail file to smooth the tip of the nail. File the nails from the top over the edge down toward the tip of the toe. The goal of the trimming and filing is to remove any rough or sharp edges. File the nails so when you run your fingertip up and over the tip of the toe no rough edges are felt. It’s even better to file the nail so that no tip of the nail is felt. If you have thick nails, file the top of the nail down to reduce its thickness.
3. Any time you can, remove your shoes and socks to dry and air your feet. Your feet will be wet from water disciplines, stream crossings, cooling yourself off by pouring water over yourself, and simply sweaty feet. When stopping to eat or rest, remove your shoes and socks. Lay your socks in the sun to dry and switch to a clean dry pair if possible. Issues caused by wet feet will multiply over time and can end your race or at the least, result in extremely painful feet.
4. Do everything in your power to prevent and reduce maceration. This means not letting water poured over your head get into your shoes by bending over before dousing yourself. If means following the tips outlined in # 2 above. Use a moisture-controlling agent to help prevent the skin on the bottoms of your feet from macerating. Several include Desitin Maximum Strength Original Paste (available at drug stores, Walmart, etc), zinc oxide, Chafe X, SportsSlick, Trail Toes, and RunGoo. Apply liberally and before all water segments to help prevent damage to your skin. Once serious maceration happens, only drying your feet and letting them air, with the help of powder and warmth, will reverse the condition. If left unchecked, the skin can fold over on itself, split open, and tear layers of skin off the bottom of your feet.
5. Use gaiters to prevent pebbles and rocks, trail dust, and other debris from getting inside your shoes and socks. These become irritants and can lead to hot spots and blisters.
6. Take care of small issues before they become larger problems. Lance and drain small blisters whenever you feel them to keep them from becoming larger. Put a dab of ointment over the blister and then apply a strip of tape over the top to protect the skin.
7. Finally, make sure you have the supplies to treat your feet out on the course. Waiting to get to a TA to repair a blister can make a small problem much larger.
Filed under: blister care, Footcare, Health, Sports, toenails
I get questions by email all the time. Toenail questions are quite common, so I thought I’d post this one. Here’s the question.
“I am emailing you because I have a 50K trail race this Saturday and for some reason I am just starting to get pressure from under my large toenail. It is in its early stages and my nail has not turned black yet, but it is starting to be uncomfortable. At what point do I decide to puncture thru my nail and lance the fluid under the nail? Also, if I should be lancing the fluid, what are your thoughts of using a really thin and clean drill bit (turned by hand) to get thru the toenail? I lost a toe nail once before and tried using a really hot paper clip and needle, but I had a hard time getting all the way thru my toe nail. Any help and advice you can give me would be much appreciated… thank you!”
The answer is pretty straightforward.
Can you recall any nailbed trauma? Once fluid is underneath the nail, the pressure becomes painful You’ll know. If you can see the fluid from under the tip of the nail, lance it there. A drill bit works better than a paperclip. Be forewarned that as it goes through the nail, it can go into the soft tissue underneath, so go slowly. Then press on the nail to expel as much of the fluid as possible. Cover with a Band-Aid for now (tape on race day) but don’t plug the hole with ointment, as it will still need to drain for a few days.
Relieving fluid from underneath a toenail is a simple skill that every runner should know how to perform – just in case. It could be on one of your toes, or the toe of a friend. If you have ever experienced the intense pain of a black toenail with blood or fluid underneath, you’ll appreciate knowing how to fix it.
One of my goals is to educate athletes about good foot care techniques. You may recall blog posts where I stress the importance of knowing how to do foot care and importantly, to know what’s best for your feet.
I recently received an email from Rob, asking for some advice. Here’s Rob’s email:
“I have been running a modest 30 miles a week for a few years. Last weekend we attended a tennis camp and during the first night of drills during ball pick up (not during a drill or competitive play) another player smacked a ball in to the arch of my foot from a shot distance away causing severe pain. I played through the pain and the next morning I asked the trainer to tape up my bruised arch, which she did. I played all day and at the end of the day there was a blister in the center of my foot between the taped and un-taped area.
“I went back to the trainer in the morning and she created a donut shaped pad about a 1/4-inch thick and taped it to my foot. I took out my shoe arch supports and played for another 1/2 day in a bit of pain. When I took off the shoe, sock, and bandage and pad I found that the blister had filled with liquid to the size of the donut hole – now a huge blister about the size of a silver dollar and 1/4-inch thick. The camp staff took pictures of the biggest tennis-related blister they had seen.
“I went back to the trainer at the college and she drained about half of the liquid out of the blister and we decided I was done playing tennis for the rest of the camp. I’m not sure going to the trainer really helped and I probably should have had your book along as reference and taped myself up. Now I am back home and have a huge blister on the bottom of my foot.”
This is a case where the trainer patched Rob’s blister the best way she knew how. It was an “old-school” patch job. A piece of moleskin cut in a donut shape with a hole in the middle for the blister. There may have been Vaseline on the center, and then tape or gauze over the top.
The problem with this old-school method is that it adds bulk to the foot – that can easily alter the person’s gait. This gait change can lead to further problems. At the same time, the patch can cause irritation, expanding the original blister or leading to new blisters.
Rob’s experience shows there is a long ways to go to get everyone up to speed about good blister care. I’d bet that if Rob had been prepared, he could have done a better job then the trained did. It’s hard to go everywhere with a blister patch kit in hand, but here’s my recommendation. Make up several simple kits and put them in Zip-Lock bags and stash one in your car and another in your gear bag. Fill the kits with your choices of blister tapes and patches. Then of course, make sure you know the best way to patch any blisters that may develop.
This post is from July 2102, but is important for athletes to understand.
Filed under: Foot Care Products, Footwear, Footwear Products, Health, Sports
Superfeet’s Wool Insoles
I have liked Superfeet’s insoles for many years. Last year I was sent a pair of Superfeet’s Wool Insoles to try. Before talking about these insoles, a bit of information about the design of their insoles is in order.
If you need good support in an insole, look at a Superfeet insole. They are designed to work with the volume and fit profile of your feet. The volume is the amount of room needed inside your shoe to accommodate your feet, the sock and the insole. The fit is the amount of support and the shape of the insole under the foot and heel. With these insoles, you don’t get a one-size-fits-all type of insole. This is important if you have feet that require heel or arch support, like an insole with a well-defined heel cup, or simply want a insole that will hold up for a long time.
Their volume and fit profile is based on three types of feet – low, medium, and high fit; and low, medium, and high volume. Low is the most common foot type, medium fits in most types of footwear, and high gives the most support. Fortunately, the Superfeet website shows how each insole is designed for volume and fit, which makes it easy to find the best insole for your feet.
Their merino wool insole would be a good choice if you want a bit of added warmth in your shoes. The insole has the typical plastic support from the heel and mid-foot. Over that is the full-length foam that supports the top layer of merino wool. I measure these layers at about 1/8th inch each. That gives some added insulation from the cold coming up from the ground. The wool thickness is generous. They are very comfortable. You can get the merino wool insole in grey, which is thicker and made for high fit and volume, or white, which is made for medium fit and volume. All of the Superfeet insoles can be viewed on the Superfeet website. After that, you can purchase them from Superfeet, Zombierunner.com, your local running store, outdoors store, or other online stores.
They key with any insole is to try them in your shoes. Some are thicker and will reduce the amount of space in your shoes for your socks and feet. If that’s the case, you can either move to a thinner and lighter weight sock, or find an insole with less thickness.
So make sure you try an insole in your shoe before going out for your long run or hike. Wear them around the house for a while and see how they feel.
Filed under: Foot Care Products, Footwear Products, Health, Sports, Travel
Many athletes suffer from cold feet.
Athletes have several options to deal with cold feet. The first, most commonly tried, is different socks. Some simply try thicker socks or two pair. Others go straight to thermal type socks made with wool or some other blend of yarns.
Footwear is often a contributing factor to cold feet. Today’s running shoes typically have a part-mesh upper, which lets cold air inside the shoes. And since the mesh is over the forefoot and toes, they get cold first. Secondly, footwear that is too tight, because the wearer has thicker than normal or two pairs of socks, causes constriction and impedes circulation.
Something else often tried is disposable chemical warming packets. These seem inexpensive at first, but because they are single time use, the costs add up quickly. Packs of 10, using two at a time, go fast. And they often don’t generate enough heat to provide overall warmth.
Another option for cold feet is one of the new lines of heated insoles. One major heated insole companies is Thermacell. While not cheap, if you suffer from cold feet long enough, you’ll likely be willing to spend the money for warm feet. Their insoles are water resistant, and durable. Once they reach the desired temperature, they turn off and then turn back on when needed. The insole’s top is molded and cushioning while underneath the inner components, is an insulated layer to keep heat from escaping. The insoles can be trimmed to fit shoes or boots.
Thermacell has two types of insoles:
Heater Insole Foot Warmers with embedded batteries that can be recharged 500+ times. Operated by a wireless remote control, they operate with lithium-ion polymer batteries embedded in the insoles. The three options are no heat, medium (100 degrees F), and high (111 degrees F). Each charge will last up to five hours with a medium heat setting. The batteries can be recharged at least 500 times and recharges in four hours or less. Their website currently offers a free car charger with every pair purchased while supplies last. These Heated Insoles retail are selling for $129.99 and come in full and half sizes. Click here for Thermacell Insole Foot Warmers.
ProFLEX Heated Insoles with removable batteries for extended use. They have the same features as the above insoles, same heating options, same wireless remote control, and the same rechargeable batteries. The first main difference is that the batteries are removable and replacement batteries are available. The second difference is that these are charged with a USB port or the customary wall charger. These insoles retail for $184.99. Click here for Thermacell ProFLEX Heated Insoles.
Thermacell’s insoles have been tested by SATRA, the worldwide leader in footwear research development and testing. SATRA found the insoles resistant to moisture, verified the five hour run time, and that the insoles maintain foot comfort with their heating.
If you feet are always cold, I’d look at these Thermacell insoles to help keep them warm. These could work in running shoes, cycling shoes, and hiking boots, as well as your normal everyday shoes. Make sure to check the insole thickness inside your shoes to see if you need to wear a less bulky sock.
Tonight I finished watching three episodes of the 2014 Spartan Races – two regional races and then the final World Championship. Regional races are about eight miles with 20+ obstacles while the World Championship is about 15 miles with 25+ obstacles.
I know. Some of you are saying. They aren’t the same as a 50-mile or 100-mile race. Ultrarunners are tough and our events are hard. Spartan Races are much shorter.
You are right of course. But. And it’s a huge “but”, Spartan Races have obstacles that I’d bet most ultrarunners could not complete. Carrying a 60-pound sandbag up and down a long grassy hill, the barbed wire roll, rope climbs, the log carry, carrying a five gallon bucket filled with rocks up and down a hill, tire pull, water obstacles, and more. In the World Championships, the sandbag carry was not one but two 60-pound bags carried up and back down a quarter mile black diamond equivalent grassy hill!
At the end of the Spartan Race World Championships, one of the top runners said, “In a triathlon, you sometimes say, ‘Ah shoot, I’ve got a pebble in my shoe – it threw my race off. This is so much beyond pebbles!’” What he’s saying is that what you think is bad in a one race is nothing in another race. Pebbles are the least of your worries in a Spartan Race.
You have to be in the best physical shape of your life for these events. So do your feet. Between the grassy hills, slick with water and mud, the muddy trails and roads, the uphills and downhills over rocky trails and roads, jumping onto and over walls, down cargo nets, and other challenges, your ankles and feet take a beating. You get junk in your shoes, and while no one in the shows complained of blisters, I am certain many of the racers had them. Just watching the shows I could see there would be sprained ankles along with other injuries.
If you can’t complete an obstacle, you have to do 30 burpees. And that’s after you failed at the obstacle. Your heart is racing and breathing is labored, and you are exhausted.
The Spartan Race website has the full series of races for 2015. Check out the website and see if this type of race interests you.
In April 2014, I wrote a review of the Reebok All-Terrain shoe designed for obstacle races like Spartan Races. Check it out here: Reebok All Terrain Shoe.
In addition, Joe Desena, the founder of Spartan Races, has a book Spartan Up! about overcoming obstacles in life, and is starting a podcast also called Spartan Up! You can subscribe at iTunes or Stitcher.
If the challenge of doing a Spartan Race interests you, here’s a code that will save you 10% on any race: SPARTANBLOGGER
Many of you have participated in a 50-mile race, a 100-mile race, an adventure race, or some other type of multi-day race. Some multi-day races are non-stop while others are stage races. A lot of these races provide medical care at aid stations – and some also provide foot care.
If you have received foot care aid at these aid stations, you have been helped by the generous people I’ll call the “heroes” of foot care.
The picture shown here is from the Amazon Jungle Marathon this past October. Every one of the 15 members of our medical team helped with foot care. No one said they didn’t want to do feet. You can see the working conditions: sand everywhere, water bottles as footrests, a tarp to protect the runners and our knees (that quickly filled with sand), and supplies strewn all over and shared between medics. What you don’t see are the flies and bugs that were constantly in our faces, and the sweat running down our faces from the humidity. Now keep this up for hours, well into the night.
These are the heroes of foot care.
Most races have them. They volunteer their time and even supplies. They often go to races at their own expense. They work often under adverse and uncomfortable conditions. They want to do the best patch job possible. They are dedicated to getting you back into the race. They want you to have a great race experience. In short, they care.
I’ve been at races that have well-organized foot care services and others that have nothing. Some people providing their services are podiatrists, doctors, nurses, paramedics or EMTs, physical therapists, chiropractors, or other medical specialists. Other times they are simple people who have learned foot care techniques on their own or from someone else.
I know you appreciate these foot care people.
So how can you thank them? Let me share a few ideas.
- Simply say thank you.
- Make sure you have done everything possible to have healthy feet going into the race.
- Trim your toenails short and then file them smooth.
- Reduce calluses as much as possible.
- Wear quality shoes and socks.
- Know how to do your own foot care just in case we aren’t there or there’s a line for our services
- And finally, be patient. Good foot care and blister patching takes more than a minute.
We love helping runners and always welcome your appreciation.
Filed under: blister care, Foot Care, Footcare, Health, Sports, Travel
In early October I had the unique opportunity to return to Brazil and provide foot care to runners at the 10th Annual Jungle Marathon Amazon. The race is more than a marathon. It’s three races in one event set in a stage race format. Every day the race camp moves to a new location as the runners go through the jungle and along the beaches of the Amazon River. There’s a seven day, six stage race and a four day race, that both start at the same time. Then on day four, the single day marathon stage starts.
This year’s race was the toughest of any event I have been a part of. There was single track trails hacked through the jungle, red dirt roads with loose dirt, swamps and streams and rivers, humidity, heat, rain, sand that got everywhere, never ending wet feet and water-logged shoes, bugs and spiders and snakes, jaguar sightings, a lot of bee stings, either cold food or food heated with hot water, jungle and beach camps, carrying all your gear in a backpack, and nine nights in a hammock. Runner’s feet took a beating and as the days progressed, it was harder for them to recover. The cumulative affect of having your feet wet for the majority of every day, became a struggle for many runners. Maceration was a serious problem for everyone, and blisters affected all runners to varying degrees.
After the race ended, I was able to take a a few minutes and interview Amy Gasson, the second place women in the seven day race. Amy was a joy to know and smiled every day with a great positive attitude. Here’s the link to listen to the audio interview. It’s 17 minutes long.
Considering the interview was recorded with a handheld digital recorder, in the lobby of our hotel with all it’s normal background noises, the sound quality is remarkable. There’s a lot we can learn from what Amy shares. She did her homework and prepared well – both physically and her feet. Here’s a photo of Amy and me at the finish line.
Thanks Amy for letting me get to know you at the Jungle Marathon Amazon.