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.
Efraim Manzano caught my eye a few weeks when I learned that he had run the HURT 100 in Hawaii in Crocs. I messaged in on Facebook and we chatted back and forth a few times. He lives in Honolulu, Hawaii and has been running all his life, but running races for the past 10 years, and ultras for five years. Efraim said he’d be happy to share some tips about running in Crocs and how he came to use them rather than trail shoes. Here are the questions I asked Efraim and his responses. I added content about Crocs in a couple of sections.
Question: How often do you run in Crocs?
I run with my Crocs all the time.
Question: Do you also run in road or trail shoes?
No road or trail shoes, I only run in Crocs.
Question: What style Crocs do you use?
I use the Classic Beach style for road running (Marathon, Ironman) and the Bistro style for trail running. The Classic model has vent holes both on top of the toebox and around the side of the toe and forefoot. These are good for road races and help ventilate the feet. Crocs on average weigh 11 ounces per pair.
Question: How did you get started in wearing Crocs?
Back in 2007 before the Honolulu Marathon a friend of mine dared me to run in a Bahag (Filipino G String) or loincloth, commonly used throughout the Philippines before the arrival of the European colonizers, and which is still used by the indigenous tribe of the Philippines today. Shoes looked awkward with the Bahag so that’s when the Crocs came about and been I’ve been running in them ever since then.
Question: Do you use them in training and in races?
Yes! I always train in Crocs and use them in all my races.
Question: What’s the longest run you have done in them?
My longest run in Crocs is 100 miles.
Question: How long will they last (miles/time)?
They last a long time, approximately 1000+ miles, I still have the Crocs that I’ve use back in 2007 Honolulu Marathon and still use that pair for training.
Question: Do you wear socks with them?
Yes I always wear socks with them. I use any socks – even use socks I buy from Costco.
Question: Because they fit loosely, how do you keep them on your feet? Do you use the strap around the heel?
My feet always swell up after running anything over a marathon distance so I like my Crocs to be loose and yes, I always use the strap around the heels for insurance. The swelling that I’m talking about is the normal swelling of the feet when you are running or cycling. With regular running shoes it would bother me a lot because my feet get squeezed in there – so I like the looseness of the Crocs specially on those long run like marathons and especially on those ultra runs.
Question: Because they are fairly smooth on the bottom, how are they on trails?
I use the Crocs Bistro style on the trail. Crocs Bistros are designed specifically for those in the food service, hospitality and health care industries and has the Crocs lock slip-resistant tread. It works pretty well on the trails, even muddy trails. The Bistro also has an enclosed toe and forefoot design without the holes common to other Crocs designs like the Classic. The Bistro also has a more cushioned metatarsal area in the forefoot. The Bistro Pro has even more cushioning, an adjustable heel strap, and beefed up toe and heel bumpers for protection. The Bistro sells for about $45 and the Bistro Pro for $60.
Question: Have you had problems with rocks, dirt and trail grit getting inside?
At the HURT 100 a couple weeks ago when I feel something inside my Crocs I don’t let it bother me. I just stop running and take my Crocs off and shake it out. It gives me three seconds rest and recovery! The enclosed toe design helps keep junk out of the toebox.
Question: Have you had any foot problems from wearing them?
By the grace of God I never had any foot problems from wearing them, I had more problems before when I use to wear those high-end shoes. About blisters, it all depends if the socks got wet, this past HURT 100 I didn’t got any blisters. I changed my socks every loop so I didn’t get any blisters, but in the previous races that I’ve done before I’ve had blisters from the Crocs – especially on the rainy day.
Note: Thank you John for giving me this privilege to share my experience using the best and the most comfy running/cycling shoes in the world!
There you have it. You can run in Crocs! Thanks Efriam for sharing your story with our readers. I’ve heard of people wearing Crocs before, but this had never made a connection to do an interview. I’ll continue to use the three pair I have at home. Maybe the next pair I get will be the Bistro Pro. If you want to leaner more about the entire Crocs line, check them out at Crocs.com.
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
Filed under: blister care, Foot Care, Foot Care Products, Sports
I have often mentioned the website BlisterPrevention.com.au as a great source of information on blister care. Rebecca Rushton, manages the website and is on top of developments in the prevention and care of blisters. She’s a podiatrist in Australia – and a friend.
Through research and looking at the mechanism of how blisters form, Rebecca has changed some old theories of what causes blisters. Heat, moisture, and friction were always considered the three contributors of blisters. Further consideration has found that shear is a major factor. Shear and friction combine to cause blister formation.
I want to quote a blog post by Rebecca about Healing Foot Blisters Faster to help you understand more about friction and shear.
“You know friction is responsible for friction blisters. But I bet you think friction is rubbing. It isn’t. Friction is about grip. High friction means two surfaces grip together. Low friction means they don’t … they’re slippery.
“Here’s how friction is responsible for foot blisters … There is high friction in your shoe. There just is. This means your skin grips your sock; and your sock grips your shoe. All three surfaces grip together so your foot doesn’t slide around in your shoe.
But with every step you take, your bones are moving around under the skin. And while the skin is stuck and the bones are moving back and forth. Everything in between is pulled and stretched. This pulling and stretching is what causes blisters.
We call it shear. And it needs high friction to get anywhere near blister-causing.”
With this opening, Rebecca starts to explain the effect of shear and friction on blister formation. She talks about cutting friction levels, especially when a blister develops, and gives examples of six friction reducers. Some of these are better than others.
We have always tried to reduce friction in both preventing blisters and when treating blisters. As Rebecca says, and I support, “Otherwise all that stretching (shear) continues at the blister base while it’s trying to heal. Making it hurt more. And taking longer heal.”
So take a moment and click on the Blister Prevention link and read Rebecca’s full blog post. While you are there, I encourage you to subscribe to her email list.
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.
This post is an editorial about foot care at races – and more importantly, the lack of it.
Last week I returned from my second trip to Brazil to help provide foot care at the Amazon Jungle Marathon. I plan to write a post about the race later, so I won’t go into detail here – but this is the toughest race I have seen. Over the years I have worked many multi-day multi-sport adventure races and multi-day running races. Most of these are six or seven day events. Adventure races are races where the clock doesn’t stop until the team gets to the finish. Running races are typically stage races where each day is a specific mileage and camp changes every day.
Please continue reading – even if you don’t do multi-day races – because this blog post applies to those doing 24-hour races, 100 mile races, and athletes in general.
These types of races always have a list of mandatory gear. The list is composed of mostly safety items with a mix of medications and first aid stuff. Some of the first aid items can also be used for foot care. The photo shows an example of a first aid mandatory gear list. Here’s the rub though. Most athletes want to minimize, as much as possible, the amount and the weight of the stuff they have to carry. If the list calls for tape, they’ll carry a ½ inch wide very small roll, as few as possible blister patches, 2 or 3 alcohol wipes, 2 Band-Aids – you get the picture. They don’t have the right stuff because the lists are very general and don’t specify exact brands or types of supplies. They don’t have enough because they are not the average athlete and will need more. They only carry what they are required to carry and miss what they need for their feet. And many of these athletes don’t know how to use what they carry.
I have worked many multi-day races and have seen athletes finish a day’s stage and come to medical for every little thing. The medical staff should not have to manage all your foot care. You can manage the small pea-size blister on your toe. If you have hot spots, you can tape over them and check your shoes for seams. There is usually not enough medical staff to care for 100% of each runner’s needs. In addition, the supply of medical equipment is limited and can easily be over taxed by runners wanting everything done for them.
One runner in the Jungle Marathon came to see the medical team every day, telling us what he wanted down to the color of the tape and showing us all the spots on his feet he wanted fixed. We would have had to spend an hour just on him, with a lot of supplies, when he had a medical kit but wanted us to do it for him.
I am becoming more and more convinced that mandatory gear lists should be material specific. The width, length and type of tape should be listed. The number and type of blister patches. Scissors rather then a needle. Specific powder and amount. A specific number and type of tape adherent. And do on. The mandatory gear list needs to be reviewed with the medical director. This applies to runners in any race 50 miles or longer too. While the majority of runners don’t typically carry foot care supplies in a 100-mile run, their crews need to have the supplies.
I also am convinced that runners need to know how to patch their feet. Running a 100-mile race with no knowledge of how to care for one’s feet if and when problems develop is asking for trouble and putting undue burdens on the medical teams. You cannot assume that all medical personnel know how to patch feet – and have the best supplies for doing so.
Earlier this year I worked a multi-day event that had only basic medical supplies at the aid stations. There was virtually nothing that could effectively be used for foot care. The participants were not promised foot care, only first aid and medical personnel. In fact the pre-race materials did not mention foot care. Many aid stations did not allow crew access. The result was runners who were generally not carrying a foot care kit, had no crew access at many aid stations to help with their feet, and no medical personnel trained in or equipped to do foot care – a disaster waiting to happen. I had my complete foot care kit and worked on many runners’ feet. I know several other aid stations happened to have medical people who knew how to do basic foot care. But we each used our own supplies. I can honestly say that without the few of us on the course, the finishing rate would have been less than 30% because the race organizers did not think through the possible problems and build in solutions. Their disclaimer to me was that they had not promised foot care and runners were on their own.
In my opinion, putting on a race of any length requires race organizers to put runner safety as their first concern. Runners pay their money and expect a certain amount of good organization and common sense in return. In what has become a catch-22 situation, many runners genuinely expect there to be medical personnel able to manage emergencies as well as manage their feet. They think “first aid” and “medical personnel” means foot care. In reality, many races make no provision for foot care and take an “Oh well – that’s life” attitude. In fairness to medical personnel, I know anyone doing medical at an aid station will try and help any runner needing it. However they may not have the supplies and / or the training.
The Jungle Marathon had multiple doctors and paramedics, a fully stocked medical cache of basic and emergency supplies including medicines and narcotics, bandages and foot care supplies galore, and a complete set of medical protocols. Each checkpoint was manned by at least two medical personnel with a complete medical kit. Western States has great medical care at the major aid stations. So does Badwater.
In the end, every race lives and dies based on runner perceptions and what they share with their friends. Give them a bad experience; bad or non-existent medical care and / or foot care, and the word will spread.