Filed under: blister care, Foot Care, Foot Care Products, Health, Sports
Since the 6th edition of Fixing Your Feet came out and I worked Western States 100 and Badwater for another year, I’ve been thinking about putting on a few one-day foot care clinics in 2017.
I‘d like to do these around the U.S. – in Northern California, Southern California, Florida, maybe Texas and Oregon, and elsewhere if there is enough interest. If it were just me, I could teach 10 people. If I had a knowledgeable helper, we could teach 20 people. If there were enough in one area, we could do it twice in two days.
My preferred audience would be athletes who want to learn the finer points of patching feet, taping, blister care, shoe modification, and more. I envision different sections: the basics, hot spots and blisters, toes, general taping, specialized taping, post event care, and more. This would be full hands-on training. Ideally attendees would like to learn and then share the skills with others – medical people, runners’ crews, those with a keen interested to learn but without the opportunities to learn.
Attendees would received full instruction, watch and do the skills, get hands-on with the tools and tapes, handouts, copies of the presentations on CD, and a bunch of goodies I’d try to get from companies with relevant foot care products.
My plan is to hold these in a location easily accessible to those in the area – a hall or community center, a hotel meeting room or something similar. I realize some people would have to travel and would work to arrange nearby accomodations.
I have the outline of the day completed and it would run from 9am until 5pm. The clinic would cost participants to cover the meeting location, supplies, lunch and breaks, and associated miscellaneous expenses.
I had originally wanted to do the clinics on a Friday and then have participants work aid stations at a local 100-mile race the following day – but the logistics of that are too complex.
If you are interested in this kind of foot care clinic, please send me an email and tell me where you are located. I’ll collect names and locations, and if there is enough interest, will get back to everyone in future emails.
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, Footcare, Health, Sports
At Western States we saw a lot of negative results from wet feet. Even though we tried to spread the word, many runners did not protect their feet. Runners had poured water over their heads, which went into their shoes, and they sat in streams. Runners were complaining of blisters on the feet, mainly the balls of the feet but it was maceration. In reality, almost everyone had one or more skin folds common to their feet being wet for long periods of time. These might be in the center of the mid-foot or at the ball of the foot near the toes. Some did fine by warming their feet, applying powder, changing socks and shoe when possible, and maybe sitting a bit – and continued on and ran well. Others did not stop at aid stations or get crew help, and ran on with wet feet. Then they reach a pain point at which they cannot continue, or they reach the finish line – and they want help with their feet.
There is no quick fix to maceration. The more severe it is, the longer it takes to return to normal. Maceration can be painful – and yes, feel like one’s feet are burning. The skin is so soft and tender that every step is painful. Many times the skin has folded over on itself or has lifted to form deep creases, which can split open. I have seen maceration go through several stages:
- First, the skin begins to soften and becomes tender.
- Second, the pruning starts as the exposure continues. The skin wrinkles and softens even more.
- The third stage is when the skin can form creases and folds over onto itself. The creases may be shallow or deep, but are painful.
- The fourth stage is the most severe. The folds split open and/or the skin may tear.
If there are blisters, they must be drained and covered with a waterproof dressing to help keep tissue swelling under control. Tissue swelling leads to cold and damp skin, swollen and difficult to patch.
There are ways to deal with maceration, but it’s even more important to take steps upfront to prevent it. For instance, change into dry shoes and socks whenever possible, change socks as often as possible. When getting crew aid or at aid stations, remove your shoes and socks to allow your feet to dry, sprinkle with powder and rub it in, warm your feet with light massage, let them see some sunshine, and use one of the moisture control agents.
For moisture control, RunGoo from Foot Kinetics is one of the best. Its thick white paste works wonders on the skin and helps keep moisture at bay and it last a long time. FootKinetics.com has created a great product that works. Other excellent products include Trail Toes, ChafeX. SportsSlick, and Desitin Maximum Strength Original Paste. One thing to look for in these products is how long they last and do they come small packages or could they be packaged small enough to be carried in a hydration pack. My preference for applying any of these is to use them liberally. Then bunch your socks and roll them over your feet. Avoid just pulling your socks on, which can thin the product around your toes and forefoot.
Having severely macerated feet is not a badge of courage. It’s a sign that you could have made better earlier choices in foot care. Some of the worst feet I have seen have been because of severe maceration.
For 20% off your purchase of RunGoo from Foot Kinetics, use the coupon code “tfk20john.” I’m even using it as a chamois cream when road bike riding. It does last.
In a future post, I’ll talk about treating feet and maceration at a race finish line.
A month ago I wrote a blog post about two multi-day races in Europe that are implementing a triage system for medical care at aid station – the outcome of their being overwhelmed by the amount of treatment and time that their participant’s blistered feet were requiring. Here a link to that post about Providing Foot Care for Athletes.
In this post, I want to expand on a quote from their website that I included in the original post. It was about the 6Ps of foot care.
They stated that foot care is easily divided into several phases, what they call the 6Ps: “Proper Preparation Prevents Piss-Poor Performance” and provided 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. Let’s talk about these one-by-one.
Proper Preparation – In the months leading up to your race, and even race to race, you, and you alone need to be responsible for learning proper preparation. You need to learn how your feet respond to being wet and maceration starts, to being in sweat soaked and dirty socks, and when your feet are caked with dirt and grime. You need to learn about the best lubricants and/or powders, and insoles. You need to learn what causes the hot spots and blisters and what steps you can take if or when they develop. You need to practice taping or whatever strategy you plan to use. This is your job – not your crew’s job – and not the medical or non-medical people at aid stations.
Prevents – You need to know what to do when you develop hot spots and blisters, and have the materials and tools, and even more importantly, the skills, to fix your feet. This focus on “prevents’ needs to happen in the months before your race and during the race. It’s about proper toenail care, skin care, callus reduction, shoe and sock selection, whether to wear gaiters, preparation for a variety of weather conditions, and of course, putting the required and necessary training miles on your feet. This also is your job – not your crew’s job – and not the medical or non-medical people at aid stations.
Piss-Poor Performance – This is what can happen when you fail at any of the first three Ps. Your performance suffers. Your race may be over. In many races, medical volunteers will try and help patch your feet. Some races do not have the luxury of dedicated medical volunteers for all the aid stations, much less the finish line. You cannot and should not count on a race having medical personnel to help with your foot care needs. Just because there is a doctor, nurse, or EMT at an aid station, that doesn’t mean they know how to patch feet. You cannot and should not count on races to have the foot care supplies that you want for your feet. If you will have a crew, work with them so they know how to work on your feet with your supplies.
Some runners may feel I am being too harsh as I tell you these are your responsibilities. Let me share a story from years ago. In 1985 I ran Western States for the first time. After crossing the river at Rucky Chucky, I had blisters in the arch of one foot. Someone at the far side offered to help patch my feet. After lancing the blisters, I had a wad of gauze taped to my arch, which changed my gait. I finished the race, but learned a lesson. The treatment, while well intended, was not the best for my foot. I learned to take responsibility for my own foot care. For the next three years running Western States, I managed my feet – and I’m sure that experience helped fuel my interest in foot care.
So my point in expanding on the 6Ps in this blog post is to reinforce the notion that foot care of your feet is your responsibility. If there are medical volunteers at a race, and they know how to patch feet, and have the supplies – and the time, consider yourself fortunate – but don’t count on them being there.
Please feel free to agree or disagree with my position, and share by commenting below,
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.
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.”
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.
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?