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?
ICESPIKES have been around for a while and have proven themselves to be a reliable tool for those wanting to run, walk, and hike in winter conditions.
It doesn’t take much in bad conditions to take a nasty fall. Landing on hard ice, a rocky trail, or rocks hidden under snow can ruin your day. Protecting your tailbone, hands and wrists, knees, hips, and ankles, and your back is key to staying active. This is where ICESPIKES come in.
ICESPIKES are a traction system of 32 spikes that are applied directly into the sole of your shoes or boots. Their cold-rolled, tool quality steel will maintain hardness and grip 10 times longer than other systems. The spikes are self-cleaning, while their patented design provided great penetration and stability. They should last up to 500 miles.
ICESPIKES allow you to run, walk, and hike through the winter with the anti-slip spikes
ICESPIKES can also be used in water, mud and muck conditions, on slick rocks and gravel, uneven and root-bound terrain; and in mossy and slick leaf conditions.
For a limited time, use the coupon code “stockingstuffer” for 20% off your purchase.
ICESPIKES are packaged in a kit of 32 spikes and an installation tool and in packages of 32 spikes.
It’s not common but it can happen. At the worst opportune moment, your shoes fail you. Maybe it’s on a training run, or worse yet, it’s during a race or somewhere where you are miles from getting help or another pair of shoes.
I’ve seen it more than a few times.
Shoes that fell apart where the upper joins the midsole. Shoes where the upper material was so flimsy it came apart running in an adventure race. Shoes that partially melted when left too close to a fire in the desert in Chile (that was user error though!). Shoes with seams that did not hold, leaving gapping holes in the uppers. Shoes where the outersoles came apart. Shoes whose shoelaces won’t stay tied. Shoes that simple fell apart.
Then the other day a story on Facebook caught my attention. One of Nike’s elite runners was running the Berlin Marathon this past Sunday and had a major shoe failure.
Keya’s Eliud Kipchoge won the marathon, but the insoles of both shoes came up and out the back heel counter of the shoe. He had run in the shoes previously in Kenya without incident. Here’s a link to the story on The Wall Street Journal’s website.
In the marathon, the shoes failed around the first kilometer! It’s hard to be certain, but he missed the world record by just 63 seconds. Setting a new world record was his goal for the race. Nike said he was testing a new prototype.
I feel for Mr. Kipchoge.
Sometimes stuff just happens. Sometimes though it happens because of user error, as in one of my examples above.
Your job is to make sure that whenever you lace up your shoes, they are in good working condition. How often do you take a few minutes and check your shoes? Take out the insoles and clean out the shoes and wipe off the insoles. Check the insoles to make sure that aren’t flatter than a pancake or even worn through. Make sure the back edge of the insole around the heel hasn’t folded over or formed a hard, thick edge. Check your laces for worn spots that could break, Check the shoes top to bottom for seams coming apart or weak areas. Check the midsole to make sure it still has life left in it. Make sure the inside fabric of the heel counter doesn’t have holes in it. Make sure the outersole hasn’t loosened at the edges and that it isn’t work through.
That’s your job. It really pretty simple. But you’d be surprised how many times I’ve seen runners in a race that they’ve paid a lot of money to enter, and trained hard for, only to wear shoes that should have been replaced.
Don’t let your shoes fail you, -and make sure you don’t fail your shoes.
Filed under: blister care, Foot Care, Foot Care Products, Footcare, Footwear, Footwear Products, Sports, toenails
8 Top Tips for Foot Care
If you are a subscriber to Backpacker magazine, check out the October issue, page 34 for a full page of eight top tips to care for your feet. I have included an image of the page in this post. If you click on the image, you’ll get a larger view.
I was contacted by Backpacker several months ago and did a phone interview. Here are the eight tips:
- Trim nails
- Get in shape
- Fix calluses
- Prep your shoes
- Pack camp sandals
- Two ways to treat blood under a nail
- Wash your socks
- Lance right
The tips are good whether you are a backpacker, runner, walker, adventure racer, or just plain person who loves the outdoors.
I like Backpacker magazine. It’s one of my favorites. I encourage you to pick up a copy and check it out.
The 2015 Primal Quest Expedition Adventure Race concluded a few days ago, after nine days of challenges to the 11 four person teams. This was an unsupported race, meaning there was no crew support. Race organizers, medical staff, and general volunteers all worked together to provide levels of support that were awe-inspiring. People worked together to help the racers get through over 400 miles of a variety of disciplines: trekking, orienteering, white water kayaking and rafting, mountain biking (sometimes referred to as hike-a-bike), ascending and rappelling, sleep deprivation, extreme heat and more. Through all this I am fairly certain that everyone had fun.
At the eight TAs (transitions areas), where racers changed from one discipline to another, were a number of volunteers. Medical staff included doctors, podiatrists, nurses, paramedics, physical therapists, athletic trainers, and more. Our job was to care for whatever medical needs the racers had, including anything and everything. Even though the teams carried mandatory medical gear, most relied on the medical staff for their advanced foot care skills and materials. Khristy Gavigan, an RN and the medical volunteer coordinator, had done an amazing job of assembling extensive medical kits for each TA.
I worked two TAs – TA3 and TA6. At each TA, we set up and area where the teams checked in, arranged their gear so they could get to their gear and bike boxes, and decided on an area for medical and foot care. Generally we went through all the medical bags to see what supplies we had.
Because the four person teams were seen at each TA, there was a lot of foot care required. Many times we worked on all four team members in assembly line fashion. There was a mix of problems, but it seemed we saw more toe blisters and toenail care required than usual. Many toes had the skin torn off the top of blisters. While there was a lot of heel blisters, there didn’t seem to be many ball-of-the-foot blisters. Treatment was with kinesiology RockTape and in some instances, Leukotape.
Teams might receive some foot care at one TA, and the next, and the next, and so on. That’s the nature of an adventure race with multiple disciplines.
Some of the teams were short coursed – meaning they bypassed one or more discipline due to overall time cutoffs. This reduced the number of racers with maceration from one of the kayak sections, and reduced more foot issues from the following 50-mile trek. All in all, I think feet were pretty much what I expected. The majority of teams were prepared with supplies to repair their feet, which is always nice to see.