Infections from Blisters – A Serious Condition

December 3, 2013 by · 1 Comment
Filed under: blister care, Foot Care, Health, Sports 

Susan Alcorn’s Backpacking & Hiking Tales & Tips is a monthly email newsletter from her website at Backpack45.com. Susan and her husband Ralph have done hikes on the Pacific Crest Trail, the John Muir Trail, the Camino de Santiago, and more. Every month I review her newsletter for tips and information that I can share with my readers. I encourage you to check out her website and subscribe to her newsletter.

Only once before in the 15 plus years of publishing an email newsletter and this blog have I shared information that has the potential to save a life. Please read on and take this information to heart.

In the December newsletter, Susan shared a story they experienced while hiking the John Muir Trail. They met a hiker with a sobering tale he shared with them. He and his wife had reached Palisades Lake when she was suddenly hit with nausea, fever, and weakness. Initially he thought it was exhaustion, but the next morning his wife was worse so they did a layover day. She was even worse the following day so they decided to exit at Bishop.

His wife became so weak that she could no longer walk – even without her pack and with help. She collapsed on the attempt to descend the Golden Staircase. Her vitals were a temperature of 105, blood pressure of 90/50, a resting pulse 135 – and she was unaware of her surroundings. He and two others tried to carry her out, but found it impossible because of the narrow trail. A helicopter was brought in and she was airlifted out in a basket to Deer Meadow, where she was put inside the helicopter and taken to the hospital.

The Alcorn’s met the husband as they were leaving the John Muir Trail over Bishop Pass. He was going out on the east side and then going to find a way over to the hospital in Fresno. We wondered for days how this had played out and were happy when they heard a subsequent report. After four days in the hospital on antibiotics, the lady was ready to be flown home – not entirely well, but no longer in danger. The hospital did not do tests to determine the cause, but only treated symptoms, so the cause of the problem was up for speculation. Her husband thought that an infection had probably entered her blood through blisters in her feet – most likely the source was open blisters and their soak in hot springs.

Susan says, This is a reminder of the importance of avoiding infection in any open sore – especially under trail conditions.

Cari's Blister Infected Foot

Cari’s Blister Infected Foot

I agree. In 2007 I wrote an article about another hiker on the Pacific Crest Trail who had to be evacuated out and spend a long time recuperating from a serious infection. Her infection was also caused by an infection through an open blister. This first photo shows her infected foot after she reached the hospital.

Bacteria causing the infection can come from your skin, from the environment, or from anything that gets inside the blister. The web spaces between the toes have more skin bacteria and open blisters here present an increased risk of infection. The second photo shows the redness common to an infection.

An Infected Blister

An Infected Blister

The take-away here is that we need to understand how to properly clean and care for blisters, have the right materials to patch them, and know the signs of infection.

All open blisters should be watched for redness, streaks up the leg, pus, heat to the touch, pain and/or swelling around the area, and fever. When any of these are present, prompt medical care should be obtained.

In my 2007 Fixing Your Feet newsletter I wrote, I think this is the most serious and important issue yet. It has in-depth focus on infections as a result of blisters. First read my editorial, Blisters Can Lead to Serious Infection, and then the feature article, My Infected Blister – Almost My Life! where Cari Tucker “Sandals” tells her story. I think you’ll agree with Denise Jones, the Badwater Blister Queen, who told me, ‘This is indeed sobering and shocking (literally). I think people need to see this because I do not think they take blisters very seriously!’ I urge you to fully digest the articles, then read the articles on Blood Blisters and Infections, Staph Facts and Cellulitis Facts.

Here’s the link to the July 2007 Fixing Your Feet newsletter with the articles.

 

Kinesiology StrengthTape in the Amazon

November 13, 2013 by · 3 Comments
Filed under: blister care, Foot Care, Foot Care Products, Sports 
Taping in the Amazon

Taping in the Amazon

Last month I provided foot care at the Jungle Marathon Amazon. In preparation for the trip, I searched for new tapes. One of my searches turned up Theratape.com, a web-based store that specializes in kinesiology tapes and supplies. The website is a wealth of information on kinesiology tapes and kinesiology in general.

I emailed the owner, and received answers to all my questions regarding different brands of kinesiology tape. They carry many to choose from: Kinesio Tape, Nasara, PerformTex, RockTape, SpiderTech, and StrengthTape. Another brand is KT Tape. That’s seven brands to choose from.

Because I was going to the Amazon, where I knew feet would be wet, tape adherence was a major factor. The Theratape staff told me that the two best adhering tapes for wet condition were RockTape H20 and StrengthTape.

StrengthTape

StrengthTape

Three weeks before the Amazon, I tried a roll of each tape. On one foot I used a strip of StrengthTape, and another of Kinesio Tex Tape (my old standard). On the other foot I used a strip of RockTape H20 and another of LevoTape (a brand from the U.K.). I had one strip on the mid-foot, side-to-side, and another strip on the forefoot behind the toes. I did not use Compound Tincture of Benzoin as a tape adherent. The LevoTape came off on day four and the Kinesio Tex on day five. Finally on day six I removed the Rocktape H20 and the StrengthTape. Of the final two, the StrengthTape still had some stickiness left. It became my first choice of the kinesiology tapes. I promptly ordered one of the bulk rolls. Service from Theratape.com was great.

StrengthTape on Toes

StrengthTape on Toes

Here is the StrengthTape description from the theratape website: StrengthTape by LifeStrength begins with all the features of a high quality kinesiology tape, but is then “supercharged” with the addition of advanced ionic technology. Seven different minerals and gemstones are crushed into microscopic particles and infused into the tape. The natural properties of these substances create a negatively charged material that emits anions or negative ions. When applied to the skin, these negatively charged particles are readily absorbed into the body, enhancing the pain relieving and healing properties of the tape. Its 10% greater elasticity provides additional support for injuries and snap-back for performance enhancement. The proprietary AllSport extra-strong adhesive provides superior sticking power in all conditions, including water when properly applied, most applications will provide pain relief, comfort and support for 3-7 days. Uncut rolls are16’ in length and two inches in width, while each 16′ pre-cut roll contains twenty 10″ strips.

For those familiar with RockTape, I did try the RockTape H20. On the website, RockTape H2O is described as, the ultimate kinesiology tape for water sports. With an adhesive twice as strong as regular RockTape, H2O has undergone rigorous testing in the wild waters of the Pacific. H2O is a great tape for swimmers, triathletes, and other water sports participants. RockTape H20′s other features include a tighter weave and greater elasticity than other kinesiology tapes. It stays on longer and provides enhanced support, even under the toughest conditions.

In the Amazon, I used Leukotape, RockTape H20, StrengthTape, and Hypafix for between the toes. To start with, I used the StrengthTape and Rocktape equally, sometimes both on one runner. I wanted the feedback.

We had the advantage of applying the tapes in the late afternoon and evening, which allows the tape’s adhesive time to bond with the skin. After applying the tape a short 20-30 second rub was done to warm the adhesive and activate the adhesive.

Problem toes taped with StrengthTape

Problem toes taped with StrengthTape

Several things are important when using kinesiology tapes. Lay the tape on the skin and if you have to stretch the tape around a heel or toe, only apply a slight stretch. The more stretch you apply, the more likely the tape is to come loose, especially in wet conditions. Secondly, whenever possible, apply the tape the night before it is needed. At Badwater we try and tape the night before the race to give it good bonding time. At a minimum, try to apply it an hour before activity for the tape to set.

StrengthTape was the winner. Several days in to the Jungle Marathon, runners were asking for the “blue” tape (my blue StrengthTape). On some runners, the tape did not hold – but in fact no tape held up well when the runners walked around on the sand and dirt in bare feet or skimpy homemade flip-flops. The combination of the wet conditions when they finished the day’s stage followed by dirt and sand constantly worked away at the edges of the tape. That’s why we re-taped most afternoons and evenings.

We taped a lot of toes with StrengthTape, as you can see from these pictures. The runners would come into camp after finishing their stage and tell me how the tape had held up – or not. Sometimes the sand was simply too abrasive and it rubbed against the tape, working it’s way under the edges. I’d apply a light strip of Benzoin along the edge of the tape and the skin to help the edges hold better. This helped a lot.

StrengthTaped toes to fit in FiveFingers

StrengthTaped toes to fit in FiveFingers

In wet conditions, the race medical team from past years found that Injinji socks were better than other socks for blister control. Many runners wore Injinji socks. For these runners, the little toe socks of the Injinji’s was perfect to help hold the StrengthTape in place. One runner completed the race in Vibram FiveFinger Lontras, which also help hold the tape in place. To read my blog post about the survey and what worked, click on the link: A Survey About Feet From The 2012 Amazon Jungle Marathon.

In my tests, I found the RockTape H20 had good adherence, but frayed around the edges. Applying a strip of Benzoin on the edge of the tape and skin can help control the fraying.

I will be using StrengthTape at the races where I provide foot care. My stash of other brands of kinesiology tapes will be used as I learn about using the tape for its intended purpose of kinesiology.

If you are interested in ordering StrengthTape or RockTape H20, I recommend checking Theratape.com. They have generously offered a 15% discount on anyone’s first order of StrengthTape or RockTape – just use the code “fixyourfeet” in the discount code box on the order page. The discount code is good for any of the two tapes, tape size and quantity. The tapes come in a variety of colors. I welcome your feedback when you use the tape.

Disclaimer: Kinesiology is the study of human movement. The benefits of kinesiology tape include relief of pain and swelling, relaxation of overused or tight muscles, activation of weak or poorly-toned muscles, and enhancement of athletic performance. Made from cotton with a hypoallergenic acrylic adhesive, kinesiology tape is designed to be worn for 3-5 days, providing therapeutic benefits 24/7, the entire time it is worn. I apply kinesiology tape to feet because of its ability to stretch and shape to the curves of the foot, in addition to its smooth surface, adhesive, breathability and lack of leaving tape residue on the skin. If you watch the Olympics, you have probably seen kinesiology tape on athletes’ shoulders, arms and legs, and more.

FiveFingers in the Jungle Marathon Amazon

October 29, 2013 by · 2 Comments
Filed under: Foot Care, Footwear, Sports 

This blog post is a summary of Stefanie Bacon’s experience with Vibram FiveFinger Lontra’s in the Jungle Marathon Amazon. The first image shows Stefanie in one of the water crossings. She did the four-day 122km race and was the second place female. When I noticed she was running in FiveFingers, I asked if she could write a short review of the shoes. Here’s her report followed by information on the Lontras.

Stefanie in the Jungle Marathon Amazon

Stefanie in the Jungle Marathon Amazon

I have been running in my Vibram FiveFingers for over 2 years now. I am very careful choosing which ones to run in, depending of the terrain. When I decided to run the Jungle Marathon Amazon, I decided to research which ones would be best as I knew I was going to encounter water crossings, soft sandy beaches, mud swamps, forests, creepy crawlies on my ankles etc. So I knew they had to be somewhat more resistant then the ones I use to run on normal roads and sand tracks. I went for the Lontra, which have the thickest sole, and extra protection over the toes, and are higher on the ankles (to avoid sand coming into them so easily).

Stefanie's FiveFinger Lontras

Stefanie’s FiveFinger Lontras

The second photo shows Stefaine’s Lontras.

For a race like Jungle Marathon I really found my FiveFingers Lontra’s to be an advantage, especially at water crossings and soft sand. It was way easier because you can swim in them without feeling any kind of weight on your feet, and when running in soft sand, no sand came into them and my feet felt really light. Like with any other shoes you need to really be careful with cut off trees, to not step on one of them, but I must say the Lontra’s made me feel confident, as they are way more resistant then any other Five Fingers. One thing I did realize, is when I did the water crossings, as the fabric they are made of is meant to be water resistant the water didn’t escape the shoe so quickly like other Vibrams I have which are made of neoprene, but this didn’t make my feet suffer in any way.

Stefanie's Taped Toes

Stefanie’s Taped Toes

The only problem I had (which I only realized on the third day what was causing that problem) were my big toe nail and my pinky toe nail, I felt some pressure on them and couldn’t understand why, after a lot of thinking I realized that it was my socks, when using five fingers you need to make sure that your toes fit perfectly into the sock (I highly recommend to use Injinji, I was wearing the Nike ones and those where not good for my toes). The image here shows her toes taped with StrengthTape Kinesio tape.

I don’t recommend anyone who is starting to use Vibram FiveFingers to do a race like this in them; it is essential to have a lot of experience, and test different styles on different terrains. 

Vibram FiveFinger Lontras

Here are the links to Vibram’s website for the Lontra shoes: Vibram’s FiveFinger Lontras and Women’s Vibram Lontra.

Vibram FiveFinger Lontras

Vibram FiveFinger Lontras

Vibram Men’s Lontras are shown in the next photos. You can see in the first image how high they ride up the ankle and the strapping system. The next photo shows the more aggressive than normal tread.

Here’s Vibram’s website description: The all-new Lontra makes cold weather running in minimalist footwear a breeze. A multi-layer laminate upper with fully taped seams provides insulation and water resistance. The micro-pile fleece liner is soft against the skin while helping wick perspiration away from the foot. Other features include a neoprene heel cuff to keep out snow and debris, and a reinforced hook-and-loop closure for a snug and secure fit. Run safely at night with reflective surfaces for enhanced visibility. The 4mm EVA midsole provides insulation from frozen surfaces, and the TC-1 Dura outsole provides traction, durability and superior plating protection.

The Agressive Lontra Outersole

The Agressive Lontra Outersole

Stefanie made a good choice in the Lontra’s for her Jungle Marathon Amazon race. The shoes hardly showed any wear after her race. I could see these shoes working for similar events and trail runs. Considering the other shoes I saw runner’s wearing at the Jungle marathon, the Lontras performed well, did not fall apart, and did not become waterlogged. For an event where water, sand and mud, and streams or swamps are on the route, these shoes are worth a look.

For the record, the Jungle Marathon Amazon also had a marathon one-day race and the main event, a seven day 254km race.

Shoes at the Jungle Marathon – Amazon

October 22, 2013 by · 1 Comment
Filed under: Footwear, Sports, Travel 

The Amazon Jungle Marathon had 78 runners. Most of them did not have problems with their shoes – but some did.

Most shoes were trail runners with good tread. I saw a lot of Salomon shoes and a mix of everything else. At least one runner wore Hokas and another wore Vibram Five Fingers. Every day I tried to watch the runners and check with shoes.

There was so much water and sand that their shoes were always wet and covered in sand – with the exception of when we spent the night in the deep jungle camp. Even then, it was dirt that caked the shoes.

The afternoon before the race started, seven of us hiked three miles into the first day’s checkpoint. It gave me a taste of what the runners would start with the next morning. The jungle is unforgiving. Roots, rocks, and vines are everywhere. Leaves and ferns are on the trail and hanging over it. Low hanging branches and tree stumps line the trail. Inattention to the trail will lead to catching your foot on roots and vines, stubbing your toes, or turning an ankle. Inattention to the stuff alongside and up high on the trial will lead one into running into something hanging head height.

When they got to the checkpoint, they had their first water crossing, a deep stream that once they crossed, took them into a swamp. Two other days started on a beach where they had 200 to 300 yard plus river crossings – pulling themselves and their packs along a rope. You get the picture.

Torn Mesh on Shoes

Torn Mesh on Shoes

At the end of the first day several runners had major problems with their shoes. As you can see from the first picture, the shoes were coming apart where the uppers meet the midsole. The mesh in the shoe’s upper was torn. Without repair, the next day the shoes would have fallen apart.

Mesh uppers have become popular in many road and trail shoes. In fact it’s hard to find shoes without mesh. Mesh makes the shoes lighter and cooler. Water typically drains better too. In the Amazon, these mesh shoes were worn by most all the runners. And they were filled with sand and trail junk. With the water, they became much heavier than normal.

In the Amazon, the vines, branches, rocks, and whatever else the jungle threw at the runner’s feet destroyed the shoes’ mesh. On a mountain trail race, the same thing can happen. All it takes is one swipe across a sharp rock or root.

Remember that mesh allows grid, dust, dirt and sand to get inside. The mesh is also susceptible to tearing, especially at the junction of the upper and midsole.

Repaired Shoes

Repaired Shoes

Fortunately, one of the runners was an expert with needle and thread. He expertly and patiently sewed the mesh back into place – more than once. The second picture shows a runner’s shoe that has been repaired. If you look closely, you can see the thread at the bottom edge of the mesh.

Sewing Shoes

Sewing Shoes

The last two pictures show how Roberto Domingues Areiro used dental floss to sew Jean-Paul van der Bas’ shoes back together.

Roberto sewing Jean-Paul's Shoes

Roberto sewing Jean-Paul’s Shoes

Another runner wore Hokas and loved them. For the first six days they served her well. For the final day, she switched to a lighter pair of regular shoes. The reason was evident. She realized that her Hokas were waterlogged and each weighed two pounds. Hokas are larger than average shoes. Every pound on a foot is equal to five pounds on the back. For the runner, that meant carrying an additional 20 pounds in her pack.

Remember that while your shoes may be fine when they are dry, once they go through water, their weight can increase dramatically. All that weight is added stress on your legs and back.

Remember that where ever your race, consider the terrain and conditions when you pick your shoes. Making sure you have good shoes, as close to new as possible, but broken in to your feet. Don’t chance your race to a pair of old and worn shoes.

The runner who wore Vibram Five Fingers did well. She was used to the unique shoes and had trained with the miles necessary to do 142km in the minimalist shoes. She had minor problems with her big toes and pinky toes that we taped, but she managed to complete the race.

Remember that if you wear minimalist shoes in a race, make sure you put the miles on your feet with the shoes so your feet and legs are used to them.

The Amazon Jungle Marathon is a great event that promised runners an adventure. They got that and more. Their shoes showed the wear and took everything the jungle threw at them.

Feet, Sand and Water

October 15, 2013 by · 1 Comment
Filed under: blister care, Foot Care, Sports 
Jungle Marathon

Jungle Marathon

I am writing this as I am flying home from the seven day Jungle Marathon Amazon stage race. Since 2002, I have helped at races like Death Valley’s Badwater, BC Canada’s Raid the North Extreme, Chile’s Racing the Planet Atacama, California high Sierra’s Western States 100 Mile Endurance Race, Costa Rica’s Coastal Challenge, and the Primal Quest and Gold Rush Adventure Races – and each is unique and difficult in their own way. The Jungle Marathon topped most of them in difficulty.

We had a medical team of 15 doctors and paramedics for the 78 runners. The team manned checkpoints along each day’s stage. Each medic team had a full medical kit, which included provisions for foot care. Depending on the stages, the medic team went out the afternoon before to get to the checkpoint to set up their hammocks and eat before jungle darkness came. For example, Todd and I hiked three miles through the jungle to get to the first checkpoint of stage one. We were accompanied by Rod and Lee to set up the ropes over a water crossing, four locals to clear the camp and manage the fire and water, and an interpreter. Our job was to make sure the runners were in good shape, and provide any medical care if needed.

This checkpoint came only three miles into the first of seven stages. But it set the stage for the whole race. The runners had come through three tough miles of jungle trail with rocks, roots, loose vines to trip feet, low hanging branches – all on terrain that was rarely flat. Toss in the stifling humidity and heat, and you get the picture.

Now comes the heart of the race – water. Our little camp was about 30 feet long and 20 feet wide, on the bank of a stream, carved out of your typical jungle fauna. Once they reached us, the runners had a mandatory 15 wait before continuing. When their time came, they jumped into the chest high stream and used the rope to pull themselves to the other side. Of course, there were no dry trails on the other side. The route was through a swamp. Three miles and 100 feet into the race their feet would be wet most of the time.

But as if water was not enough, there was sand. The trails through were on sandy jungle soil and on sandy beaches.

Combine water and sand and you have a mixture of two elements that are problematic to runner’s feet. We saw it every day. I have written about maceration many times, and generally tell people to avoid getting their feet whenever possible to avoid this painful condition. But in the Jungle Marathon Amazon, water is present everyday – along with sand. Even without the water crossings, the humidity would keep your feet wet. By the time we hiked the three miles to our camp with our overnight packs, my pants and shirt were soaked. And nothing dries overnight.

Without a doubt, I think the Jungle Marathon Amazon has been the toughest event when it comes to the participants’ feet.

The sand gets everywhere. And it sticks. While I did not see the skin abraded from the sand inside socks and shoes, especially at the heels, it’s damaging effects were more visible in the runners’ shoes, socks and insoles. One runner had holes in the toes and heels of one of his socks after day one. Another runner had holes through both heels of his insoles.

You might be asking yourself why people do this race. Good question. It has a great reputation in a very beautiful setting. The jungle is fantastic. This section of the Amazon River has white sand beaches. The race offers three events, the seven days race, a four-day race, and a marathon day. Runners carry all their gear including clothes, hammock, mandatory gear kit, and food for seven days.

Helping at this race was a fantastic opportunity, which I will never forget. Over the next few months, I will be writing about what I observed and learned. My posts will talk about shoes, socks, insoles, skin treatment, “hot shots”, tapes and taping, blister patching, and several products. As you might expect, a common thread through these post will be water and sand.

Even though you may never do the Jungle Marathon Amazon, there is a lot that can be learned from what these runners experienced. I hope you will stay tuned.

A Survey About Feet From The 2012 Amazon Jungle Marathon

Vicky Kypta is the Medical Team Manager for the Jungle Marathon, which starts October 6 in the Amazon in Brazil. Last year she did an informal survey of the participants and the results are interesting. The race lasts seven days and goes through the jungle on pre-existing paths, trails, and tracks with natural obstacles to pass including streams and shallow rivers. This leads to feet that are constantly wet.

Jungle Marathon foot care

Jungle Marathon foot care

This is the race that I will be at in a few days.

Vicky shared the results of the questionnaire and commented it was quite interesting, although the sample group was quite small. There were about 30 participants.

Here are some of the findings:

  • 77% of the respondents wore Injinji socks
  • 100% of those NOT wearing Injinji sock got blisters
  • 46% of those wearing Injinji sock got blisters: out of those 50% were on the balls of the foot and 50% were on the toes. Those who had blisters on their toes all wore shoes in their normal size.

Out of those with no blisters:

  • 100% wore Injinji socks
  • 100% wore shoes one size larger
  • 75% applied some form of anti-friction compound to their feet; i.e. Body Glide, 2nd Skin or Zinc Oxide cream
  • 75% pre-taped problem areas or hotspots

I find this interesting and wonder what we will find with the 78 participants next week. The Jungle Marathons are well run and the staff tells runners to train with wet feet. They have found this results in less foot problems.

The results are striking in several areas (remember this is a seven day stage race):

  1. All the runners who did not get blisters wore Injinji socks and shoes a full size larger than their normal shoes
  2. All the runners who did not wear Injinji socks got blisters
  3. Runners wearing their normal size shoes all got toe blisters
  4. The majority of blisters were on the forefoot and toes

Over the past 17 years, I have worked a lot of ultramarathons and multi-day stage races. I can honestly say that overall, feet have improved. More runners are prepared and know how to manage their feet.

When I return, I will share what we found at this year’s Amazon Jungle Marathon.

Moisture on Your Feet – Moist, Very Wet or Very Dry

September 22, 2013 by · 1 Comment
Filed under: blister care, Foot Care, Health, Sports, Travel 

Back in May I posted an article about Training With Wet Feet. My being invited to work on the medical team at the Jungle Marathons in Vietnam and the Amazon prompted the article. While the Vietnam race had to be cancelled, the Amazon race is happening – in a bit over two weeks.

As I wrote in that article, it was long felt the best way to manage your feet was to keep them as dry as possible. This was more and more evident as Denise Jones and I worked the Badwater Ultramarathon in the heat of Death Valley each July. Runners who kept their feet dry typically finished better than those who had wet feet. This was also based on our experiences at Western States and other events.

Then came the invite to help at the Jungle Marathons.

The Jungle Marathons are run by Race Director Shirley Thompson and the Medical Team Manager is Vicky Kypta. They found their runners had a better race when they trained with wet feet. As part of their instructions to their race participants, they stress the importance of training with wet feet.

The reason for this is the Jungle Marathons are wet. Very wet is typical in the jungle. Whether through rivers or streams, the Amazon is full of water.

When I am helping runners at the race in early October, I will be closely monitoring the condition of their feet. I expect runners will use lubricants and other products to control the moisture, or powder, socks, well-draining shoes, and maybe a few home-grown tricks.

Over the past few months, I have shared some of the findings by Rebecca Rushton, a podiatrist from Australia. In her Blister Prevention Report, she talks about managing moisture control. She supports her report with studies from medical and other professional journals. What she found through the studies is that you could reduce the incidence of blisters by keeping the skin either very dry or very wet.

Rebecca writes that, “… the very high or very low skin moisture strategies aim to reduce the coefficient of friction value between the sock and the skin to below blister-causing levels.”

The Coefficient of Friction

The coefficient of friction (COF) is the number that represents the slipperiness or stickiness between two surfaces. According to studies, this number is generally below 1.0. Inside the shoe, the COF between the foot’s skin, and the sock and insole can range from 0.5 and 0.9. Compare this to the COF between a sock and a polished floor – about 0.2.

In Rushton’s report, she illustrates this with an example of a runner whose feet sweat a lot. His socks become damp, creating a moist condition. The COF in this case might be 0.7. By moving away from a moist condition to either very dry or very wet, the runner might reduce the COF to 0.5. If the runner’s blister-causing threshold is 0.6, getting to 0.5 will reduce his chances of blistering. Reducing the COF between your skin and socks/insole combination is important to having healthy feet.

Moist Skin

Moist skin produces higher friction than very dry or very wet skin. Whether skin is dry and becomes moist through sweat or through a water moisture source, or is very wet and becomes moist through heat or simply drying out, when it hits this middle stage, it becomes more susceptible to blistering.

Very Dry Skin

Drying the skin can be done with powders, antiperspirants or other drying agents, used by themselves or in conjunction with moisture control socks. Keeping the skin very dry is tough because our feet sweat naturally. Humid or hot conditions can also make it hard to keep the skin dry. Dumping water over your head to cool yourself can result in water running down your legs into your shoes – defeating your efforts to keep your feet dry. Airing your feet with shoes and socks off can help. If you use powders, make sure it is high quality and does not cake, which can be an irritant. When counting on any of these methods to keep your skin dry, you mush also have shoes that allow moisture to escape. That may include shoes with mesh uppers and drain holes in the arches and heels.

Very Wet Skin

Increasing skin moisture leads to very wet, lubricated skin that reduces the skin’s coefficient of friction. This can be through the use of a lubricant and or by simply having wet feet. The thing to remember is that over time, 1-3 hours, friction will increase as the lubricant is absorbed into the socks – so ongoing application is required.

Amazon Wet Foot

Amazon Wet Foot

Remember too what happens to your skin when you spend too much time in the water. It becomes weaker and less able to resist trauma on wrinkly skin. In extreme cases, the skin can fold over on itself and split. Severe maceration can be painful and athletes say it feel like a giant blister on the bottom of their feet.

In the Amazon Jungle Marathon, the trick will be to dry the feet at the end of each day’s stage. Because the feet will be wet during much of each day’s stage, the runners will have to find the balance between very dry and very wet, avoiding moist as much as possible.

Here’s some advice from my previous post about training with wet feet.

As said earlier, stop and deal with any hot spots as soon as you feel them. Check for folds in your socks, friction from dirt or sand, pressure inside your shoes – and get rid of these irritants. Lube the area or apply a piece of tape or blister prevention patch to help. This may seem like common sense, but many people ignore this simple step.

At the end of each day’s stage, remove your wet shoes and socks, dry your feet and air them as much as possible. If your feet have tape on them, remove the tape to dry the skin underneath. Wear sandals or Crocs around camp to keep your feet away from the wet ground and dirt and sand. Walking around barefoot will often aggravate wet, cold, and soft macerated skin. Later in the day or the next morning, re-tape your feet and patch any blisters.

Rest assured that I will write about how everyone’s feet held up in the wet Amazon jungle.

Credit is due to Rebecca Rushton for her Blister Prevention Report. Her website is Blister Prevention. Check out her website and sign up for her newsletter and free reports.

Here is the link to the Jungle Marathon Amazon.

If you want to read more, check out this article I did in November 2012 about Stuart Crispin who completed the race in Vibram FiveFingers.

ENGO Blister Prevention Patches

September 8, 2013 by · Leave a Comment
Filed under: blister care, Foot Care, Foot Care Products, Footwear, Sports 

In my last post, I talked about four ways to reduce shear and the likelihood of blisters. To recap, they were fit, cushioning, moisture management, and socks. Today’s post will cover a fifth way by using ENGO Blister Prevention Patches.

Tamarack Habilitation Technologies is well known for providing healthcare professionals and clients with innovative, value-added orthotic-prosthetic componentry and materials. Their ShearBan product is similar to the ENGO Blister Prevention Patches reviewed in this article. ShearBan is used in the orthopaedic and prosthetic industry on prostheses at amputation stump sites to reduce the incidence of skin breakdown.

ENGO in Footwear

ENGO in Footwear

Introduced in 2004, ENGO Blister Prevention Patches have radically redefined the way hot spots, blisters and calluses are treated. As a preventative measure, ENGO patches provide peace-of-mind that blisters won’t become a painful, debilitating problem. If a blister has already formed, applying patches to footwear, corresponding to the blistered area eliminates painful irritation and further skin damage, allowing continued activity. Friction forces are reduced by more than 50% when you apply an ENGO Patch to your footwear.

ENGO Applied

ENGO Applied

The patches are made from an ultra-thin Polytetrafluoroethylene (PTFE) film and are 0.015 inches total thickness – a very slippery surface. They are very durable, lasting four to six weeks in most applications. The aggressively sticky patch peels away from the backing and is applied to dry shoes or boots. The PTFE ENGO Patch reduces the ‘stickiness’ between the shoe and sock so they can glide over one another. The foot, inside the sock, glides over the patch shear distortion and friction are reduced, and blisters can be averted, in spite of pressure.

Avid runners, hikers and sports players rely on their feet to reach performance goals; from day hikes to ultra marathons. But quality footwear and socks alone don’t eliminate the skin trauma your feet can experience from repetitive rubbing — building friction forces to levels that cause hot spots, blisters and calluses. While I use these patches in runners’ footwear at races, they can also be used in ordinary every day shoes to reduce calluses.

Similar to Tamarack’s ShearBan material, ENGO patches are applied directly to footwear and equipment, not to the skin. Outcomes of this unique application include ease of use, long-lasting and guaranteed friction relief.

ENGO Patch in Shoe

ENGO Patch in Shoe

ENGO Patches are made in several sizes and types:

  • A large oval – 2 ¾ x 1 ¾
  • A small oval – 2 x 1 ½
  • A rectangle – 3 ¾ x 2 ¾
  • Back of the heel patch – 3 ¾ x 1 ¾
  • A cushion heel wrap – 3 ¾ x 1 ½

When I work a race I always have a bag with different sizes of ENGO patches. I have applied the ovals and rectangles and the back of the heel patches. The patches are applied to the shoes and insoles – not to your skin. This means wherever you are going to apply a patch has to be dry. My advice is to apply patches before your race when your shoes are dry. I have used them inside the shoes in the sides, in the heels, and on the insoles.

ENGO in a Shoe's Heel

ENGO in a Shoe’s Heel

Typical problem areas in footwear are under the heel and forefoot, and at the side of the heel. An oval patch can be applied to overlap the side of the heel counter and the insole as seen is the photo. I often use a rectangle or large oval under the ball of the foot or an oval under the heel – applied directly to the insole. The patches are useful over stitching or seams in footwear that are rubbing the wearer. If necessary, a patch can be cut to shape for where it will be applied.

The patches will reduce shear and friction; provide relief from hot spot and blister pain, and can be used in any type of insole or orthotic and footwear, from sandals to running shoes, and any type of hiking or ski boot.

I like ENGO patches because they work. The patch is thin and does not alter the fit of the shoe. When properly applied to dry footwear, they stick.

Rebecca Rushton, a podiatrist in Australia, strongly recommends ENGO Patches. She discovered the patches after getting blisters herself and now represents ENGO in Australia. She has written several free reports on blister prevention available on her website, Blister Prevention.

If you are unclear about shear and blister formation, here’s a link to my article An Introduction to Shear and Blister Formation.

The Technical Stuff

JM Carlson, in a 2009 report wrote, “The measurement of friction is the ‘coefficient of friction’. The coefficient of friction (COF) is a number that represents this slipperiness or stickiness between two surfaces and is generally below 1.0. Within the shoe, the COF between the foot, socks and insole can range from 0.5 – 0.9. In contrast the COF between a sock and a polished floor is around 0.2.” Tests have shown PTFE patches to reduce the coefficient of friction (COF) in the shoe by up to 80%. The COF is in approximately 0.16, which is significantly lower than all other in-shoe materials. Importantly, the low COF is maintained even in most and wet conditions inside the shoe.

Check out GoEngo.com for more information about ENGO Blister Prevention Patches. They also offer a money-back guarantee.

ENGO Patches can be purchased at the ENGO website, Zombierunner.com, and Rebecca’s Blister Prevention website.

Disclaimers: I support ENGO Patches and am supplied with whatever I need for the events I work. I am an affiliate of Zombierunner and make a bit of any sale made through the link above.

More on Shear and Blister Treatments

August 26, 2013 by · Leave a Comment
Filed under: blister care, Foot Care, Footwear 

Back on June 17 I introduced the concept of shear with a post by podiatrist Rebecca Rushton from Australia who has studied blisters and identified shear as a major factor in blisters.

It’s best to start by refreshing our memories about what was shared on the previous article. Here’s the link in case you want to see the full post: An Introduction to Shear and Blister Formation. Otherwise, here’s a short piece from that post:

Poor blister prevention outcomes are due in no small part to the misunderstanding of the cause of this obstinate injury. The force that causes ‘friction’ blisters is not friction. And it’s not rubbing. It’s shear. But if you ask 100 people the question “what causes blisters”, nobody would answer “shear”. Shear is the sliding of layers across one another – internal layers that are structurally connected. Those connections can break and when fluid fills that cavity, you have a blister! What Does Shear Look Like?  Try this … Step 1: Place the tip of your right index finger on the back of your left hand. Step 2: Wobble it back and forth but keep it stuck to the same bit of skin. Notice how your skin stretches? This is shear and this is what causes blisters. Shear might look like rubbing but it’s not. Notice how your finger tip has not moved relative to the skin of the back of your hand? But your hand skin has moved relative to the underlying bone. This is shear. Your skin doesn’t need anything to rub over it for blisters to form. It just needs shear (this stretching of the internal tissue layers) to be excessive and repetitive.

That’s shear.

Managing shear is key to managing blisters. Let’s look at several ways to reduce shear.

The first way is to make sure your footwear fits. Many people buy shoes that seem comfortable in the store but don’t make sure they feel ok by wearing them around the house for a few days. Make sure they have enough room in the toe box both in height and length. Make sure there is not undue pressure on soft tissues over any bony spots (sides of the forefoot, ball of the foot, sides and back of the heel, over the instep, etc.). Make sure they are not too loose, allowing too much movement leading to skin abrasions, hot spots, and then blisters.

Using a cushioning product is a second way to reduce shear. This might be a gel pad under the ball of the foot or under the heel bone, or a replacement insole meant to pad and cushion.

Applying power during an adventure race

Applying power during an adventure race

A third method is to manage skin moisture. This can include skin-drying strategies and skin lubrication. Studies have shown that you can reduce the incidence of blisters by keeping the skin either very dry or very wet. Drying the skin can be done with powder, benzoin, alcohol wipes, and antiperspirants. Lubricants can include SportSlick, BodyGlide, BlisterShield, and other popular products. Zinc oxide is also effective at controlling moisture. The method of having runners train with wet feet has been successfully used by Shirley Thompson and Vicky Kypta of the Jungle Marathon Amazon. They have found that the feet of their race participants have been better with this suggestion given to runners before the race.

The fourth method of controlling shear is with socks. This may include double layer socks or wearing two pairs of socks – a thin liner and usually, a thicker second sock. This allows movement between the two sock layers. Injinji toe socks are great for those with toe blister problems.

Next time, we’ll talk about  a fifth way to reduce shear – Engo Blister Prevention Patches.

In the mean time, check out ZombieRunner for many products that can help with cushioning, skin-drying and lubricants, and socks.

Feet Tell a Story

August 15, 2013 by · Leave a Comment
Filed under: blister care, Foot Care, toenails 

I have a large file of feet pictures on my computer. Pictures of toes, heels, balls of the feet, and arches. Pictures of blisters of all shapes and sizes. In addition, I see all kinds of feet when I work events. Over the years, I have worked races ranging from short distances to ultramarathons, to multi-day stage races.

I am probably one of a limited number of people in the world who gets excited at photos of bad feet. I like them because they tell stories.

The first full multi-day event I worked was Racing the Planet’s Atacama Desert six-day stage in the high desert of Chile in 2004. The stressors of being on your feet for long distances day-after-day for six to seven days often bring out the worst in feet.

A lady in that race wanted us to remove her toenails at the end of day two. Another runner had the worst case of trench foot I have ever seen. That was nine years ago and my techniques have changed for the better, but the feet remain the same – bad!

I believe that feet tell a story.

Hurting Toes

Hurting Toes

The photo here is from the Racing the Planet Iceland. I don’t know the owner of the feet. I don’t know the level of training and experience the person had prior to this race. I also don’t know what experience this person had with foot care planning before a race and during the race.

Here are my observations about the story behind these feet.

  • Almost every toe has something going on.
  • The photo was posted online for stage five, meaning the runner had to tolerate these toes for four plus days.
  • These blisters don’t typically happen in one day. My guess is they started on day one, progressed to blisters on day two and then got worse.
  • My bet is the shoes’ toebox was too short in length and/or too low in height.
  • The runner may have worn two pairs of socks, which could have made the fit too tight.
  • The toenails don’t look too long but it’s hard to see if they have any rough edges or are thick, both of which can lead to toe blisters.
  • These toes scream pain – especially if they are encased inside shoes.
  • It’s possible the toes received some degree of care, but it is hard to tell from their condition.
  • Four of the toes have major trauma.
  • We cannot see what is going on under the toes, but from the outside edges of the big toes, you can see blistered skin of the left one and maceration on the right one.
  • The left big toe has blood showing in the blister on the outside edge.

That’s a lot of information pulled from a photo. I wish I knew the toes’ owner. It would be nice to learn more about his/her race. What shoes and socks they wore. How the trauma to the toes progressed day-to-day. What care they received. Whether they finished the race.

My guess is that with proper care, much of this could have been prevented. That care could have included lubricants, moisture control skin protect, tape, modified shoes, and nail care.

What story do your feet tell?

Here’s the link to the Racing the Planet’s Iceland race. Racing the Planet does four desert races every year called The 4 Deserts: the Gobi in China, the Atacama in Chile, the Sahara in Egypt, and Antarctic. Every year they add a new location for that year. Past sites have included Australia, Nepal, Namibia, Vietnam, and 2014 will be in Madagascar. You can check them out at Racing the Planet.

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