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.
Filed under: blister care, Foot Care, Footwear, Health, Sports, toenails
Which is more important, blister prevention or blister treatment?
For more than 17 years, I’ve taught foot care techniques to anyone who will listen. I have taught classes at running stores, REI stores, events, and more. In addition, I have worked medical at many races, helping provide foot care to participants. These races have been in Death Valley, Chile, Costa Rica, BC Canada, Colorado and Washington, and many in California. This year I will be at Western States 100, Badwater, the Gold Rush Adventure Race, the Jungle Marathon in the Amazon, and hopefully at races in Colorado and Namibia.
I have never counted the feet I have worked on but I would put the number well over 3000. I remember one race in Colorado in 2010 when I saw the same lady 10 times. It was a six-day stage race and she’d come in every evening and morning! I’d patch her feet in the evening and she’d take it off when she went to bed in her tent. She had foot wear issues that gave her blisters on top of blisters. She was never into prevention mode – only treatments.
In this picture, taken from the cover of the 5th edition of Fixing Your Feet, we see treatment taking place. I love the picture. I even know whose foot it is. What I can’t tell you is what he did for prevention. I wish I knew.
My question in this blog post is what should we spend more time on, blister prevention or blister treatment?
Prevention can take many forms: good choices in footwear, the right socks, lubricants and powders, toenail care, skin care, taping, Engo patches, correct lacing, the right insoles, and training and conditioning.
Treatments likewise offers many options: blister draining, many different types of patches, taping, ointments and salves, a multitude of tapes, wraps and straps, silicone pads, Engo patches, toe caps, and lubricants and powders.
So here are a few questions:
- Does prevention last only until the race starts?
- What are your best prevention options?
- How much do you count on aid station personnel to manage treatments?
- Do you know how to treat your feet?
- Do you carry materials to treat your feet?
- What are your best treatment options?
- How well do you understand blister formation and prevention?
For 17 years, athletes have had Fixing Your Feet as a resource to learn important information about foot care. As I patch feet at races, I try to educate the athletes about what I am doing and why, and what could have helped in their feet. If crews come to me for advice, I try to help them too. I have watched athletes and crews work on feet with materials and using techniques I have long preached.
In general, foot care has advanced over the years. Shoes, socks and insoles have become light years better. Lubricants, powders, blister patches, and our tools are better. People interested in foot care are trying new blister patching techniques.
All this is good because every day there are new athletes coming into running, adventure racing, hiking and thru-hiking, walking, and other feet stressing sports. Let’s make sure they understand the importance of prevention before treatment.
Filed under: blister care, Foot Care, Footwear, Health, Sports, toenails
I believe strongly in prevention as a proactive measure in foot care.
Tim Noakes’ sixth law of running injuries must be heeded—any running injury can be cured only after the cause is found and eliminated. All of us who run, hike, or adventure race at some point have problems with our feet or sustain foot injuries. The prevention chapters are numerous and lengthy because many factors contribute to foot problems and injuries, and for every factor, there is a preventive measure that can reduce or eliminate it. Prevention is the key to saving your feet. Dave Scott, a good friend and ultrarunner, put the foot problem in proper perspective: “When you don’t take care of your feet during a long run or race, each step becomes a reminder of your ignorance.”
It’s very easy to relinquish our responsibility for preparedness and let someone else dictate what we should do. We tend to listen to those whom we look up to and to those who are more experienced. In many ways this is OK, and it is often the way it should be. However, only you can determine what works for your feet.
Knowing your prevention options is important. That’s being proactive. I get emails every week from athletes who are looking for answers for their feet issues.
Some have my book but others don’t. Some have the book and have gone through the chapters to find possible treatment options. Others have the book and haven’t read it – and want me to answer their questions.
I try. Sometimes it works and sometimes not. While I answer from my experience and knowledge, I don’t have your feet. And that’s important.
Your feet have your abnormalities (hammer toes, bunions, thick toenails, skin that calluses, a tendency to athlete’s foot, a tendency to blisters, etc.), your ankles, your shoes and socks, your fit (good or bad), your training base, your stride and gait, and more.
You are the best person to find what works for your feet. Others may give suggestions. Fixing Your Feet can give suggestions and I may offer a few via email or in this blog, but you need to try them on your feet to find the one that works best.
You are the key to prevention.
Please, don’t show up at a race with a bad case of athlete’s foot, holes in your socks, shoes that have outlived their support, insoles that are flat as paper, toenails that are long and untrimmed, shoes that don’t fit, huge thick calluses, blisters that are unhealed, thick nails from untreated toenail fungus.
Yes, I have seen all of these.
Again, you are the key to prevention.
In August I worked the Gold Rush Adventure Race in the California Sierras. Throughout the race I worked at three checkpoints. As racers needed foot care, I carried my lounge chair and foot care box to where their team was set up and did what I could.
Most racers had hot spots, blisters and sore feet. A lot of times, athletes tell me that have blisters and yet, after cleaning their feet, none are visible. They may have a very sore spot or a hot spot, but there is no blister. Sometimes I can tape over the area or place a Spenco patch to provide a bit of cushioning. I often add an Engo Blister Prevention Patch to their insole underneath the tender area on their foot.
A lot of the racers needed blister care and taping. My whole aim when patching feet is to get the racers back in the race. I do what I can to drain and patch blisters on any part of the foot.
One of the racers came into checkpoint where they were transitioning from bikes to foot. At this point, they had been on their feet for almost two days. They started with a long paddle, followed with a long bushwack up a canyon, and then a really long bike section. The team was near the end of pack. The four members sat and discussed their options and whether to continue. The next section was a long trek of about 36 miles.
The racer needing foot care took off his shoes. As he sat back in my lounge chair, I removed his socks. His heels were fine, however he had major problems with blisters at the ball of the foot where the toes started. Both feet were the same. I cleaned his feet and did an evaluation.
I wish I had taken a few pictures of his feet but I was too involved in getting his feet patched so the team could continue. At the base of each toe were blisters. Many extended to several toes. Some of the blisters extended up between the toes. The majority had blood in the fluid. There were blisters at the base of the toes from one side of the foot to the other side – on both feet. His feet were swollen so the blistered skin was stretched tight from the fluid. In addition, several of the toes had blisters on the bottoms or sides, several with blood inside.
The blood in the blisters was my major concern and that there were so many of them. I usually drain blood blisters and with clean skin and a dab of antibiotic ointment – in a 24-hour race, I’m comfortable doing that. I always ask the person if they are up to date with their Tetanus shots and give them instructions about infections.
I talked to the racer and gave him my honest opinion – that he not continue in the race. We talked and I gave him my reasons. The next section was about 36 hard miles of cross-country trekking. His feet would get wet, and this would soften the skin and lead to further skin breakdown. The blisters were in a hard area to patch and it would especially be one long patch at the base of all his toes. The swollen condition of his feet was not going to get any better. And most important, the blood in so many blisters, even with the blisters lanced and patch, would increase the chances of an infection. Plus, if his feet took a beating during the trek, the blisters would become a huge open unpatchable mess (for lack of a better term). And of course, his feet would hurt badly.
He took my advice and I wrapped his feet as shown in the photo.
I think I can count on my fingers how many times I have advised racers to stop because of foot problems. Sometimes your feet simply quit. They have had enough.
Could this have been prevented? Based on my experience, I have to say, probably. Changing socks, treating hot spots, earlier blister care, better socks, moisture controlling lubricants, airing feet at checkpoints, and better shoe fit. In a team event, such as adventure races, every member of the team must help the other members with foot care. Every team member must be honest with their teammates about the condition of their feet. In solo races where athletes are racing alone, they need to be constantly aware of their feet. And where there are crews, these important people must ask questions about the condition of the athlete’s feet.
There are no guarantees in a race of any length. Our feet propel us forward, but every so often, out feet quit.
Last week I worked the Gold Rush Adventure Race. We had 11 teams working their way through paddle, trek, bike, trek, bike, trek, ropes, raft, and finally a last trek. The full course was 285 miles, although some of the teams were short-coursed because of time.
I started at TA2 (transition) where racers went from trek to bike, then TA3 – from bike to trek, TA4 – from trek to bike, and lastly, TA5 – from bike to trek. I saw the same teams, TA after TA.
I did not count the number of racers on whose feet I worked. I didn’t matter. My goal, as always, is to get the racer back in the race. I worked on some of the racers feet multiple times.
I quickly noticed a problem.
Racers would come into the TA and remove their shoes. They needed to change footwear – from bike shoes to shoes for trekking and visa versa – and change clothes too. TAs also meant dismantling and packing their bikes, or unpacking and assembling them. This was often done in the sun – and it was hot.
We had tarps set up for the teams to change on. It kept some of the dirt off their feet – but not all the dirt. The tarps were dirty and there was small twigs, bits of leaves, pinecone pods and seeds, and small stones. A lot of stuff to be walked on and stick to socks.
I usually patched blisters and applied tape as a preventive measure. I advised them to keep the tape as clean as possible and not get it wet.
Then I watched as they worked on their bikes, walked around, and sometimes went down into the river. They walked as gingerly as possible over the rocks and sticks. I don’t fault them; they did what needed to be done. I would have done the same.
The problem I noticed was that racers were compromising their feet, and any patch or tape job, by walking around without anything on their feet.
They had bike boxes for their expensive bikes and large gearboxes for their footwear, clothes, food, and whatever gear they wanted to pack. Of all the racers, I remember only a few who had the foresight to pack flip-flops. An inexpensive set of flip-flops might cost $5 – that can easily help your feet.
So here’s my recommendation. If you are involved in a multi-day race, any race with transitions, or even a one day event where you will have rest times, invest in a pair of flip-flops to protect your feet and any patch job or tape on them.
The same goes for hikers and backpackers. Lightweight flip-flops weigh next to nothing. Another option is to wear Crocs. They provide protection of one’s toes and tops of the feet, which flips-flops do not offer.
There is something to be said for taking your shoes and socks off when resting during a race, multi-day run, or long hike. Your feet like to be aired and if there is macerated because of water, airing them will help dry out the skin. But do yourself a favor and pack a pair of flip-flops or Crocs.
Message from John: This guest blog post is the first of several parts about the AFX, the Ankle Foot maXimizer. This is a new strengthening system that enables you to strengthen the muscles and tendons of the entire foot and ankle complex.
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By Matt Ferguson, MA, Medical Technology Development Professional
I hate to be the bearer of bad news however, I have to tell you that despite the fact that you run / hike / adventure race / walk, chances are that you have very weak feet.
I know, I know, your first reaction is: ‘what? That is impossible! I have logged thousands of miles over all kinds of terrain, been blistered, battered and bruised, ripped more rubber off the bottom of shoes than most NASCAR drivers do off tires, and YOU are telling me my feet are weak?’
Yes, I am. And yes, they are.
You see, during the process of attaining those impressive achievements, you likely wore well-supported shoes that had a firm sole, and competed in one direction: forwards. Even if you have transitioned to minimalist / barefoot and you have a stronger ‘base’, logging all of those miles in a forward direction still means that you are likely relatively weak in toe flexion, lateral (side to side) and dorsiflexion (toes towards shin) movements.
Therefore, to stay injury-free and get the most out of your favorite sport, you need to be actively strengthening and stretching your feet and lower leg muscles. If not, you could be in for a world of hurt. That is, if you aren’t hurting already…. c’mon, how is that plantar fascia? Shin splits doing okay? Achilles flaring-up? And how about further up the kinetic chain with knees, hips and back?
The fact is that with over 100 muscles, tendons and ligaments, your feet and ankles can be an incredible source of strength, stability, balance, agility, and power. But they need to be strong and mobile.
Do We Really Have Weak Feet and Ankles?
So why am I so confident that you have weak feet? In addition to the scientific research, we see proof of weakness and limited range of motion every time we have a booth at a marathon or similar running event. We do hundreds of demos and the response from runners is always the same: they confidently strap on the AFX – Ankle Foot maXimizer and with smug pride easily perform ankle plantarflexion.
I smile, acknowledge they are “strong like bull” and then say (also smugly), ‘okay, for this rep I want you to curl your toes and arch your foot so that you engage the intrinsic muscles’. The first thing that we see is what the AFX team refers to affectionately as ‘that face’: the scrunched-up ‘OMG I forgot I had muscles there’ face.
Repeat this same process with scrunched-up face for lateral movements (inversion & eversion).
Then repeat it for dorsiflexion and toe extension.
Tongue-in-cheek commentary aside, the unfortunate fact is that most athletes have significant deficits in their foot and ankle strength, and range of motion. These weaknesses and limited range can cause a host of problems including the aforementioned (and dreaded) plantar fasciitis, shin splints, Achilles issues, ankle sprains, and the list goes on.
What to Do?
So what do you do? I gave you the bad news at the beginning of the article, so here is the good news: by adding some foot and ankle strengthening to your training and seeking a little bit of education, you have a much greater chance of staying injury free, and improving your performance.
Prior to the development of AFX, if you wanted to strengthen your feet and ankles you were resigned to using makeshift equipment and conducting modified movements on exercises equipment. Rubber banding that slid down the arch or flew off the foot, scrunching a towel with your toes, picking up marbles, etc. The end result was programs that were too complex, confusing and not effective.
The AFX was developed to not only address all these issues, but to also enable more advanced training such as eccentric loading and fast concentrics – all from one comfortable seated position!
Foot and Ankle Strengthening
We know that you want to be outside doing what you love vs. being inside doing a strengthening program, so we’ve made the AFX effective and as easy-to-use; 8 to10 minutes a foot three times a week… and it is even portable so you can strap it on to your hydration pack and do your reps on a mountain top! Add to your workout some simple barefoot exercises like 1-leg deadlift, side-to-side ankle hops, and balance exercises on a Bosu.
Foot and ankle health is also about biomechanics, and not just the biomechanics below the knee, but the pelvis and core play a huge roll. Spend some time with a qualified running specialist to see how you can improve your overall posture. This will not only help you stay injury free, but will also improve your efficiency which is critical for endurance sports.
So the next time you are about to lace-up those new fancy $100 – $200 shoes or boots, think about the feet you are sliding in to them. Are they strong? Are they mobile? In your quest for conquering new challenges and achieving PB’s, are you taking care of the two things that are going to carry you to glory? When you put AFX to work, you’re harnessing a source of strength you never knew you had.
About Progressive Health Innovations
Progressive Health Innovations develops user-friendly and affordable products for the rehabilitation, sports medicine and fitness markets. The first product line is the AFX, a foot and ankle-strengthening technology for the athletic training, injury prevention and physical rehabilitation markets. Developed over five years in close collaboration with practitioners and researchers across the health and fitness spectrum, the AFX is the brain-child of three inventors: Matt Ferguson, MA, Medical Technology Development Professional; Rick Hall, MSc., Kinesiologist; and Dr. Jordan Myers, Chiropractor.
John’s Disclosure: I have no financial interest in the AFX.