Blister Volunteers Needed

January 4, 2013 by · 1 Comment
Filed under: blister care 

For years blister care has been fairly standard. Many athletes use Second Skin over the top of a blister and then apply tape to hold that in place. Some still use Vaseline. Others will drain the blister and cover with a Band-Aid or athletic tape. And some will use zinc oxide under tape.

All can work – but some work better than others. I’ve seen many runners who have tried one of the above with poor success.

Sometimes the lack of blister patching success happens because of a poor tape job. Maybe too little adhesive around the patch and it didn’t stick. Maybe the blister was not lanced correctly and refilled with fluid. Or maybe the Second Skin migrated under the tape and folded on itself or might have been old and too dried out to work as designed. Or the Second Skin made the skin too moist and maceration occurred, causing more problems. Or too little Vaseline or zinc oxide was used and friction reoccurred, leading to an increase in fluid.

So here’s the deal. I am interested in hearing from a few athletes, runners or adventure racers, walkers or hikers – who get serious blisters almost every time they go out. I don’t mean a minor ¼ inch blister, but a blister ½ inch or larger, anywhere on the foot. And especially those where the roof tears off, leaving raw skin underneath. The worst, the better and the bigger the better. This is not a prevention item but would be used as a treatment for formed blisters.

I have a product to test and need four to six testers.

Send me an email and tell me about yourself, what you are doing when you get blisters, and how you have treated them in the past – what you have tried and what worked or didn’t work. If will do my best to respond to all who send me an email. Please sned an email rather than a comment on the blog.

I’ll pick the best of the worst cases and supply you with sample product and suggested ways I want you to use it in the trial. I’ll give you forms to use to record your results and may ask for a photo or two. I will ask for your confidence in the trail until I can judge the results.

I make no guarantees as to whether this will work or not. But I think it’s worth a test. This is not a homegrown product but one made by a medical company.

Follow Badwater starting Monday 7/16

July 12, 2012 by · Leave a Comment
Filed under: Sports, Travel 

Next week is Badwater. I’ll be there along with Denise Jones, patching feet. I’ve captured the press released from Chris because if utilizes the best of social media and the web to keep followers in touch with the race. After the race, I’ll post pictures. Promise. Here’s the story and links.

 

Badwater

Badwater

AdventureCORPS, Inc., an event production firm specializing in ultra-endurance and extreme sports events, will host the 35th Anniversary Badwater Ultramarathon on July 16-18, 2012. Recognized globally as “the world’s toughest foot race,” this legendary event pits approximately 95 of the world’s toughest athletes – runners, triathletes, adventure racers, and mountaineers – against one another and the elements. Covering 135 miles (217km) non-stop from Death Valley to Mt. Whitney, CA in temperatures up to 130F (55c), it is the most demanding and extreme running race offered anywhere on the planet.


The start line is at Badwater, Death Valley, which marks the lowest elevation in North America at 280′ (85m) below sea level. The race finishes at Mt. Whitney Portal at 8360′ (2533m). The Badwater course covers three mountain ranges for a total of 13,000′ (3962m) of cumulative vertical ascent and 4,700′ (1433m) of cumulative descent. Whitney Portal is the trailhead to the Mt. Whitney summit, the highest point in the contiguous United States. Competitors travel through places and landmarks including Mushroom Rock, Furnace Creek, Salt Creek, Devil’s Cornfield, Devil’s Golf Course, Stovepipe Wells, Keeler, and Lone Pine.

A true “challenge of the champions,” the 2012 AdventureCORPS Badwater Ultramarathon features 49 Badwater veterans and 49 rookies: die hard “ultra-runners” of every speed and ability, as well a athletes who have the necessary running credentials, but are primarily known for their exploits as adventure racers, mountaineers, triathletes, or in other extreme pursuits. They represent twenty countries by citizenship or residence: Argentina, Australia, Brazil, China, Costa Rica, Czech Republic, Canada, France, Germany, Iran, Italy, Japan, Mexico, Poland, Serbia, Spain, Sweden, United Kingdom, United Arab Emirates, and United States of America (and nineteen America states).

There are 18 women and 80 men. The youngest runner is 23 (rookie entrant Claire Heid of Tacoma, WA) while the oldest is 70 (Arthur Webb of Santa Rosa, CA, a thirteen-time finisher), with an average age of 45. Full details are available on the race roster.

The men’s course record is held by Valmir Nunez of Brazil with a time of 22:51:29 set in 2007, while the women’s course record of 26:16:12 was set in 2010 by Jamie Donaldson of Littleton, CO. It is expected that the winner of the 2012 AdventureCORPS Badwater Ultramarathon will finish in 22 to 26 hours. The average finishing time is approximately 40 hours, while the overall time limit is 48 hours, as compared to the 60 hour limited used in the races held through 2010. For those who finish in less than forty-eight hours, their reward is the coveted Badwater belt buckle. There is no prize money.

The 2012 race field is particularly competitive. Veteran contenders include 2011 men’s champion Oswaldo Lopez, 40, of Madera, CA (also place 2nd in both 2009 and 2010; Mexico citizenship), 2010 men’s champion Zack Gingerich, 32, of Tigard, OR, 2009 men’s champion Marcos Farinazzo, 44, of Brazil and 2004 men’s champion Dean Karnazes, 49, or Ross, California. Also competing is Marshall Ulrich, 61, of Idaho Springs, CO, the 17-time finisher who placed first in 1991, 1992, 1993, and 1996.

The women’s field, with 18 entrants, includes 11 rookies and 7 veterans. Veteran contenders include the 2011 women’s champion, Sumie Inagaki, 46, of Aichi, Japan and Pam Reed, 51, of Jackson, WY, the 2002 and 2003 overall champion who also won the women’s field in 2005. Every year is a new year at the Badwater Ultramarathon, with rookies and “previously unknown” athletes surprising the contenders with top performances. New stars will shine as the race unfolds in July.

RACE MAGAZINE Download the 2012 edition (44 pages; 3.4MB).

RACE WEBCAST Follow the race live via the webcast.

BADWATER ON TWITTER
Follow the 2012 Badwater Ultramarathon via Twitter. We will post race updates and observations, photo links, and important news and announcements. NOTE: Please use hashtag #bw135 to join the Twitter conversation! Here’s the current conversation stream.

BADWATER ON FLICKR
Official race photos by the Badwater Race Staff will post to Flickr July 15-18. Race Director Chris Kostman’s race photos will post to Flickr July 15-18 in his photostream.

BADWATER ON INSTAGRAM
Badwater Race Director Chris Kostman will be posting photos “live” (whenever a cellular connection is available, which is in Furnace Creek and then the latter 1/3 of the course and the finish line) via his Instagram account. Follow his photo stream on your iPhone or Android with the Instagram app and his stream at “chriskostman.” Photos also automatically post to Chris’ Instagram stream for viewing online.

BADWATER ON YOUTUBE
We will be posting videos from the race on the AdventureCORPS YouTube channel. Most videos will appear on Tuesday and Wednesday, where the internet connection is far superior to that in Death Valley.

Ankle Sprain: Going Beyond R.I.C.E.

Back in January I had a guest post on the AFX – Ankle Foot maXimizer – Part I. This is part II where ankle sprains are discussed. This is a guest post by Timberly George, a Sport Physiotherapist (bio at the end of the article). Here’s Timberly’s post. The photos demonstrate the Ankle Foot maXimizer.

Slippery roots. Rocks. Deep puddles. Steep slopes. Momentary lack of attention to the trail and suddenly – pop! There goes your ankle. Uneven terrain, speed, fatigue, previous ankle injury, poor balance, weak foot and ankle muscles – they can all be to blame for the ankle sprain that plagues many an outdoor adventurer. In a study of 300 adventure racers 73% of them reported an injury over an 18-month period.i Ankle sprains were the most commonly reported injury.

Most of us are aware of the immediate treatment protocol for an ankle sprain, following the old acronym R.I.C.E (Rest, Ice, Compression, Elevation).  Do this! It definitely helps in the initial phase of injury management. But, recovering from an ankle sprain doesn’t end there. Just because the swelling has gone down, and the pain has diminished, that doesn’t mean your ankle is ready for the trails again. Research and clinical experience shows us that a person needs to go beyond R.I.C.E. to focus on the instability of the ankle caused by the sprain, in order to prevent another sprain from occurring.ii

So what exactly is an ankle sprain?

In order to understand why you need to go beyond R.I.C.E, you need to understand what exactly happens when an ankle is sprained.

The term “sprain” refers to an injury that involves damaging a ligament.  Ligaments are passive structures that connect bones to bones and help stabilize the joints. A ligament sprain can be as simple as a minor stretch or as complex as a complete disruption or tearing of the ligament fibers that give stability to a joint.

There are 3 main types of ankle sprains:iii

Inversion (lateral) ankle sprain - Over 90% of ankle sprains are inversion, making it the most common type of ankle sprain. It occurs when the foot is inverted too much, affecting the lateral side (i.e. outside) of the foot.

Eversion (medial) ankle sprain – far less common due to the strength of the medial ligaments and the mechanics of the joint.  Affects the medial side (i.e. inside) of the foot.

High Ankle Sprain - An injury to the large ligaments above the ankle that join together the two long bones of the lower leg, called the tibia and fibula.

Ankle sprains can be classified in to 3 categories: iv

Grade 1: minor damage to a ligament or ligaments without instability of the affected joint. Mild swelling may be apparent but you can usually walk without too much discomfort;

Grade 2: partial tear to one or more ligaments, in which they are stretched to the point of becoming loose. Moderate swelling and some bruising are likely apparent; and,

Grade 3: complete tears of one or more ligaments, causing instability in the affected joint.Moderate to severe swelling and bruising will occur around the ankle and most people will be quite hesitant to immediately bear weight on their foot.

Once ligaments have been damaged, the ankle is left with a loss of range of motion and a mild to severe level of instability. As a result, it is more susceptible to further injury and recurrent ankle sprains are very common. Unfortunately, a ligament does not regain its ability to stabilize the joint and therefore, we are left to rely on the muscles and tendons surrounding the ankle to provide the active stability.  A solid rehabilitation program guided by a physiotherapist to regain full mobility, proprioception, and a proper strengthening program is crucial to getting you back on the trails and running again with confidence.

What do you do to recover from and/or prevent an ankle injury? 

To begin with, do your own R.I.C.E protocol and get some help from a physiotherapist as soon as possible.v Many people choose to “wait and see” how the ankle repairs itself with time.  The trouble with that approach is most Grade 2 and 3 ankle sprains will never regain full mobility and strength on their own without assistance.  Even a simple Grade 1 ankle sprain, left untreated, will likely result in another ankle sprain down the road.

Seated Balance Exercise – non-weight bearing exercise, good for early-stage rehab. Improves proprioception, balance and strength. For added difficulty, close your eyes.

Seated Balance Exercise – non-weight bearing exercise, good for early-stage rehab. Improves proprioception, balance and strength. For added difficulty, close your eyes.

Rehabilitation following an ankle sprain cannot be overemphasized. Restoring the normal mechanics and improving the stability of the ankle will allow for a return to safe activity and will decrease the risk for another sprain.ii Your physiotherapist will also be able to determine whether you may have caused other damage, outside of just ligament damage, such as a fracture or cartilage damage which may require further investigations such as x-rays or other imaging.

 

Once the swelling and range of motion have improved, the next step is strengthening and regaining the control, or proprioception, of the joint.  Proprioception refers to our ability to sense where our joints are in space, and to be able to control them without necessarily looking.  This is essential when hiking and running in trails when your ankle is constantly adjusting to the terrain of the earth beneath your feet. Proprioception is controlled by nerve receptors in the ligaments around a joint.  When the ligaments are damaged in an ankle sprain, so too are the proprioceptive nerve endings.  Some simple balance exercises are a good way to start.  See the Balance Standing photo at the start of this post.

 

Standing Balance Exercise – progression from seated balance exercise. Improves proprioception, balance and strength. For added difficulty close your eyes but have something close-by that you can hold to maintain balance.

Standing Balance Exercise – progression from seated balance exercise. Improves proprioception, balance and strength. For added difficulty close your eyes but have something close-by that you can hold to maintain balance.

In order to build the active stability system around the ankle, strengthening the muscles that cross the joint is critical.  There are 4 main motions that should be focused on.  Your physiotherapist will assess the strength of each muscle group to determine which muscles need the most work, and to ensure balanced strength across the joint.

 

Strengthening can be done using resistance bands and tubes, or more preferably for many therapists recently, using the AFX-Ankle Foot maXimizer TM foot and ankle strengthening system (www.afx-online.com).  The AFX allows for far more controlled and specific strengthening in more variety of planes of movement than the typical bands and tubes, as well as for more balanced strengthening across the ankle joint.  The photographs shown here demonstrate the motions.

 

 

Plantar Flexion – The motion you do when going up onto your toes, or pointing your foot like a ballerina. Primarily uses your big calf muscles (gastrocnemius and soleus), but also gains assistance from some deeper calf muscles helping to control the position of the foot.

Plantarflexion

Plantarflexion

 

 

Dorsiflexion

Dorsiflexion

Dorsiflexion – the opposite of plantarflexion. Required for lifting the toes off the ground as you swing your leg through in running and hiking. Necessary for clearing the ground and not tripping on rocks and roots. The muscles involved cross the front of your ankle joint.

 

 

 

 

Eversion – Movement of the sole of your foot away from the midline of your body. Requires strength of the peroneal muscles running along the lateral or outside border of your calf. Strong peroneii are crucial to help prevent the ankle from rolling over, into inversion, and spraining the ankle.

Eversion

Eversion

 

 

 

 

 

 

Inversion

Inversion

 

 

 

 

 

Inversion – Movement of the sole of your foot towards the midline of your body, similar to the direction you would move into as your sprain your ankle in an inversion sprain.  Although one might think this would be counterintuitive to strengthen, it is an important motion as the muscles that cause it to occur are crucial for the strength and stability of the arch of your foot.

A thorough ankle rehabilitation program is essential for protecting ourselves from further injury.  An ankle that does not re-gain full range of motion, strength, and proprioception will learn to adapt to its new, less than ideal, way of functioning.  This in turn leads to overcompensation of other muscles and an imbalance of strength and flexibility around the joint.  This imbalance can not only be the cause of further ankle sprains, but potentially also the cause of overuse injuries in the feet, knees, hips and back. In addition, because we rely on our feet and ankles to take between 7,000 to 10,000 steps a day (and endurance athletes much more!) even minor strength and stability issues can lead to major problems.

But it is not all doom and gloom. The good news is that with a little bit of effort and a good rehab program you can get back on your feet, hiking and running the trails, perhaps even stronger than before.

References

  1. Fordham S, Garbutt G, Lopes P. Br J Sports Med. 2004 Jun; 38(3):300-3.
  2. Barr, K, Harrast, M. Phys Med Rehabil Clin N Am. 2005 (779-799)
  3. Brukner, P & Khan, K. Clinical Sports Medicine. 3rd edition 2007
  4. Brotzman, SB, & Manske RC. Clinical Orthopaedic Rehabilitation. 3rd ed 2011
  5. Levin, S Early mobilization speeds recovery. Physician Sportsmed 1993; 21:70-4

Timberly George’s Bio

Timberly is a Sport Physiotherapist holding a post-graduate Diploma from Sport Physiotherapy Canada and is a clinical instructor at the University of British Columbia. She is very active in the sport physiotherapy community at the regional, national, and international levels. She was Venue Medical Manager for the Richmond Olympic Oval during the Vancouver 2010 Olympic Games and is a therapist for Rugby Canada. Timberly is one of the Vancouver Sun Run’s “Ask an Expert” panel members and provides injury prevention advice to runners through the Vancouver Sun newspaper and at local running clinics throughout Vancouver. In her spare time, Timberly can often be found running the trails or riding one of her bicycles around the mountains of the North Shore and Sea to Sky corridor.  Her primary areas of interest are treating sport related injuries, injury prevention and pre and post-surgical rehabilitation. *Timberly has no financial interest in AFX.

AFX Product Site

Merry Christmas from Fixing Your Feet

December 23, 2011 by · Leave a Comment
Filed under: Books 
Fixing Your Feet

Fixing Your Feet

Feet are a big part of my life. For the past 15 years, Fixing Your Feet has introduced me to great people. I have enjoyed helping runners at events like Western States; Badwater in Death Valley; Primal Quest in Colorado, California and Washington; Raid the North Extreme in BC Canada; the TransRockies in Colorado; Racing the Planet Atacama in Chile; the Coastal Challenge in Costa Rica; the Avon Walk; the Susan G. Komen 3-Day Breast Cancer Walk; and others. In all these events, I have worked on thousands of feet. In addition, I have responded to an uncounted number of emails from folks asking for foot care advice.

The best part has been the people I have met. Runners, hikers, adventure racers, walkers, and their crews. Athletes walking a fine line between making a cutoff in a race, front runners, back of the pack runners, short and long distance hikers, solo and in groups – all ages. Athletes with a simple blister and others with blisters all over. Athletes in pain, and those wanting to quit.

I can recall many of these people. I remember their stories. Some of you are in my stories. I have learned a lot from each person whose feet I have patched. I don’t pretend to know everything about feet. Together we have learned a lot. I thank each of you for what you have contributed to the Fixing Your Feet story.

I wish all my readers a fun, bright, delicious, warm and cozy, and loving Merry Christmas. I hope you can spend time with family and friends.