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.

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.

Blister Treatment or Prevention?

June 3, 2013 by · 5 Comments
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.

FYF Cover Image

FYF Cover Image

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.

A Great Vibram FiveFingers Review

November 25, 2012 by · Leave a Comment
Filed under: blister care, Foot Care, Footwear, Sports, Travel 

Last week I read a report over at BirthdayShoes.com about a guy who completed the Jungle Marathon in the Amazon in Vibram FiveFingers. I was fascinated by what I read and contacted the race director who made the connection. Stuart Crispin sent me the article he submitted to Vibram.

“I recently completed the 2012 Jungle Marathon in Brazil, and in doing became the first person ever to take part in and finish this grueling event wearing a pair of Vibram FiveFingers (VFFs). With the help of a pair of VFF Spyridons men’s 43 I even managed to finish the worlds toughest endurance race, as listed by CNN, in 5th place overall. I did not wear toe socks at any time during the race. [Stuart’s overall time was 47 hours, 43 minutes.]

Stuart Crispin at the Jungle Marathon

Stuart Crispin at the Jungle Marathon

 The race is a six-stage, seven-day self-supported foot race. Runners have to carry all of their food, clothing, hammock, sleeping bag/liner, medical kit and other mandatory kit, as well as 2.5 litres of water (picked up at every checkpoint). My rucksack at the start of day one weighed about 12.5kg. The longest stage on day five is a non-stop 108.5 km ultramarathon. The total seven-day distance covered was over 255km across swamps, dense jungle, mangroves, sandy beach, creeks, rivers and dirt roads. (Details at junglemarathon.com).

Before flying out to take part, I wrote to the race director who advised me not to wear VFFs suggesting they might not offer enough support for such a long distance race. I also emailed a previous competitor, who is also a physiotherapist for her advice on wearing VFF. Her response was ‘… FiveFingers will be a disaster… they will not offer your feet the support they need… they are not designed for such long distance running… and they won’t have enough grip to help you stay upright on the seriously wet and muddy terrain, particularly on the severe ascents and descents.’

Despite this advice I opted to go with my Spyridons. Thanks to the clever Kevlar lining in the sole I had every confidence they would give my feet enough support to avoid injury to the sole of my foot while running through the dense jungle, where the floor was covered in sharp spiky objects as well as spiky stinging insects like scorpions. I felt no impact at all underfoot and the Spyridons’ grip was more than adequate to cope with the muddy terrain. A week before going to Brazil for the race I wore my Spyridons to hike up Snowdon, the UK’s third highest mountain. They were great for that too, although while walking across large, wet slightly tilted rocks and boulders I could feel my feet slip slightly, but I think that may have happened in walking boots also. The hike up to the summit left me in no doubt that my Spyridons were the right choice for the Jungle Marathon.

The tough material used for the upper is still in exactly the same condition it was before the 255km race. There are no tears or cuts at all to the upper of both shoes, and the soles too are also damage free. The only minor sign of wear and tear is a very small section of the material on the outside of one of the big toe pockets, where it has very slightly come away from the sole. But in order to see it you have to look closely and after such a long way in some seriously aggressive and tough terrain, including deep bogs and swamps I think that is extremely impressive and shows how robust the Spyridons are.

I did have a concern about using the Velcro strap version as I wondered how it would hold up in the swamps and bogs. Some of the bogs were up to 1km long and over knee deep with mud. My concern was whether the strap would stay secure and tight when pulling my leg up out of the mud, as I did not fancy losing a shoe. However, the VFFs are designed to fit snugly to the foot so although on a couple of occasions the strap came undone the shoe remained firmly in place on my feet. But this did not happen during every swamp or bog, and there were many.

Every single day of the race I had several other competitors asking me about my choice of footwear, often questioning whether I would be able to finish the race. My reply was the same every day, that they were extremely comfortable and I felt no pain or any objects under foot at all. They looked amazed but also looked very impressed. Many of them said they were going to try using VFFs after the event. Perhaps even more impressive than the toughness of the shoe, is the comfortableness of the Spyridons for running and hiking. After running 255km I did not have a single blister on either of my feet, and that is dispite starting and finishing every day with wet soggy feet. The only sores I had on my feet were between a couple of my toes caused by sand getting between them during the 108.5km long stage. I had already run several miles on sand during the previous four stages without any problems with the sand at all. During the long stage I think it only happened due to having had wet feet since 4.30am at the very start of the stage when we started with a river crossing, and by the time I ran on sand I had been running with wet feet in 35 degree heat in almost 100% humidity for over 12 hours. Perhaps if I had put on a pair of toe socks I may have been able to prevent the sores at all but as they were only minor I opted to just carry on to the finish.

The race director, who advised against wearing VFF, saw me on day four at the first checkpoint and said she couldn’t believe I was still going wearing them, and going so well. She said every day she expected me to pull out with trashed feet and after the race told me how seriously impressed she was with me for finishing in 5th place and wearing VFFs for the entire race.

I had reservations myself about wearing VFFs and I don’t think my Bikilas, KSO’s or Classics FiveFingers would have been up to the task. But thanks to the Spyridons trail running qualities I was able to wear them. In my opinion the Spyridons are the most comfortable running shoe I have ever worn. I have run over 20 marathons on both road and off road, and several ultramarathons including multi-day events in the Sahara, the Atacama in Chile, the Himalayas and Scottish highlands, as well as 100km and 100 mile non-stop races. I have worn several different brands of running shoes, some of which have left me with horrendous blisters. Some have been ok when it comes to blisters, but even if I finished blister free I always felt ‘hot spots’ which is the start of a blister. I have never worn a running shoe that has left me with zero blisters and zero hotspots.

I would have no hesitation at all in recommending VFF to other runners and for trail/off road running at the moment in my mind there is no better option than the Spyridons.

I will definitely be using Spyridons for my future off road running and will continue to recommend them to other runners who always approach me at races and while I’m out training, asking about them and how they feel.

I would be happy for you to use this review if you wish, as I would like other people to know about my experience of using VFFs. I searched the web before the race looking for other reviews or advice on using VFFs in such extreme environments but the information out there was limited. No one has ever worn Fivefingers in such an event and I would be happy to share my experiences with others. I am also a qualified personal trainer, as well as a London based firefighter, and will recommend the sensible and safe use of VFFs to some of my clients where suitable.

Stuart Crispin
London

I asked Stuart a few questions and here is what he wrote back, “The Jungle Marathon was my first multi-day race wearing Vibrams. Before that I ran the London Marathon in VFF Bakilas but since I hadn’t run further than 12 miles in them before the marathon the jump in distance was rather silly and I did get some minor pain in my left foot. But I didn’t get a single blister or hot spot and like in the jungle I ran with no socks. My longest run before the Jungle was 14 miles off road and I ran with wet feet and again had no blisters. I have run several multi-stage ultras and marathons and only the VFFs left me with no blisters. I know they probably won’t work for everyone but I won’t run in trainers ever again. Before wearing VFFs I used Injinji toe socks and they definitely helped reduce the amount and severity of blisters I got from running than when I wore normal socks (including two socks).”

Thank you Stuart for this great report and congratulations on your finish.

If you are interested in learning more about the Jungle Marathons, the links are below. Shirley Thompson, the race director, puts on challenging races, well run with a great safety record, and a professional staff. It is my hope to be at both these events next year.

The Jungle Marathon – Amazon (2013 October)
The Jungle Marathon – Vietnam (2013 June)

In October 2010 I wrote a blog post about a runner at the six-day ThanksRockies who wore FiveFingers for the 115 mile race. If you want to check out the link, here’s the post: Vibram FiveFingers at the Gore-Tex TransRockies.

 

Accolades for Fixing Your Feet, 5th edition

December 8, 2011 by · Leave a Comment
Filed under: Books 
Fixing Your Feet - 5th edition

Fixing Your Feet - 5th edition

I first wrote Fixing Your Feet back in 1996, self-publishing it in 1997. Then came the 2nd edition in 2000, a 3rd in 2004, 4th in 2006, and finally the 5th edition earlier this year. That alone makes it a very successful book.

Do you have a copy?

I have talked to some athletes who have an old edition. As much as I love every edition, I am especially proud of the 5th edition. It is the best of them all. Each edition has built on previous editions.

After all these years, the book remains popular. I was surprised when I saw the sales number for the first six months of the 5th edition. It sold more copies than any previous six months after the release of past editions. Also surprising was that close to 300 copies were sold of the Kindle version of the 5th edition.

This morning I received an email from Runner’s World. The email had been sent to their subscribers. It gave information about a book with “583 secrets for foot-savvy athletes – like you.”  It went on to say, “In the pages of Fixing Your Feet, you get secrets…” I wondered if someone had published a book with the same title as mine. I scrolled down in the email and saw the picture of the cover – and it was for my Fixing Your Feet! My publisher and Runner’s World, with Rodale Books, had worked the deal to offer Fixing Your Feet to their readers. The link to their three page website for the book is below.

I am honored.

This 5th edition has received accolades from lots of folks. This promotion by my publisher through Runner’s World and Rodale Books, is an honor. It shows how respected the book is. I hope you have a copy. If you don’t have a copy of the 5th edition of Fixing Your Feet, here is where you can get it:

ZombieRunner – click through to the website and then Books & Magazines

Amazon.com for the print copy

Amazon.com for the Kindle version

Runner’s World / Rodale Books

While you’re there, please consider a copy for a friend. Drop me an email and give me your feedback. I value your comments.

You, the athletes, are the ones who keep me going. I wrote Fixing Your Feet for you. Enjoy it.