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.

Blood Blisters

July 22, 2012 by · 1 Comment
Filed under: blister care, Foot Care 

In reality, most blisters don’t have blood in them. Repeated heavy pressure (friction) or simply long periods of pressure can turn an ordinary blister into a blood blister.

The fluid will go from clear to light pink, and with continued pressure, to blood red.

The general rule of thumb is not to lance and drain any blood blister. You may have to pad the area to take the pressure off the blood-filled skin. You need to now how to manage a ruptured blood blister.

Here’s why. The problem with blood blisters is that by draining them, the athlete’s circulatory system is opened to possible infection. In a sterile environment or at your home, this may not be an issue. However out on a trail, or somewhere where the athlete may be unable to keep his feet clean, it’s a different story. Where the blister is on the foot can present more problems. A blood blister on the side of the heel is not as problematic as one on the bottom of the foot. The opened blister is exposed to dirt, grime and any bacteria on whatever is touching the skin. Blood blister must be treated as wounds.

Another issue is whether the athlete has he right supplies in his foot care kit to patch the blister. Opening it up and not applying antibiotic ointment and a covering it is a huge mistake.

I tell athletes that normally blood blisters are not lanced because that is the wise thing to say. If everyone thinks they can simply lance them, without fully understanding how to care for them, we’ll have a lot of people with infected feet.

At Badwater last year we had a runner with a very large heel blood blister. She was from Brazil and would be flying home – but she was also a diabetic. Because of her diabetic status, we declined to lance the blister. It would not have been safe.

Arch of the foot blood blister

Arch of the foot blood blister

The photo here is from last week’s Badwater Ultramarathon in Death Valley. The runner had completed the 135-mile race. I talked to him at the finish line and told him the pitfalls of lancing a blood blister. I told him to shower and be careful of popping it and to come see us in the medical room if it did pop. It popped when he was in the shower, the best of all places.

I cleaned the area with alcohol wipes and lanced the blister with a #11 scalpel. I made three cuts so any more fluid would be forced out as he walked. I expelled the blood and applied a generous layer of antibiotic ointment. A gauze 4×4 was placed over the top and then the foot was wrapped with Coban, a wrap material that sticks only to itself. I gave the runner a Zip-Lock bag with a small tube of ointment, several more 4x4s, a Popsicle stick to apply the ointment. I told him he could unwrap the Coban and reuse it multiple times. Then I asked him if his Tetanus was up to date after which I gave him the usual infection speech.

Recheck the blister three times a day for signs of the infection. Each time you check, apply a new coating of antibiotic ointment and change the dressing. Early treatment can keep the infection from becoming more serious.

An infected blister may be both seen and felt. An infection will be indicated by any of the following: redness, swelling, red streaks up the limb, pain, fever, and pus. Treat the blister as a wound. Clean it frequently and apply an antibiotic ointment. Frequent warm water or Epsom salt soaks can also help the healing process. Stay off the foot as much as possible and elevate it above the level of your heart. If the infection does not seem to subside over 24 to 48 hours, see a doctor.

It’s wise to keep a tube of antibiotic ointment in your foot care kit. You may never get a blood blister, but then again, you might. And if you get one, it may not rupture, but then again, it might.

It’s better to be prepared by knowing how to care for blood blisters.

 

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.

See You at Badwater?

July 10, 2010 by · Leave a Comment
Filed under: Foot Care 

Sunday I will arrive at Furnace Creek in Death Valley for the Badwater Ultramarathon. For those unfamiliar with Death Valley, it is a beautiful place. And, contrary to most people’s imagination, it is not flat.

My role is to serve on the medical team and assit the 80+ runners as they start in three waves Monday morning: 6:00, 8:00 and 10:00 AM. The route is 135 miles through the National park and into Lone Pine, before starting the long road up to the Whitney Portal. This is a very extreme event and all runners and crews have my support. They are allowed 60 hours to finish.

Here is the link to view the webcast: http://www.badwater.com/2010web/index.php

And the link for Twitter updates: http://twitter.com/adventurecorps

Catch the webcast if you can. Maybe you’ll see me. I expect to patch quite a few feet and many of my best patching jobs and the worst feet I have seen, have been at Badwater.

When I return, I will share what happened and what I learned about feet. I wish all the runners and crews a good and safe experience.

Toenails at Western StatesTo tide you over until my next post, here’s a photo that I shot at Western States two weeks ago. The runner came in for a bit of foot care and his, yes, his, toenails surprised me. I complemented him on his colors.

About

January 15, 2009 by · Leave a Comment
Filed under:  

John Vonhof brings a varied background and extensive experience to FixingYourFeet.com. This website and blogt is the synthesis of over 18 years of experience as a runner and hiker.

Over the years he has provided volunteer medical aid at numerous running events and has patched thousands of feet at events like the Western States 100 Mile Endurance Run, the Badwater Ultramarathon in Death Valley, the Raid the North Extreme Adventure Race in northern BC Canada, Primal Quest Expedition Adventure Races, the TransRockies, the Gold Rush Adventure Races, the 4 Deserts Atacama race in Chile, the Coastal Challenge in Costa Rica, the Avon Walk, and more.

This background has provided a wealth of learning opportunities for what can go wrong with feet and ways to fix them.

Having run since 1982, John discovered the challenging world of trail running and ultras in 1984. Over the years, he has completed more than 20 ultras: 50KMs, 50-milers, 100-milers, 24-hour runs, and a 72-hour run. John has completed the difficult Western States 100  Mile Endurance Run three times and the Santa Rosa 24-Hour Track Run ten times.

In 1987 John, with fellow runner Will Uher, fastpacked the 211-mile John Muir Trail in the California High Sierra’s in 8.5 days with 30 pound packs.

As the former race director of the Ohlone Wilderness 50 KM Trail Run (15 years), John worked at providing a quality event for runners of all skill levels. This run is known as one of the most difficult 50 KM trail ultras in Northern California.

An opportunity to change careers in 1992 led him into the medical field where he has worked as an emergency room technician with certifications as a paramedic and orthopaedic technician. He currently works for the Alameda County Emergency Medical Services Agency in the San Francisco Bay Area in Central California.

All Kinds of Blistered Feet

July 29, 2006 by · 4 Comments
Filed under: Footcare, Footwear, Health, Sports, Travel 

Last night I got home from the Badwater Ultramarathon. This 135-mile road race takes runners from Death Valley to the Mt. Whitney Portal at the southeastern end of California’s Sierra’s. We were treated to the beauty of the desert, especially at night. The heat you ask? The highest I heard mentioned was 123F. Of course that’s air temperature. The road, where the runners are, can get anywhere from 40 to 70 degrees hotter. I saw someone with an iron skillet sitting in the sun—waiting to fry an egg.
Dscf0060_1     Since my life revolves around feet, what did I see? Let me describe what I saw and patched. Virtually none of the 85 starters had feet untouched from trauma and blisters. The most common was toe blisters. These were most often at the cuticle of the toenail from pressure pushing the toenail back into the cuticle. In many of these, the blister lifts up the nail off the nailbed. Second most common were blisters on the heels and the balls of the feet. And finally, many had blisters extending between the toes. Toes, far and away, took the most beating.
Dscf0047     The largest was one from the base of the little toe down underneath a callus on the ball of the foot, and across the mid-foot to the other side of the foot. I could see fluid moving under the loose skin.
     Some had blood in the blister—evidence of trauma from pounding or pressure. These are particularly difficult to manage. The general rule is not to pop a blister if there is blood inside because it opens up the circularity system to possible infection. But, the runners want to continue, so you pop the blister, patch it carefully, and give them special instruction of its care.
Fixingyourfeet1_3     I patched quite a few feet and Gillian of Zombierunner.com, patched a lot too. In the coming posts, I’ll talk about some of these blisters, how to best avoid them, and how to patch them.
     As a side note, take a moment and check out my new website, FixingYourFeet.com and read about the new 4th edition of my book, titled, what else, Fixing Your Feet. If you don’t have it and you are an athlete, you need it. If you have an earlier edition, it’s time to upgrade to get all the new information and tips. After all, it’s important to keep our feet happy.

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