Filed under: blister care, Foot Care, Foot Care Products, Footwear, toenails
Next week is the Western States 100 Mile Endurance Run and all the fun and hoopla that goes with it. I ran the race from 1985 – 1989 with a best time of 24:32. It was a challenge but I had fun every year. Ever since then I have been associated with the run in some capacity and for the last 16 or so years have provided foot care help at an aid station or two and the finish line. In that time I have seen a lot of runners come through aid stations needing foot care.
This year I decided to make a list of my top 12 foot care tips for success at 100’s – whether Western States or any other 100-mile run. You don’t want feet like in this picture.
- Make sure your shoes fit. That means a bit of room in the toe box and good grip in the heel. It also means that the shoes are in good shape.
- Make sure you wear good socks. That means no cotton, but only moisture wicking or water-hating socks. If you are prone to toe blisters, consider Injinji toe socks.
- Trim your toenails short and then file them smooth so when you run your finger over the tip of the toe, you don’t feel any rough edges or points. This goes for thick toenails too – file them down.
- Reduce your calluses with a callus file and moisture creams. Trust me, you don’t want blisters under calluses.
- Wear gaiters over the top of your socks and shoes. This keeps dust and grip from going down inside the shoes and inside your socks. Understand though that the mesh in today’s trail shoes does allow dirt and grits inside the toe box, even with gaiters.
- Use a high-quality lubricant like SportsShield, Sportslick, RunGoo, Trail Toes, or ChafeX. Do not use Vaseline.
- Know how to treat a hot spot and blister between aid stations – and carry a small kit in your hydration pack. Early care is better than waiting until a blister has formed or until the blister has popped and its roof torn off.
- Just as you have trained by running and conditioning, you need to know what your feet need to stay healthy and blister-free during the race. Just as you have learned what foods you can tolerate during a race and during the heat, you need to be prepared for foot care problems. Your feet are your responsibility.
- Make sure you have a well-stocked foot care kit(s) with your crew and they know, in advance, how to care for your feet. Trailside, at an aid station, is not the time to learn or to train them what you like done.
- When you pour water over your head and body to cool off, lean forward to avoid water running down your legs and in your shoes. Getting wet feet or waterlogged socks can lead to maceration very fast.
- Consider using RunGoo or Desitin Maximum Strength Original Paste liberally on your feet and toes to control moisture from excessive sweat, stream crossings, snow melt, and water poured over your head that runs down into your shoes. Reapply at aid stations. Maceration can quickly lead to skin folds, tender feet, skin tears, and blisters.
- Finally, DO NOT assume that every aid station has people trained in foot care or have the supplies necessary to treat your feet. If you have a crew, have them work on your feet. Many times the medical personnel are backed up or dealing with more serious medical emergencies. And, truth be told, blister are not a medical emergency. Heat stroke, heat exhaustion, dehydration, and the like are more serious than blisters.
Every year I am amazed at the number of runners who are ill prepared. They put extra socks in their drop bags – that have holes in them. The have open Athletes foot sores between their toes. Their shoes are shot and should have been replaced. They have not done good toenail care. They have thick calluses. They start the race with old unhealed blisters. Their shoes don’t fit. They wear full-length compression socks and then are amazed when we can’t get them off at the aid station to work on their feet. Tight fitting compression socks may feel good but are almost impossible to get off and even worse to get back on over patched feet.
While medical people will always try to help you, we can’t work miracles with your feet when you have neglected caring for them from the start. Again, your feet are your responsibility.
Today’s post is a thru-hiker’s story about her experiences with her feet. It’s one that make you grimace when you hear the details and see the pictures. I share the story because there are lessons to be learned. Here’s her story.
“This past April, I started the Pacific Crest Trail intending to thru-hike northern-bound to the Oregon/Washington border. I’m an experienced long distance thru-hiker and frequently hike 20-25 miles without issue.
“Rarely do I get blisters, and I have no calluses. The day I started at Campo, California, I hiked a 20-mile day and was shocked to find my toe pads laden with deep blisters at the end of the day and a couple smaller surface blisters on my little toes. This is how the trip started! I did my best triage but wasn’t very familiar with how to treat such ailments, and so continued hiking.
“By the time I’d reached mile 350 on the trail, my feet were an absolute mess. Blisters had become wounds, wounds became infected, toenails were falling off and each foot was severely compromised. At one point I sat on the edge of the trail so frustrated I was in tears! What was wrong with my feet?
“Only after my feet got good and angry did I switch to a larger size shoe in hopes of accompanying the swelling. I think one of my mistakes early on was that I used gauze and Neosporin along with athletic tape and made mummies of the feet. Add to this 90-degree heat through the desert and my feet looked like big balloons, which barely fit in shoes. They were so painful that one day while walking, I took my socks off to give my feet more room. That caused heel blisters. But aside from cutting the sides out of my shoes, I had no other choice. I was in a remote area hardly able to walk despite taking NSAIDS.
“After I hit Big Bear Lake, I rested for 4.5 days in hopes of curing my issues. When I set back out on the trail I switched to Altra Olympus 2.0, in a half size larger than normal (for swelling issues) since they offered more cushion. I hiked for two days, but my feet were not healed all the way and I suffered terribly during that timeframe. Blisters popped up in places they’d never been, likely because my gait was compromised and I was still in pain. I was finally able to hobble down to a highway and hitchhike to a town where I put on flip-flops, rented a car and flew home.
“I’d never had these issues before in all my years of long treks. When I got home, I started researching foot care online and came across your book, which I downloaded. I read it cover to cover and feel it’s the part of the puzzle that I never knew I needed and also, the solution moving forward. I’m following your advice with the tapes and have been practicing with bandaging as you suggest, including the betadine prep and a dab of zinc oxide on the new recovering skin. I also purchased some powders and lubes and will take the whole shooting match with me when I get back out on the trail.
“I’m also trying Injinji liners to see if that helps, although my feet aren’t particularly sweaty. I believe that the deep blisters in my toe pads were due to the heavy water weight I had to carry through the desert, which was different than how I trained since I underestimated how much water I’d need in such a harsh environment. I did wear trail gaiters, but my shoes were Altra Lone Peak 2.5’s and they allowed dirt to come in. There was a lot of abrasive mica in the desert soils and it’s hard to keep feet clean with little water available. I used wet wipes but it was still hard to get the grit out. My pack’s base weight is very low at 14 pounds, so I’m doing everything I can to keep the pack as light as possible and have lots of experience with backpacking. Nothing else hurts – no hip, knee or ankle pain – just these silly feet.
“I did not make any changes to my shoe or sock choices before starting. I used the same combination I’ve used for years without problems. Things I did not do which I probably should have: take more breaks, start out slower and not push huge days, wipe my feet off several times a day with wet wipes, change socks more frequently, stop more for hot spots, listen to my body, and take preventative measures to not get blisters.”
I initially asked the thru-hiker my usual questions. Did you change footwear, socks, conditioning, etc? Were you wearing good socks? Was the weather a factor? Do you wear gaiters? Do your shoes/boots have a mesh upper that allows grit and dirt inside? It sounds like your feet rebelled at what you wanted them to do. We traded emails several time with her providing answers and my giving suggestions.
The lessons I mentioned at the start of the post? Here are a few that pertain to thru-hikers, hikers in general, runners, ultrarunners, and adventure racers.
- Know your event. Carrying extra water, food, and other supplies in a weighted fannypack, hydration pack or backpack can put extra stresses on your feet.
- Know any possible weather issues. Heat, rain, and humidity can all cause problems.
- Know any possible trail/road issues: water, stream crossings, desert sand, grit, and rocks.
- Know about any special accommodations necessary for like swelling feet, and grit or sand getting into your shoes’ mesh uppers.
- Know what to do when you have problems with your feet and have the supplies to fix them. Practice ahead of time to refine your skills.
- Know how to get your blistered feet back into hiking/running condition.
A month ago I wrote a blog post about two multi-day races in Europe that are implementing a triage system for medical care at aid station – the outcome of their being overwhelmed by the amount of treatment and time that their participant’s blistered feet were requiring. Here a link to that post about Providing Foot Care for Athletes.
In this post, I want to expand on a quote from their website that I included in the original post. It was about the 6Ps of foot care.
They stated that foot care is easily divided into several phases, what they call the 6Ps: “Proper Preparation Prevents Piss-Poor Performance” and provided a thorough list of preparation, prevention, assessment, and treatment suggestions. “Proper Prevention” means in the months before the event, “Prevents” means during the race, and “Piss-Poor Performance” is what happens if you fail to follow the first three Ps. Let’s talk about these one-by-one.
Proper Preparation – In the months leading up to your race, and even race to race, you, and you alone need to be responsible for learning proper preparation. You need to learn how your feet respond to being wet and maceration starts, to being in sweat soaked and dirty socks, and when your feet are caked with dirt and grime. You need to learn about the best lubricants and/or powders, and insoles. You need to learn what causes the hot spots and blisters and what steps you can take if or when they develop. You need to practice taping or whatever strategy you plan to use. This is your job – not your crew’s job – and not the medical or non-medical people at aid stations.
Prevents – You need to know what to do when you develop hot spots and blisters, and have the materials and tools, and even more importantly, the skills, to fix your feet. This focus on “prevents’ needs to happen in the months before your race and during the race. It’s about proper toenail care, skin care, callus reduction, shoe and sock selection, whether to wear gaiters, preparation for a variety of weather conditions, and of course, putting the required and necessary training miles on your feet. This also is your job – not your crew’s job – and not the medical or non-medical people at aid stations.
Piss-Poor Performance – This is what can happen when you fail at any of the first three Ps. Your performance suffers. Your race may be over. In many races, medical volunteers will try and help patch your feet. Some races do not have the luxury of dedicated medical volunteers for all the aid stations, much less the finish line. You cannot and should not count on a race having medical personnel to help with your foot care needs. Just because there is a doctor, nurse, or EMT at an aid station, that doesn’t mean they know how to patch feet. You cannot and should not count on races to have the foot care supplies that you want for your feet. If you will have a crew, work with them so they know how to work on your feet with your supplies.
Some runners may feel I am being too harsh as I tell you these are your responsibilities. Let me share a story from years ago. In 1985 I ran Western States for the first time. After crossing the river at Rucky Chucky, I had blisters in the arch of one foot. Someone at the far side offered to help patch my feet. After lancing the blisters, I had a wad of gauze taped to my arch, which changed my gait. I finished the race, but learned a lesson. The treatment, while well intended, was not the best for my foot. I learned to take responsibility for my own foot care. For the next three years running Western States, I managed my feet – and I’m sure that experience helped fuel my interest in foot care.
So my point in expanding on the 6Ps in this blog post is to reinforce the notion that foot care of your feet is your responsibility. If there are medical volunteers at a race, and they know how to patch feet, and have the supplies – and the time, consider yourself fortunate – but don’t count on them being there.
Please feel free to agree or disagree with my position, and share by commenting below,
My October issue of Backpacker magazine featured an article about Bil Vandergraff, a Search and Rescue (SAR) Ranger. He served as a ranger for 25 years in the Grand Canyon backcountry. In the article he shared tips on surviving in the backcountry – especially in the harsh and unforgiving Grand Canyon with its heat and extreme elevation changes.
His tips on dealing with the heat are right on: wear the right clothes, embrace the sweat, go slow, stick to mornings and evenings, and know when to stop.
He stresses the importance of helping yourself and to study up – studying the route and conditions.
The one line that struck me was this:
“I don’t take care of blisters. I refuse to. If you can’t take care of your own blisters then you don’t belong in the canyon.”
Wow. I like that.
That same philosophy could be applied to runners, adventure racers, hikers – in short, anyone venturing into the outdoors on their own. Badly blistered feet can stop you in your tracks, can make it hard to climb out of the Grand Canyon, or off a mountain or out of any trail.
Can we apply that to races too? That’s a hard question. A huge question!
If a race has crew access, should the crews be responsible for foot care? Some races don’t provide specific foot care. Others have it in limited form based on whatever foot care knowledge any aid station volunteers or medical personnel may have and based on whatever supplies they have.
I know that at some ultras and adventure races participants will move along the trail from aid station to aid station, and at each one, require some degree of foot care. What was patched at an earlier aid station didn’t work or didn’t hold up. And they want someone at the next aid station to redo their feet. That’s a lot of work and a lot of supplies.
What compounds this question is that many athletes fail to do what SAR ranger Vandergraff stressed, helping yourself and study up. Anyone who has worked an aid station knows full well that many of the participants fail to take care of their feet to start with, fail to trim toenails, fail to reduce calluses, fail to wear the right socks, fail to wear gaiters, fail to replace worn shoes, insoles and socks, fail to learn how to do self-care, fail to educate their crew on good foot care techniques, and fail to have adequate foot care supplies. So then, when they run into problems, they want help. Their failure to plan, and in many cases, take common sense action that could have prevented or reduced the problem, then creates work and expense by others.
I remember an old quote by Benjamin Franklin, “If you fail to plan, you are planning to fail.”
Many events would see their finishing rate drop dramatically if they eliminated foot care. There is a definite need for medical care to ensure that participants don’t get into trouble that could cause them serious injury or bodily system failure – but is foot care one of those?
I’ll repeat Vandergraff’s statement. “I don’t take care of blisters. I refuse to. If you can’t take care of your own blisters then you don’t belong in the canyon.”
Again, can we apply that to races too? That’s a hard question. A huge question!
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.
Today’s post is long, but illustrates a valuable point. The Facebook post below started a long chain of responses – all suggestions on what the poster could do to eliminate her blister problem. There were a total of 64 responses. Let’s get right to what was initially posted.
Original Facebook Post
So some of you may remember the nasty blood blister I got during Boston in 2011. I am very unhappy to say I have another one as a result of yesterday. Today I will be doing a GREAT amount of reading on not only how to treat but prevent this from happening again. My next long run is 20 miles. I think that moleskin is going to become my new best friend for EVERY long run.
I use Sportslick and only wear Wright socks (thin, double layer) for long runs. For my last Ironman I put anti-perspirant on my feet everyday for a week before the race. I got no blisters. Good luck!
Soldiers have been known to wear panty hose footies during marches. And tape every hot spot.
Going to look up mole skin because since I lost 90+, my sneakers were huge on me and I didn’t realize it so after the bursitis incident I walked a few miles and had horrible blood blisters that were UBER painful. I applied Band-Aids the next day and kept hustling… moleskin eh? Thank you and healing love to your blisters. They hurt!
May be time to re-evaluate your shoes. I got a whopper this summer after a 20 miler. My inserts in that particular pair of shoes were causing me to run a little odd.
Moleskin! I used it with any shoe that pinches or rubs, especially heels. I found cleaning my skin with alcohol first helps it adhere the best and stays even after taking showers!
If you have sweaty feet be warned moleskin can be sweated off. It is probably the best out there though to prevent blister. If it gets rolled or folded it can make the problem worse.
I use Sportslick and wear Wright socks as well. No blisters as of yet. It got me through my first marathon with no blisters and it rained that day and my feet were soaked. It didn’t do much for my bruised toe nails though lately I have been using Monkey Butt” anti-chafing powder when training for triathlons. Have had great results with this product with my bike shorts. But for feet, I would recommend Sportslick as it is a thick petroleum based ointment. Best of luck! And remember, one foot in front of the other. It doesn’t have to get any more complicated than that!
New shoes may also be the answer. I switched from running in Nike Air Pegasus years ago to Mizuno Wave Riders with little to no blistering. Turns out I needed a narrower toe box and the Nike Pegasus toe boxes would stretch a great deal over time.
Research socks and use a Bodyglide type product .
I have hyper mobility in my feet. I was using Sauconys. Horrible foot pain. Got some Mizuno. Best shoes ever! I can run without pain!
I use anti-perspirant and change my socks every 5 miles .
Try Balega dry fit socks. I NEVER get blisters anymore and I’ve completed two marathons and two Ironmans in them. Used to get blisters all of the time before I switched!
Mizunos + Bodyglide + a great fitting pair of socks = No blisters… ever again!
I get the cheap Monistat anti-chafing cream and put that on my blister prone areas, and it works perfect!
My latest blood blister peeled off the end of my toe just this week! I had a little party!
Have you ever tried Smartwool socks? They are pricey, but worth it. I haven’t had a blister since I started wearing them on my runs .
We always wore two thinner pairs of socks in high school if we had history of blisters… one pair inside and it worked like a charm.
Inside out [socks].
Here’s my 2 cents! I keep my toenails as short as I can handle- short! Smear on some Vaseline between my toes wear the same brand of sox and so far so good.
Moleskin is amazing, and glide works well too. I have heard if you’re in a pinch use deodorant where there is any friction.
In the years I have done marathons/half marathons, I find that having the right shoes, using wicking socks (I too use the Wright socks), and use talc/baby powder in between my toes I do not get blisters.
I gave up on running because of constant and ongoing blisters, I tried several shoes etc nothing helped, I loved running but those blisters were so painful, what is moleskin?
Totally agree with Smartwool socks. They rock.
Try Nuskin. I have a friend who is a marathon runner and this company is her sponsor. Supposedly very good!
Love moleskin! I get wicked blisters without it and none with it. The stuff rocks! Superb for healing blisters too!
Military uses just basic slip on panty hose/dress socks especially with long hauls when carrying 80+lbs in the desert – it works and it is cheap.
Mole Skin and my hiking boots = Love.
Panty hose and then socks over?
I swear by these don’t know if you have used/seen them – Nike Elite Anti-Blister Low-Cut Tab Running Socks.
I spray my feet with Trislide if I start getting any rubbing in my shoes. I can run barefoot and not get a blister no matter how long I go.
SUPER HELPFUL! OKAY NOW FOR TREATMENT FOR MY EXISTING BLISTER? IDEAS? I HAVE RUNS THIS WEEK.
There are lacing techniques that you can try to that help prevent this – as with some of the other comments; you may need a different shoe or sock. I’m sorry, that’s such a pain! I recently switched from Saucony to Mizuno’s & have had a really great experience so far.
Try the book Fixing Your Feet by John Vonhof. We ultra runners swear by this book.
Yeah I do believe my Saucony Kinvaras are out for this very reason. Both times I wore them – in Boston and again yesterday it happened.
The best stuff for blister is Compeed. It is now sold by Band-Aid as Blister Band-Aid and still says Compeed on the box. You can put over the blister and still run without feeling anything. I always carry with me on races. Just in case!
To heal the latest blisters I had to pop them as they were so big I couldn’t put shoes on. Then I cut the size of the blister out of the center of the moleskin and place it over/around the blister. Kept blister clean and voila, perfectly fine that night!
Yes – pantyhose and then socks over – they glide and no friction in between skin and toes.
I play hockey and some girls get the worst blisters from skates. It was actually a doctor on our team that recommended using duct tape! It does work better than moleskin and with good socks. This is at the stage where you are getting irritated in a certain spot, not of course after the blister has formed!
I second the double sock and panty hose method. I actually found ones you wear for ballet flats very helpful. Not sure how they would do on long hauls as I was a short and medium distance sprinter. Cheap and easy.
I have ran a ton of marathons and have stopped getting blisters when I purchased a good pair of socks and bought my shoes a size and a half bigger. So one good sock and big shoes = happy feet.
What you are describing sounds like poorly fitted shoes to me. Make sure you get fitted a good running shoe store, and tell them up front that you have a problem area. A good running shoe fitter should be able to fix the problem.
Knee high pantyhose along with powder maybe but the pantyhose should protect your feet from the friction.
You need to check out Incrediwear.com – they have the best socks for runners. My husband does marathons and I’ve recently started running myself. There is no question our feet don’t hurt and they wick away the sweat. They are made with bamboo charcoal and they increase blood circulation.
Wright socks!! I get them sometimes. But I wear Vibram FiveFinger shoes. And any other running shoes I have are minimalist shoes. So not socks… But if you do wear socks. Get some 2-layer Wright” socks! They are awesome. Or an old army trick. Wear nylons/knee highs under socks.
You are not supposed to pop blisters ever. If they pop on their own fine. But I would cover it up with something like the moleskin or a blister Band-Aid and wear good socks and shoes. I like the knee-high panty hose idea. Good luck & feel better!
I hate to hear that girl…I run in Asics, and those socks I told you about and have never had a blister…sorry feel better girl!
I remember that blister because I had an awful one at the same time! I finally stopped getting them when I went to a actual running store, they fitted me with a pair of Sauconys with a wide toe box and laced them just from the middle of the shoe and up. In all the miles I ran after that never got another blister and my black toenails grew out and had no more problems with that either! It’s the wide toe box that saved my feet.
If the blister is open, use vitamin E oil on it at night. Air it out as much as possible. If the blisters are so large you can’t wear shoes, take a cleaned (alcohol) safety pin and drain. Don’t tear skin off. It is best not to pop but sometimes it’s needed. Motrin for the pain may seem extreme but if you r in so much pain and start altering your stride you’ll get even more blisters.
Try Second Skin. It works very good for soldiers. In two days your feet will be like new!
I never got blisters-and i used to run 65 miles a week. My trick was either Thorlo socks, or wearing two pairs of snug socks. And wearing shoes that were a full size larger. My favorites are Kswiss performance. When running distance, your feet swell so much, you need the space to be able to accommodate it.
Vibrams! They literally took away all my feet problems, including blisters. I love them.
Essential oils are helpful for treating the actual blister. Lavender and tea tree (also called Melaleuca) will help it heal. Apply 2-3 drops of each every couple hours – or when you think of it really. I hope it feels better… they are nasty.
I grease my toes and footpad down with simple cocoa butter Vaseline before any run or distance walk! Haven’t had a blister since! Took a couple times to get used to the immediate feel, but now a year later with no blisters, I hardly notice I’m doing it any more! It’s cheap & simple! And, foot fitting socks! I have my favorite kind that I own multiple pairs of, got them at the local Fred Meyer!
I do the same for long runs. And sometimes baby powder to. Helps with the moisture.
After all 54 responses, I had to weigh in. Here’s what I wrote:
As the author of Fixing Your Feet, I’ll comment that some of what has been suggested here is good but some is not what I would recommend. There is no “one right” answer to the ago-old blister problem. There are many causes and many answers. Try some and find what works for your feet. What’s important is fit, socks, trimmed and filed nails, reducing calluses, and a high-quality lube if needed to reduce friction.
Later, I emailed Jenny and based on what she described and the picture of the blister, here is my response to her.
Let’s talk treatment first. Because it’s a blood blister, I’d try to keep the roof intact. If it opens, your circulatory system is open to possible infection. I lance them, but I am used to doing that, and give the athlete a lecture on infection. Generally if you soak your foot in warm/hot water with Epson Slats, several times a day, the blood and fluid will be reabsorbed – and the blister will harden. Over time, after that, the top layer of skin may slough off but by then, the possibility of infection is over. Start there. If the blister ruptures, make sure you use an antibiotic ointment and keep it covered. Signs of infection are redness, heat, swelling, pus, pain, and streaks moving up the foot. That becomes serious. Make sure your Tetanus shot is up to date (usually about every 8-10 years).
As far a prevention goes, here are a few thoughts:
- I think I see the edge of callus at the forward edge of the blister. I don’t like calluses. Try and reduce any you might have.
- Do you have bunions? If so, that changes a few of my ideas.
- I’d guess that you have a shoe issue (meaning fit). If you have wide feet, or the shoes you wear are too narrow, you’ll have these problems. I read you wore the same shoes both time this happened. That’s a good sign you don’t have a good fit. A better fitting shoes could solve your problem. Can you get fitted at a good running store?
- Something else I see is that the bottom edge of the blister is right at the edge of where the insole hits the side of the shoe. This again gets to the issue of fit. There is pressure there, creating friction, that cayses the blister, that builds from this bottom edge upward.
- One option is to protect the area with a strip of tape. Duct tape isn’t the best, but would work. Don’t use white athletic tape. It won’t stick. I prefer Leukotape.
- You could cut a horizontal slit in the side of the shoe over the pressure point.
- I hate moleskin and never use it. It does not stick well, does not conform to the shape of the area, and is too thick. Stick to tape. The ONLY kind I would recommend is Profoot Velvetex Moleskin (available on Amazon).
- Only wear moisture wicking socks.
Something to understand, that I preach all the time, is that what works for one person will not necessarily work for another. That goes for socks, shoes, lubricants, powders, etc. We each are an experiment of one and need to determine what our feet need. Keep me posted.
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.
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.
One of my goals is to educate athletes about good foot care techniques. You may recall blog posts where I stress the importance of knowing how to do foot care and importantly, to know what’s best for your feet.
I recently received an email from Rob, asking for some advice. Here’s Rob’s email:
I have been running a modest 30 miles a week for a few years. Last weekend we attended a tennis camp and during the first night of drills during ball pick up (not during a drill or competitive play) another player smacked a ball in to the arch of my foot from a shot distance away causing severe pain. I played through the pain and the next morning I asked the trainer to tape up my bruised arch, which she did. I played all day and at the end of the day there was a blister in the center of my foot between the taped and un-taped area. I went back to the trainer in the morning and she created a donut shaped pad about a 1/4-inch thick and taped it to my foot. I took out my shoe arch supports and played for another 1/2 day in a bit of pain. When I took off the shoe, sock, and bandage and pad I found that the blister had filled with liquid to the size of donut hole – now a huge blister about the size of a silver dollar and 1/4-inches thick. The camp staff took picture as the biggest tennis-related blister they had seen. I went back to the trainer at the college and she drained about half of the liquid out of the blister and we decided I was done playing tennis for the rest of the camp. I’m not sure going to the trainer really helped and I probably should have had your book along as reference and taped myself up. Now I am back home and have a huge blister on the bottom of my foot.
This is a case where the trainer patched Rob’s blister the best way she knew how. It was an “old-school” patch job. A piece of moleskin cut in a donut shape with a hole in the middle for the blister. There may have been Vaseline on the center, and then tape or gauze over the top.
The problem with this old-school method is that it adds bulk to the foot – that can easily alter the person’s gait. This gait change can lead to further problems. At the same time, the patch can cause irritation, expanding the original blister or leading to new blisters.
Rob’s experience shows there is a long ways to go to get everyone up to speed about good blister care. I’d bet that if Rob had been prepared, he could have done a better job then the trained did. It’s hard to go everywhere with a blister patch kit in hand, but here’s my recommendation. Make up several simple kits and put them in Zip-Lock bags and stash one in your car and another in your gear bag. Fill the kits with your choices of blister tapes and patches. Then of course, make sure you know the best way to patch any blisters that may develop.
Here’s where to start – pages 228 to 256 in the 5th edition of Fixing Your Feet. If you don’t have a copy, or have an old edition, my suggestion is to get the new one. My home page has a link to Amazon if you need one. I was amazed at Badwater in Death Valley a few weeks ago. One of the runners had me autograph a copy of the 2nd edition. So much changes from edition to edition that it’s a small price to pay to help your feet.
I just had to share this photo. A few weeks ago I worked at the 21-mile aid station at the Oakland Marathon, which was also the eight-mile aid station for the half-marathon.
Back in the 80’s I ran the old Oakland Marathon and after a few years the event died. Then three years ago, Coorigan Sports took resurrected the run.
So on a Sunday morning, we set up the medical tent. It was me and six nurses from the Alameda County Medical Center. We stood outside the tent and watched the runners and walkers coming by.
I brought my foot care kit in case a runner needed help. I actually got quite a bit of business. The usual hot spot and blister care.
Then a young lady stopped. She wanted a blister patched.
She was wearing two pairs of socks. She took off her socks and I made the necessary blister repairs.
Then I helped put on her socks. Look closely at this picture and you’ll see the the threadbare sock under the ball of the foot. The rest of the bottom of the sock is so thin you can almost see through the fabric.
I told her she needed to toss the socks and gave her a few tips on socks.
It bothers me to see runners and walkers spend money on a race, wear good shoes and the right running clothes, and forget something so simple as a good pair of socks.
Please, take a minute and check your socks. If you have any like this, toss them.
You’ll be doing yourself a favor.