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.
Making a Foot Care Clinic video is one of my major objectives for 2012. I had the whole project laid out and wanted to know what others wanted to learn. Of course, I have my own ideas of what to teach, but I value the input of others. So a while back, I asked for suggestions. Here a summary of what I received.
Three Topics – I can think of 3 video topics that I would like to see covered. I’m always referring runners to your book. My experience at aid stations and answering runners’ questions tells me there are many runners that neglect basic foot care. While many runners are expert at caring for their feet, there are also many that are getting by but with the grace of God. I think a video as basic as demonstrating foot washing might be needed.
1. The Daily Routine: What the ultra runner should be doing every day to keep feet healthy and race ready.
2. The Race Routine: Preparing feet race morning or the evening before.
3. Race Emergencies: The emergency race supplies to be carried or stored in drop bags that allow the participant to be independent and successful with race foot care. Include special weather conditions. ~ Todd Baum
Blister Care – Definitely blister care, small ones to the nasty, start to finish when athlete rolls in, hows its done, tools, tricks, when to leave them alone, when to advise them to consider oh no stopping. ~ Wayne Kehr
Toe Blisters – I’d like to see a picture of toe blisters and how to tape them. The tape always seems to fall off from the toe, especially if it is the little toe. ~ Kris Martinovich
Taping – Taping would be #1–preventative. Various shoe lacing techniques to reduce pressure on tender top of the foot (skipping holes, etc.) would be helpful for hikers. ~ Susan Alcorn
Blister Popping – I’d like to see the correct way to pop a blister. ~ Patricia Carroll
Callus Care – I would very much like to know the proper treatment for reducing calluses on the ends of my toes and the balls of the feet. I’ve tried scraping, cutting, and the Ped Egg, no luck, they keep coming back, and they hurt. ~ Margie Withrow
Hydration – A section explaining why managing hydration and electrolytes can help avoid issues in the feet! ~ George Miller
Toenail Care – How about proper nail trimming and filing of the nail tip “forward” so there is no ridging to catch sock? ~ Rocky Shon
Taping, Blister Care, Toenails and Calluses – I really love the idea of a Foot Care Video. Obviously, as you mentioned, various taping techniques are a “must” when it comes to the content. I would also like to see proper treatment of blisters both on the trail and after the run at home. Another topic could be best preparation of toenails as well as calluses for ultra events. I am sure that you had those topics already on your list, but I just wanted to make sure that they are indeed covered. ~ Harald Vaessin
Specific Taping Techniques – I’d opt for some demonstration of how to properly tape one’s feet with Leukotape. I taped some sore areas early on the John Muir Trail last August, found I couldn’t remove the tape a couple days later and ended up tearing, cutting holes in my toes to get the damn tape off! I successfully completed the trail in 17 days but did suffer because of my apparent taping errors. ~ John Cusick
Plantar Fasciitis – Information on how to deal with plantar fasciitis. ~ Ed Werner
Honestly, a few of the ideas were ones that were not on my list. I envision this as a tool to teach athletes stuff that is hard to describe in print. Taping is a prime example. It’s hard to fully grasp the concept of taping toes without a series of pictures. That’s where a video will shine.
As this project evolves, my readers will receive updates and will have more opportunities for input. If you have not sent me you idea and want to be heard, please comment below.
This guest post comes courtesy of Alene Nitzky, Ph.D., RN
I ran Badwater as a rookie in 2008 with two years of crewing and pacing experience and several training runs across the valley. I’d never had foot or stomach problems before, but in the race, I suffered from an array of the usual problems runners have there: blisters, swollen ankles, not peeing enough, vomiting, nothing tasting good, and not getting enough calories.
While working on the medical team at Badwater in 2009 and 2010 and watching runners in some of the hot weather races I’ve run, I noticed the difference between runners who took cool down breaks and those who didn’t. Some dunked themselves in a cooler of ice water; others stopped and sat down in the shade of the van or sat in the air conditioning of the vehicle, while others seemed to reject the idea of stopping at any cost, as if it were a 5K road race.
What I also noticed were the number of runners who came to us in Stovepipe Wells, in various stages of dehydration and heat exhaustion, and the amazing turnaround they’d experience by spending an hour inside the air-conditioned medical room. They’d come in unable to urinate, nauseated or vomiting, unable to keep down any food or fluids. They’d lie there on a cot while their crews watched them anxiously.
We didn’t have to do too much for most of them. They’d cool off, sip fluids, and soon they’d be jumping up to urinate, the nausea was gone, they kept food and fluids down, and were on their way with their relieved crewmembers. Most of the time we wouldn’t see them again until they were at the post-race party being recognized for their finish.
What was happening?
Most of your blood flow goes to your skin and major muscles while you’re running in the heat. That means little blood is available to the GI tract, kidneys, and other organs. Low blood flow can rob these organs of oxygen and nutrient-carrying blood and make it hard to digest food and process fluids. This can lead to the puffy hands, bloating, sloshy stomach, nausea, and vomiting, and blistering, especially if you’re not getting enough sodium.
By taking a break, you allow some of the blood to be returned to the organs that allow your normal functions to resume. The blood flow that was going to your skin to keep you cool can go to the kidneys and GI tract again, so you process the fluids and start urinating again.
Here’s how I avoided a downward spiral?
Hydration and electrolyte replacement
I experimented with different products for electrolyte replacement. The one I used in 2008 didn’t have enough sodium for the extreme heat of Badwater. In 2011 I used S caps. I had tried them in the heat and humidity of Florida and South Dakota and they worked. I watched my hands for swelling routinely, made it a habit to look at my hands every time I got a new water bottle. If I was puffy, I had to think about what was happening. Usually it happened in the evening as the temperatures cooled down, when I needed less sodium. Then I’d back off. I also noticed that when my hands were puffy, my feet hurt more because they were swelling too.
Cool down breaks
I thought, it makes a lot more sense to take cool downs BEFORE you get overheated. I began trying this in my training. I’d sit for 10 minutes, put my feet up, put a little ice on my neck and legs, and soon, food started to taste better. When I got up to run again, I felt fresh.
I planned 10 minute cool down breaks every 60 to 90 minutes in the stretch between Furnace Creek and Stovepipe Wells. This year it was a lot cooler than previous years, and I often felt like I didn’t need it, so I’d go 90 minutes, but then I made myself stick to my plan. I used these breaks to my advantage to elevate my feet, check my tape, shoes and socks for moisture, get some calories in, and drink more. I had ice wrapped around me in a towel, on my neck, armpits, and thighs.
When I’d get up I usually needed to urinate. Then I’d get moving and I felt fantastic. I ran a lot more of this stretch than I anticipated, and even got into Stovepipe well ahead of my predicted time. The time I spent cooling down paid off.
Learned to work on my own feet
In 2009 and 2010 I watched Denise and John working on runners’ feet as they came in. Ugly, painful blisters, big chunks of skin peeling off their toes and heels. So many of the runners’ feet looked wet, like they’d been taking a bath.
I got a copy of John’s Fixing Your Feet book as soon as the 5th edition came out. I began doing my own weekly pedicure sessions, soaking my feet, working on reducing the calluses. I practiced the taping techniques John shows and found one that works for me. I built a well-stocked foot and first aid kit so I’d have everything I needed. And I kept my feet dry on the run.
Despite over a dozen “foot checks”, cool down breaks, and a few naps, I still managed to better my time from 2008 by over an hour and a half. I was extra cautious with my feet this time because I knew that in order to turn around and run back to Badwater, I was going to have to have my feet intact. On the way back, I followed the same strategy.
When I arrived at Badwater, after 270 miles, the only blister I had left was the one I had at 80 miles. Other than the general soreness that comes from 5 days of running on asphalt, the blister wasn’t really an issue. I used only two pairs of shoes, one for the race and one for the return trip. I never had to go to a larger size because my feet stayed dry and my feet didn’t swell much.
I thoroughly enjoyed my double and ran comfortably the whole way. When you take care of the basics like feet and hydration, everything else tends to fall into place.
Alene Nitzky, Ph.D., RN lives in Fort Collins, Colorado. She has been running ultramarathons since 1991. Check out her blog Journey to Badwater.
Alene Nitzky is a veteran ultrarunner from Colorado who two weeks ago completed Badwater, and then turned around and made it a “Badwater Double” – going back on the course to the start. She had successfully run Badwater before and spent several years working on the medical team. Her Double this year was a success in many ways. Her stomach held up well and her feet cooperated. Here is a report from Alene’s blog about what worked for her feet.
You have to remember that whatever is going on in your hands is also going on in your feet. Avoiding the swelling that comes with fluid/electrolyte imbalance means your feet are not going to swell causing friction against your shoes, the layers of skin and tissue in your feet are not going to swell and separate, which means you avoid blistering.
My biggest problem in 08 was the blister under my left foot. I had a blister in the same spot but over the past year I read John Vonhof’s book Fixing Your Feet and learned how to tape properly, and how to reduce the callus in my problem areas. In 08 the blister was so deep John was unable to drain it with a scalpel, he taped it the best he could to prevent further blistering, and the blister finally popped from repetitive trauma on it’s own at mile 127, which hurt like hell.
This year, it was easy to access the blister pocket and drain it, which was much less painful and much easier to manage. Other than that blister, I developed only a few small, minor blisters, which I was able to easily drain as soon as they developed, and they never became a repetitive problem. At the end of 270 miles, I only had one blister left, the big one under my foot, which didn’t get any worse after 80 miles.
Keeping your feet dry is another requirement. Checking your feet for moisture is critical. I use Drymax socks exclusively and they do very well, but no sock is blister-proof. There are seams, movement in the shoe, and moisture builds up eventually no matter what sock you wear.
Changing your socks frequently is important, and you have to be very careful not to disturb your tape job. Don’t let your crew mess with the lacing on your shoes or pull your socks and shoes off unless they know exactly how to do it right. The runner is better off doing this is they can.
Speaking of shoes, I run in Brooks Addictions and I used only two pairs of shoes, one during the race and the other on the return. I never needed to change shoes or go to a bigger size because my feet never got very swollen and they stayed dry.
We can learn from Alene did. She gets five starts for a well planned and executed race. She ran a good race and with her insights from running it in 08, and years of working on the medical team, she put what she learned into effect. Her Lessons Learned blog post contains great information on hydration, food choices, stomach, and more. I encourage you to check it out. Congratulations Alene on a successful Double.
If you don’t have a copy of Fixing Your Feet, check it out at ZombieRunner.
Disclosure: I have an affiliate relationship with Zombierunner.com and earn a few pennies when you buy though this link.
This past August I worked on the most horrific heel blisters I have seen in over 13 years of doing foot care. The event was the running of the Gore-Tex TransRockies Race over six days in the Colorado Rockies. The daily distances ranged from 13 to 24 miles. The course was over trails and fire roads and many were steep. It was not a particularly wet course.
While there were many other blisters, heels and toes and ball of the foot, the heel blisters on many of the runners were impressive. In this first picture, you can see how the forward most edge of a blister has torn and opened up across the whole bottom of the foot.
Looking closely, you can see that the blister’s roof is thick, at least four layers of skin. It doesn’t mean that this is a blister under a callus. The second photo from a different angle allows you to see the blister covers the whole heel, side-to-side and to the back of the heel.
Up to that point, I had only seen this type of blistering on one runner. That was during the 2008 Badwater race in Death Valley. I attended to him at mile 21. He had bilateral heel blisters as shown in these photos. His history was interesting in that he had vacation in Tahiti on the beaches and just before Badwater had hiked down and back up the Grand Canyon. I theorized that the rough sand coupled with the heat on the beaches, followed by the friction of the steep ups and downs of the Grand Canyon, made his heels susceptible to blistering on the hot roads of Badwater.
Then I saw not one runner at the TransRockies, but more than 15 runners with these same blisters! The blisters were on men and women, of all body weights, and of all running speeds. They even affected a few of the race leaders.
The third photo shows a heel blister that tore on the side of the foot. I removed the torn skin because of the condition of the torn part. Leaving it on would have not provided any protection.
At the TransRockies, I talked to David Hannaford, a sports podiatrist from California who was running the race. He speculated that the footwear or the insoles could cause the heel blisters. My feeling is that the blister formed deep under several layers of skin due to a combination of steep downhill running and pressure/friction created when the runner landed on his/her heels. As the runners ran the steep downhills, with their full bodyweight landing on their heels, the added pressure and friction led to the blisters forming deeper then normal. While the coarse was not unusually wet, the feet have hundreds of sweat glands and the sweat typically generated while running could have also been a contributing factor. Many of the runners had these blisters bilaterally on both heels.
The next time I see these blisters, I will ask the runners what type of socks they were wearing. Socks with less moisture control will trap the wetness under the foot and can contribute to softened skin and blistering. I will also look at and feel the insoles. The surface fabric of some insoles is rougher than others and might be another contributing factor.
A good question is why some runners had these heel blisters and not others. It cannot be narrowed down to one thing. Here are my thoughts on possible contributing factors:
1. The steep downhills
2. The shorter day’s distances meant that runners could run fasted than those doing longer races, meaning the downhills were run faster
3. The type of socks they were wearing
4. The surface of their insoles
5. How they landed (heels versus more on the whole foot or forefoot)
6. How much their feet sweated
7. Any pre-existing conditions as calluses or new skin under previous blisters
8. The fit of their feet inside their shoes (allowing extra movement)
9. The use of a lubricant on their feet, which can lead to softened skin
10. A lack of training with enough miles on the feet to warrant running such distance on a back-to-back daily basis
So there the 10 factors I feel could cause such extreme blisters. As you might guess, any one, or several, of the above factors, could have caused these blisters. One person could have been affected by factors that did not affect another runner. Several of the factors, such as numbers 1 and 2, were more than likely factors in a majority of the cases.
My next post, Part II, will detail how I managed the blisters and show photos of the process of patching them, what I learned and how I would manage them the next time.