Consequences of Wet Feet at a Dry Western States!  

July 4, 2015 by · 6 Comments
Filed under: blister care, Foot Care, Footcare, Footwear 

Last Saturday was the Western States 100 Mile Endurance Run over the California Sierras. As you probably know, California is in year four of a severe drought. Most of us expected the trails to be dusty and dry. From everything I heard, they were.

So in a dry Western States year, why did so many runners have macerated feet from being wet?

So in a dry Western States year, why did so many runners have macerated feet from being wet? Click To Tweet

There are several reasons. First, runners often cool themselves off by pouring or squirting water over their heads and on their body. We all know water runs downhill – right? So the water naturally runs down the legs and into the shoes. Socks become wet and as I often say – the skin of one’s feet prune up. In other words, they look like a wrinkled prune. Better to bend at the waist and let the water run off the head and shoulders rather than down the body.

Secondly, runners sometimes cool off by getting into the water at any stream. Several runners talked of sitting in the streams. While this can cool the runner, it is the worst thing a runner can do to their feet.

When they remain wet long enough, the skin becomes soft, often creating creases. Many times these creases are deep and in severe cases, the skin can split open.

Most often the runners complain of badly blistered feet. In fact, there are no blisters, just macerated skin on the bottom of their feet. This condition can be very painful. Walking and running hurts one’s feet.

There is no fast cure. They say time heals all wounds and with maceration, it takes time for the skin to dry and return to its normal state. Putting powder on the skin can help, as can clean fresh socks, gentle massage, and letting the skin air-dry.

I saw a lot of macerated feet at Michigan Bluff, mile 55.7. More than I expected. And of course there were lots of runners wanting treatment for bad blisters at the finish, and it was maceration.

Severe results of macerated feet

Severe results of macerated feet

The picture here is of a runner who completed the race, I think sometime around 28-29 hours. I don’t know his story but at some point before the race or in the race, he had his right foot wrapped in what appeared to be a self-adherent wrap, with a thick pad of some kind at the heel. Then that was wrapped with layers of what seemed to be silk type medical tape. Tonya and I had to use trauma shears to cut the thick wrap off his foot. Once it came off we saw the extent of the damage to his foot.

If anyone knows the runner or recognizes him, I’d love to find out more. It’s possible that because of maceration the skin at the heel had sheared off and someone at a medical aid station, or crew, had cut the skin and put on the wrap.

What we did at the finish was to apply a coating of antibiotic ointment to the open and raw skin, cover it with a wound care dressing, and wrap with a self-adhering wrap. We gave him instruction on how to care for this in the days after the race.

Look closely at the picture. He’s happy. He has his finisher’s medallion and knows he’s getting his buckle.

Maceration at Western States

July 7, 2013 by · 1 Comment
Filed under: blister care, Foot Care, Health, Sports 

Last Saturday and Sunday I worked medical at the Western States 100 Mile Endurance Run. I spent Saturday at the Michigan Bluff aid station at mile 55. With the help of Tonya Olson, we patched a bunch of feet. Some had blisters, one needed shoe modification, one had severe heel blisters that had split, and lots of maceration. We saw more maceration than in many past years.

After we closed our aid station at 9:45 pm, I went to Foresthill and talked to George Miller, who was doing foot care there. He had a pretty calm afternoon with nothing unusual.

I found a nice parking space near the finish line at the Auburn High School and spent an uncomfortable few hours trying to get some needed sleep. About 5 am, I headed over to the podiatrity tent and set up my gear. By then, 24 hours into the race, even with about 100 runners in, the tent was quiet.

Around 7 am, things started to pick up. As runners finished, there was a large washtub for them to wash off the dirt. Then they could move to one of the kiddy pools with cold water and ice to soak their feet. Only after that did we see them. As they moved from place to place, Dave, assigned to work finish line podiatrity, and Tonya and I (from Michigan Bluff) looked over their feet and answered any questions. This went on until well after the race ended at 11 am.

This year’s Western States was hot. I’d guess hotter than normal. To my knowledge, there wasn’t that much water on the course. However we saw a large number of runners with severe maceration.

Maceration

Maceration

Here’s a photo of one runner’s foot. This was repeated over and over as we evaluated runners at the finish. Most were convinced that they had large blisters that we needed to lance. In fact, with one or two exceptions, there were no blisters. Just wet, macerated feet with lots of skin folds, creases, and waterlogged skin.

We told the runners that time would heal their feet and to go home or back to their hotel and start a regiment of Epson Salt soaks. The salts help to dry the skin. Powders and airing the feet help too.

Some of the runners had blister with blood inside – some were tinged with pink, indicating blood traces. The decision was made not to lance these blood blisters. When runners have dirty feet and have not showered, and will be walking around in dirty shoes or sandals for a few hours during the awards ceremony, we didn’t want to increase the possibility of infection. In these cases, we gave them the same instruction to do Epson Salt soaks and watch for signs of infection.

A good question is why there was so much maceration. In the heat of the course, often time runners take advantage of every opportunity to keep cool. This includes going through streams, using water soaked sponges at aid stations, pouring water over their heads, and whatever else they can think of. Sometimes well-meaning crew and volunteers squeezed soaked sponges over the heads of runners. The problem is that the water runs down the legs and into the shoes. This helps maceration.

I have seen some runners coat their feet with zinc oxide or SportSlick to help hold moisture at bay. Changing shoes and socks can help, and can be important when maceration has started. Drying the feet and using powder in fresh socks is also important.

Here are four blog posts about maceration and wet feet. Read them to know more about this condition and gain insights about how to manage your feet when wet.

Maceration  – June 23, 2011

Training for Blisters in Wet Conditions – September 15, 2012

Training With Wet Feet – May 5, 2013

A New Kind of Foot Coating – September 25, 2011

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