Filed under: blister care, Foot Care, Footcare, Footwear, Health, Sports
Over the next few days, over 90 ultra runners will test themselves at the Badwater Ultramarathon in California’s Death Vally. 135 miles. Extreme heat, scorching roads, sand, wind, hot winds, and then at the finish line – much colder temperatures. I’ll be there to help with runner’s foot care issues, working with Denise Jones.
I decided to rerun this blog post from 2010. It describes an issue that can harm a runner, and can happen when time is not taken to repair small blisters before they become large, and then huge.
Here’s the post from July 2010.
This was a good week. Badwater in Death Valley always is. Fit runners, great crews, fantastic scenery through the harsh reality of Death Valley – and for me, lots of feet needing care.
For the most part, things were pretty normal. Blisters and more blisters. A great case of severe capillaritis (heat rash) on one runner’s ankles. Ugly toenails. Stinky feet. And more. Lots to like for someone who does foot care.
At the closing ceremony, I noticed Monica, a runner from Brazil, was favoring her right heel. I had met her several years earlier at a previous Badwater when I patched her feet at the 40-mile mark. This year, she finished her 2nd Badwater and that was important. However, she had not come in for help.
She should have.
After the awards ceremony, Denise Jones came and told me I had to see this blister. She talked as if it was really a great find. Denise, as the Badwater Blister Queen, has seen everything and it takes quite a bit to faze her. This blister did. And yes, it was good.
What started as a small blister, one that could have been treated to prevent it from getting bigger, was now an enormous blood blister. The image shows you the size.
There were several issues we had to consider. First and foremost, Monica is a diabetic. This makes foot care a huge issue because any foot infection suddenly becomes a huge health issue. Secondly, the size of this blister, filled with blood, would make it difficult to patch. As always, blood-filled blisters must be managed with care.
We debated the issues and gave Monica advice on how to take care of the blister for her trip home. We advised frequent soaks in warm/hot water with Epson salts and sticking to sandals or other open heel footwear.
What I want to emphasize here is that this never should have reached the size it was and worse yet, filled with blood. For those wondering, a blood blister is bad because, once opened or torn, it can introduce infection into the circularity system if not kept clean.
I wish Monica had taken care of this earlier. She may have never mentioned it to her crew. At any rate, what could have been easily treated now became a huge issue.
It’s a good lesson on not allowing small problems to become large problems. In other words, “Don’t do this to your feet.”
This is an update to my blog post of May 28, A Thru-Hikers Story About Feet. The thru-hiker is Tami and she is still hiking the PCT.
When possible I love to share people’s before and after stories with their feet.
Her story was interesting because she was having huge issues with her feet. I shared three pictures that she sent me, which shows the damage to her skin. I’d suggest going back to read the first part of her story and seeing the pictures. It’s important because it put today’s blog post update in a real-life perspective.
“I just wanted to drop you a follow up line and let you know that my feet have never been better thanks to you! I just walked 600 miles (trudging over 20 miles per day in the High Sierra on rough rock during dehydrating heat spells carrying an extremely heavy pack complete with bear canister…yes this is a run-on sentence but I can’t help myself) using your preemptive taping methods and tincture of benzoin for toughening and I didn’t get one single blister! This is a huge breakthrough for me and I’m giving acknowledgements to your book and your suggestions everywhere I can- you truly are helping me hike the Pacific Crest Trail.
“Yes, I’m still hiking and super in tune with these feet. Every tiny hot spot or slight discomfort makes me stop and evaluate everything. Thanks for the reminder to not get complacent, it seems like my feet are tough, but it wasn’t too long ago that I was disabled to due horrible blisters.
“I thought my foot issues would be putting the cabosh on my plans, but here I am with happy feet! I met a girl on a bus who was limping around with blister pain and pulled out my foot kit for her to look at. She took notes, jotting everything down including your book title. These are hard lessons learned, but then again, I never seem to do anything the easy way. Thanks so much.”
So what do we learn here? We see that there is hope. It shows that athletes can survive and find help and solutions for their foot issues. Whether you are a thru-hiker, like Tami, an ultramarathoner, marathoner, walker, adventure racer, or anything else, you don’t have to quit because of your feet. Tami was smart and reached out for help – and was willing to put in the effort to learn what to do and what her feet needed.
You can do the same thing.
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.
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 the donut hole – now a huge blister about the size of a silver dollar and 1/4-inch thick. The camp staff took pictures of 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.
This post is from July 2102, but is important for athletes to understand.
Filed under: blister care, Foot Care, Footwear, Footwear Products
Heel blisters are quite common – although they shouldn’t be.
Today’s post shows one participant’s feet at the 2014 Amazon Jungle Marathon.
If you look closely at this picture, you’ll see two heel blisters, both on the outside of the runner’s feet. The right foot blister is large but is not blood-filled. The blister on the left heel, however, is very large and filled with a large amount of blood.
It’s easy to think these are normal blisters – but their size makes they abnormal.
In my experience, heel blisters are caused by the constant shear when either 1) the heel is moving up and down inside the shoes’ heel, or 2) by the constant movement at the place where the shoe’s insole touches the inside of the shoe. Over the years, the majority of heel blisters have been the latter. One of the characteristics of this “insole/shoe junction” blister is that they often are flat across the bottom. The blister starts at the point where the insole’s edge at the side of the heel touches the inside of the shoe. That’s what makes the flat line at the bottom. Then the blister forms upward as the fluid forms and it grows. Given enough time and movement, you’ll get blood inside.
These are relatively simple to patch. The skin must be cleaned with alcohol wipes, and then the blister can be lanced and drained. Depending on the size of the blister, you’ll need to apply some type of blister patch. The bottom line is that you need to have something over the blister to protect the skin and prevent the top layer of skin from tearing off. For these, I would use strips of kinesiology tape (my preference is either StrengthTape or RockTape H2O) with antibiotic ointment over the blister to keep the tape from sticking to the skin. The larger the blister, the harder these are to patch but it can be done.
You are better off to prevent these blisters in the first place.
Start with the fit. Make sure your shoes hold your heels in place with just a little movement.
Check your shoes and insoles for rough and/or thick edges at the inside and outside of each heel. Side blisters are much more common than the back of the heel. If the insole has a large thick edge, replace them. If the shoe’s fabric is worn into a hole, you are due for new shoes. Under the fabric is generally a plastic edge of the shoe’s heel counter – the plastic that curves around the heel from side to side.
Engo Blister Prevention Patches are perfect for to help prevent these types of blisters. These patches are super slick. Either the small or large oval can be applied to the inside of the shoe and cover the offending edge of the insole/shoe junction. Clean the inside of the shoe and insole first. I work the patch with my fingers to form a curve to fit with area I need to cover. Then remove the backing and apply the center of the patch first and then push the top and bottom of the patch into place. Rub it a bit to assure adherence.
Filed under: blister care, Foot Care, Foot Care Products, Footcare, Footwear, Footwear Products
Vicky Kypta is the Medical Team Manager for the Jungle Marathon, which starts October 6 in the Amazon in Brazil. Last year she did an informal survey of the participants and the results are interesting. The race lasts seven days and goes through the jungle on pre-existing paths, trails, and tracks with natural obstacles to pass including streams and shallow rivers. This leads to feet that are constantly wet.
This is the race that I will be at in a few days.
Vicky shared the results of the questionnaire and commented it was quite interesting, although the sample group was quite small. There were about 30 participants.
Here are some of the findings:
- 77% of the respondents wore Injinji socks
- 100% of those NOT wearing Injinji sock got blisters
- 46% of those wearing Injinji sock got blisters: out of those 50% were on the balls of the foot and 50% were on the toes. Those who had blisters on their toes all wore shoes in their normal size.
Out of those with no blisters:
- 100% wore Injinji socks
- 100% wore shoes one size larger
- 75% applied some form of anti-friction compound to their feet; i.e. Body Glide, 2nd Skin or Zinc Oxide cream
- 75% pre-taped problem areas or hotspots
I find this interesting and wonder what we will find with the 78 participants next week. The Jungle Marathons are well run and the staff tells runners to train with wet feet. They have found this results in less foot problems.
The results are striking in several areas (remember this is a seven day stage race):
- All the runners who did not get blisters wore Injinji socks and shoes a full size larger than their normal shoes
- All the runners who did not wear Injinji socks got blisters
- Runners wearing their normal size shoes all got toe blisters
- The majority of blisters were on the forefoot and toes
Over the past 17 years, I have worked a lot of ultramarathons and multi-day stage races. I can honestly say that overall, feet have improved. More runners are prepared and know how to manage their feet.
When I return, I will share what we found at this year’s Amazon Jungle Marathon.
Back in May I posted an article about Training With Wet Feet. My being invited to work on the medical team at the Jungle Marathons in Vietnam and the Amazon prompted the article. While the Vietnam race had to be cancelled, the Amazon race is happening – in a bit over two weeks.
As I wrote in that article, it was long felt the best way to manage your feet was to keep them as dry as possible. This was more and more evident as Denise Jones and I worked the Badwater Ultramarathon in the heat of Death Valley each July. Runners who kept their feet dry typically finished better than those who had wet feet. This was also based on our experiences at Western States and other events.
Then came the invite to help at the Jungle Marathons.
The Jungle Marathons are run by Race Director Shirley Thompson and the Medical Team Manager is Vicky Kypta. They found their runners had a better race when they trained with wet feet. As part of their instructions to their race participants, they stress the importance of training with wet feet.
The reason for this is the Jungle Marathons are wet. Very wet is typical in the jungle. Whether through rivers or streams, the Amazon is full of water.
When I am helping runners at the race in early October, I will be closely monitoring the condition of their feet. I expect runners will use lubricants and other products to control the moisture, or powder, socks, well-draining shoes, and maybe a few home-grown tricks.
Over the past few months, I have shared some of the findings by Rebecca Rushton, a podiatrist from Australia. In her Blister Prevention Report, she talks about managing moisture control. She supports her report with studies from medical and other professional journals. What she found through the studies is that you could reduce the incidence of blisters by keeping the skin either very dry or very wet.
Rebecca writes that, “… the very high or very low skin moisture strategies aim to reduce the coefficient of friction value between the sock and the skin to below blister-causing levels.”
The Coefficient of Friction
The coefficient of friction (COF) is the number that represents the slipperiness or stickiness between two surfaces. According to studies, this number is generally below 1.0. Inside the shoe, the COF between the foot’s skin, and the sock and insole can range from 0.5 and 0.9. Compare this to the COF between a sock and a polished floor – about 0.2.
In Rushton’s report, she illustrates this with an example of a runner whose feet sweat a lot. His socks become damp, creating a moist condition. The COF in this case might be 0.7. By moving away from a moist condition to either very dry or very wet, the runner might reduce the COF to 0.5. If the runner’s blister-causing threshold is 0.6, getting to 0.5 will reduce his chances of blistering. Reducing the COF between your skin and socks/insole combination is important to having healthy feet.
Moist skin produces higher friction than very dry or very wet skin. Whether skin is dry and becomes moist through sweat or through a water moisture source, or is very wet and becomes moist through heat or simply drying out, when it hits this middle stage, it becomes more susceptible to blistering.
Very Dry Skin
Drying the skin can be done with powders, antiperspirants or other drying agents, used by themselves or in conjunction with moisture control socks. Keeping the skin very dry is tough because our feet sweat naturally. Humid or hot conditions can also make it hard to keep the skin dry. Dumping water over your head to cool yourself can result in water running down your legs into your shoes – defeating your efforts to keep your feet dry. Airing your feet with shoes and socks off can help. If you use powders, make sure it is high quality and does not cake, which can be an irritant. When counting on any of these methods to keep your skin dry, you mush also have shoes that allow moisture to escape. That may include shoes with mesh uppers and drain holes in the arches and heels.
Very Wet Skin
Increasing skin moisture leads to very wet, lubricated skin that reduces the skin’s coefficient of friction. This can be through the use of a lubricant and or by simply having wet feet. The thing to remember is that over time, 1-3 hours, friction will increase as the lubricant is absorbed into the socks – so ongoing application is required.
Remember too what happens to your skin when you spend too much time in the water. It becomes weaker and less able to resist trauma on wrinkly skin. In extreme cases, the skin can fold over on itself and split. Severe maceration can be painful and athletes say it feel like a giant blister on the bottom of their feet.
In the Amazon Jungle Marathon, the trick will be to dry the feet at the end of each day’s stage. Because the feet will be wet during much of each day’s stage, the runners will have to find the balance between very dry and very wet, avoiding moist as much as possible.
Here’s some advice from my previous post about training with wet feet.
As said earlier, stop and deal with any hot spots as soon as you feel them. Check for folds in your socks, friction from dirt or sand, pressure inside your shoes – and get rid of these irritants. Lube the area or apply a piece of tape or blister prevention patch to help. This may seem like common sense, but many people ignore this simple step.
At the end of each day’s stage, remove your wet shoes and socks, dry your feet and air them as much as possible. If your feet have tape on them, remove the tape to dry the skin underneath. Wear sandals or Crocs around camp to keep your feet away from the wet ground and dirt and sand. Walking around barefoot will often aggravate wet, cold, and soft macerated skin. Later in the day or the next morning, re-tape your feet and patch any blisters.
Rest assured that I will write about how everyone’s feet held up in the wet Amazon jungle.
Credit is due to Rebecca Rushton for her Blister Prevention Report. Her website is Blister Prevention. Check out her website and sign up for her newsletter and free reports.
Here is the link to the Jungle Marathon Amazon.
If you want to read more, check out this article I did in November 2012 about Stuart Crispin who completed the race in Vibram FiveFingers.
Filed under: blister care, Foot Care, Foot Care Products, Footwear, Sports
In my last post, I talked about four ways to reduce shear and the likelihood of blisters. To recap, they were fit, cushioning, moisture management, and socks. Today’s post will cover a fifth way by using ENGO Blister Prevention Patches.
Tamarack Habilitation Technologies is well known for providing healthcare professionals and clients with innovative, value-added orthotic-prosthetic componentry and materials. Their ShearBan product is similar to the ENGO Blister Prevention Patches reviewed in this article. ShearBan is used in the orthopaedic and prosthetic industry on prostheses at amputation stump sites to reduce the incidence of skin breakdown.
Introduced in 2004, ENGO Blister Prevention Patches have radically redefined the way hot spots, blisters and calluses are treated. As a preventative measure, ENGO patches provide peace-of-mind that blisters won’t become a painful, debilitating problem. If a blister has already formed, applying patches to footwear, corresponding to the blistered area eliminates painful irritation and further skin damage, allowing continued activity. Friction forces are reduced by more than 50% when you apply an ENGO Patch to your footwear.
The patches are made from an ultra-thin Polytetrafluoroethylene (PTFE) film and are 0.015 inches total thickness – a very slippery surface. They are very durable, lasting four to six weeks in most applications. The aggressively sticky patch peels away from the backing and is applied to dry shoes or boots. The PTFE ENGO Patch reduces the ‘stickiness’ between the shoe and sock so they can glide over one another. The foot, inside the sock, glides over the patch shear distortion and friction are reduced, and blisters can be averted, in spite of pressure.
Avid runners, hikers and sports players rely on their feet to reach performance goals; from day hikes to ultra marathons. But quality footwear and socks alone don’t eliminate the skin trauma your feet can experience from repetitive rubbing — building friction forces to levels that cause hot spots, blisters and calluses. While I use these patches in runners’ footwear at races, they can also be used in ordinary every day shoes to reduce calluses.
Similar to Tamarack’s ShearBan material, ENGO patches are applied directly to footwear and equipment, not to the skin. Outcomes of this unique application include ease of use, long-lasting and guaranteed friction relief.
ENGO Patches are made in several sizes and types:
- A large oval – 2 ¾ x 1 ¾
- A small oval – 2 x 1 ½
- A rectangle – 3 ¾ x 2 ¾
- Back of the heel patch – 3 ¾ x 1 ¾
- A cushion heel wrap – 3 ¾ x 1 ½
When I work a race I always have a bag with different sizes of ENGO patches. I have applied the ovals and rectangles and the back of the heel patches. The patches are applied to the shoes and insoles – not to your skin. This means wherever you are going to apply a patch has to be dry. My advice is to apply patches before your race when your shoes are dry. I have used them inside the shoes in the sides, in the heels, and on the insoles.
Typical problem areas in footwear are under the heel and forefoot, and at the side of the heel. An oval patch can be applied to overlap the side of the heel counter and the insole as seen is the photo. I often use a rectangle or large oval under the ball of the foot or an oval under the heel – applied directly to the insole. The patches are useful over stitching or seams in footwear that are rubbing the wearer. If necessary, a patch can be cut to shape for where it will be applied.
The patches will reduce shear and friction; provide relief from hot spot and blister pain, and can be used in any type of insole or orthotic and footwear, from sandals to running shoes, and any type of hiking or ski boot.
I like ENGO patches because they work. The patch is thin and does not alter the fit of the shoe. When properly applied to dry footwear, they stick.
Rebecca Rushton, a podiatrist in Australia, strongly recommends ENGO Patches. She discovered the patches after getting blisters herself and now represents ENGO in Australia. She has written several free reports on blister prevention available on her website, Blister Prevention.
If you are unclear about shear and blister formation, here’s a link to my article An Introduction to Shear and Blister Formation.
The Technical Stuff
JM Carlson, in a 2009 report wrote, “The measurement of friction is the ‘coefficient of friction’. The coefficient of friction (COF) is a number that represents this slipperiness or stickiness between two surfaces and is generally below 1.0. Within the shoe, the COF between the foot, socks and insole can range from 0.5 – 0.9. In contrast the COF between a sock and a polished floor is around 0.2.” Tests have shown PTFE patches to reduce the coefficient of friction (COF) in the shoe by up to 80%. The COF is in approximately 0.16, which is significantly lower than all other in-shoe materials. Importantly, the low COF is maintained even in most and wet conditions inside the shoe.
Check out GoEngo.com for more information about ENGO Blister Prevention Patches. They also offer a money-back guarantee.
Disclaimers: I support ENGO Patches and am supplied with whatever I need for the events I work. I am an affiliate of Zombierunner and make a bit of any sale made through the link above.
Back on June 17 I introduced the concept of shear with a post by podiatrist Rebecca Rushton from Australia who has studied blisters and identified shear as a major factor in blisters.
It’s best to start by refreshing our memories about what was shared on the previous article. Here’s the link in case you want to see the full post: An Introduction to Shear and Blister Formation. Otherwise, here’s a short piece from that post:
Poor blister prevention outcomes are due in no small part to the misunderstanding of the cause of this obstinate injury. The force that causes ‘friction’ blisters is not friction. And it’s not rubbing. It’s shear. But if you ask 100 people the question “what causes blisters”, nobody would answer “shear”. Shear is the sliding of layers across one another – internal layers that are structurally connected. Those connections can break and when fluid fills that cavity, you have a blister! What Does Shear Look Like? Try this … Step 1: Place the tip of your right index finger on the back of your left hand. Step 2: Wobble it back and forth but keep it stuck to the same bit of skin. Notice how your skin stretches? This is shear and this is what causes blisters. Shear might look like rubbing but it’s not. Notice how your finger tip has not moved relative to the skin of the back of your hand? But your hand skin has moved relative to the underlying bone. This is shear. Your skin doesn’t need anything to rub over it for blisters to form. It just needs shear (this stretching of the internal tissue layers) to be excessive and repetitive.
Managing shear is key to managing blisters. Let’s look at several ways to reduce shear.
The first way is to make sure your footwear fits. Many people buy shoes that seem comfortable in the store but don’t make sure they feel ok by wearing them around the house for a few days. Make sure they have enough room in the toe box both in height and length. Make sure there is not undue pressure on soft tissues over any bony spots (sides of the forefoot, ball of the foot, sides and back of the heel, over the instep, etc.). Make sure they are not too loose, allowing too much movement leading to skin abrasions, hot spots, and then blisters.
Using a cushioning product is a second way to reduce shear. This might be a gel pad under the ball of the foot or under the heel bone, or a replacement insole meant to pad and cushion.
A third method is to manage skin moisture. This can include skin-drying strategies and skin lubrication. Studies have shown that you can reduce the incidence of blisters by keeping the skin either very dry or very wet. Drying the skin can be done with powder, benzoin, alcohol wipes, and antiperspirants. Lubricants can include SportSlick, BodyGlide, BlisterShield, and other popular products. Zinc oxide is also effective at controlling moisture. The method of having runners train with wet feet has been successfully used by Shirley Thompson and Vicky Kypta of the Jungle Marathon Amazon. They have found that the feet of their race participants have been better with this suggestion given to runners before the race.
The fourth method of controlling shear is with socks. This may include double layer socks or wearing two pairs of socks – a thin liner and usually, a thicker second sock. This allows movement between the two sock layers. Injinji toe socks are great for those with toe blister problems.
Next time, we’ll talk about a fifth way to reduce shear – Engo Blister Prevention Patches.
In the mean time, check out ZombieRunner for many products that can help with cushioning, skin-drying and lubricants, and socks.
I have a large file of feet pictures on my computer. Pictures of toes, heels, balls of the feet, and arches. Pictures of blisters of all shapes and sizes. In addition, I see all kinds of feet when I work events. Over the years, I have worked races ranging from short distances to ultramarathons, to multi-day stage races.
I am probably one of a limited number of people in the world who gets excited at photos of bad feet. I like them because they tell stories.
The first full multi-day event I worked was Racing the Planet’s Atacama Desert six-day stage in the high desert of Chile in 2004. The stressors of being on your feet for long distances day-after-day for six to seven days often bring out the worst in feet.
A lady in that race wanted us to remove her toenails at the end of day two. Another runner had the worst case of trench foot I have ever seen. That was nine years ago and my techniques have changed for the better, but the feet remain the same – bad!
I believe that feet tell a story.
The photo here is from the Racing the Planet Iceland. I don’t know the owner of the feet. I don’t know the level of training and experience the person had prior to this race. I also don’t know what experience this person had with foot care planning before a race and during the race.
Here are my observations about the story behind these feet.
- Almost every toe has something going on.
- The photo was posted online for stage five, meaning the runner had to tolerate these toes for four plus days.
- These blisters don’t typically happen in one day. My guess is they started on day one, progressed to blisters on day two and then got worse.
- My bet is the shoes’ toebox was too short in length and/or too low in height.
- The runner may have worn two pairs of socks, which could have made the fit too tight.
- The toenails don’t look too long but it’s hard to see if they have any rough edges or are thick, both of which can lead to toe blisters.
- These toes scream pain – especially if they are encased inside shoes.
- It’s possible the toes received some degree of care, but it is hard to tell from their condition.
- Four of the toes have major trauma.
- We cannot see what is going on under the toes, but from the outside edges of the big toes, you can see blistered skin of the left one and maceration on the right one.
- The left big toe has blood showing in the blister on the outside edge.
That’s a lot of information pulled from a photo. I wish I knew the toes’ owner. It would be nice to learn more about his/her race. What shoes and socks they wore. How the trauma to the toes progressed day-to-day. What care they received. Whether they finished the race.
My guess is that with proper care, much of this could have been prevented. That care could have included lubricants, moisture control skin protect, tape, modified shoes, and nail care.
What story do your feet tell?
Here’s the link to the Racing the Planet’s Iceland race. Racing the Planet does four desert races every year called The 4 Deserts: the Gobi in China, the Atacama in Chile, the Sahara in Egypt, and Antarctic. Every year they add a new location for that year. Past sites have included Australia, Nepal, Namibia, Vietnam, and 2014 will be in Madagascar. You can check them out at Racing the Planet.