The Components of Prevention

November 12, 2017 by · Leave a Comment
Filed under: blister care, Foot Care, Foot Care Products, General, Health, Sports 

This is Part IV in a series of posts about blisters, their formation, causes, and prevention. In this post we look at the 13 components of blister prevention – five major and 8 minor components. They all play a role and are important to understand.

Blister prevention takes place through a combination of 13 components. Five are the most major components: fit, socks, ENGO patches, lubricants, and powders. Eight others are minor but still important components: skin toughening agents, taping, insoles and orthotics, skin care and hydration, antiperspirants for the feet, gaiters, lacing, and changes of socks and shoes.

Within our shoes many things are happening, and everything is related in some way. Where something touches another, we have what we’ll call an interface. The basic interfaces are between the skin and sock, the sock and the insole, and the sock and the inside of the shoe. When you put tape on the skin, it adds two more, between the skin and tape, and the tape and the sock. Adding an ENGO patch adds two more. Since the tape and the ENGO patch are stuck to the skin and shoe respectively, the only interfaces we are concerned with are the tape and the sock, and the ENGO patch and the sock. The interface with the lowest COF determines or limits the magnitude of friction. If the tape loosens on the skin, another damaging interface is added.

The Five Major Components

We’ll start with the top circle comprised of fit, socks, ENGO patches, lubricants, and powders—the first line of defense against blisters. It’s important to remember that these five components and the eight from the next circle all work in some way to reduce shear distortion. They may increase skin resilience; reduce bone movement, pressure, friction, and moisture; absorb shear; or reduce the number of repetitions. Remember that the more you use shear-reducing or shear-absorbing materials in your shoes, the more you are taking that stressor off the skin.

  1. FIT comes first. You need to start with properly fitting shoes with a quality insole. No matter how well you tape, how good your socks are, or how good any other component is, if the shoes fit incorrectly, you will have problems. If your footwear is too loose, your feet will slide around, creating shear. If your footwear is too tight in certain areas, your feet will experience excessive pressure. Wearing too-loose or too-tight footwear will change the biomechanics of your foot strike, which in turn will affect your gait and throw off your whole stride and balance.
  2. SOCKS come in either single- or double-layer construction. Some singlelayer socks, particularly those without wicking properties, allow friction to develop between the feet and the socks, which in turn can create blisters. Double-layer socks allow the sock layers to move against each other, which reduces friction between the feet and the socks. Socks can also wick moisture away from the skin. Injinji toe socks give each toe its own sock.
  3. ENGO BLISTER PREVENTION PATCHES are effective at reducing shear distortion by reducing friction at the skin and sock–shoe interface. The patches are an alternative to taping.
  4. LUBRICANTS create a shield to reduce friction and protect skin that is in contact with socks during motion. This lubricant shield also reduces chafing.
  5. POWDERS reduce friction by reducing moisture on the skin, which in turn reduces friction between the feet and the socks.

 

Prevention Components

The 13 components of defense against blisters

LEGEND

Outer Circle: Fit, Socks, ENGO patches, Lubricants, and Powders.

Inner circle: G=Gaiters T=Taping N=Nutrition and Hydration C=Shoe and Sock Changes I=Insoles and Orthotics L=Lacing A=Antiperspirants S=Skin Tougheners and Adherents

The Eight Minor Components

Now, imagine another circle made up of eight components that play a strong supporting role in prevention—the second level of defense against blisters. This innermost circle is made up of skin toughening agents, taping, insoles and orthotics, skin care and proper hydration, antiperspirants for the feet, gaiters, lacing, and frequent sock and shoe changes. Each can contribute to the prevention of blisters and other problems. You could argue that these outer components should be identified as major components, and to some extent you may be right—some components may be more important for your feet than for mine. The trick is to determine what we each need to keep our feet healthy under the stresses of our particular sport. Let’s look at each component.

  1. SKIN TOUGHENING AGENTS form a coating to protect and toughen the skin. These products also help tape and blister patches adhere better to the skin and lead to a reduction in perspiration.
  2. TAPING provides a barrier between the skin and socks so friction is reduced. Proper taping adds an extra layer of skin (the tape) to the foot to prevent hot spots and blisters. Taping can also be a treatment if hot spots and blisters develop. ENGO patches can be an alternative to taping or compliment taping. Toe caps are silicone gel devices that go over the toes and absorb shear.
  3. INSOLES AND ORTHOTICS help maintain the foot in a functionally neutral position so arch and pressure problems are relieved. Some also have absorption qualities. Small pads for the feet may also help correct foot imbalances and pressure points. They can be bought over the counter or be custom made for your feet.
  4. SKIN CARE for the feet includes creams and lotions to smooth and soften dry and callused feet. This also includes good toenail care. Proper hydration can help reduce swelling of the feet so the occurrence of hot spots and blisters is reduced. These all contribute to skin resiliency.
  5. ANTIPERSPIRANTS for the feet help those with excessively sweaty feet by reducing the moisture that makes the feet more prone to blisters. It’s another help in skin resiliency.
  6. GAITERS provide protection against sand, dirt, rocks, and grit. These irritants cause friction, hot spots, and blisters as shoes and socks become dirty.
  7. SHOE LACES and boot laces often cause friction or pressure problems. Adjusting laces can relieve this friction and pressure and make footwear more comfortable.
  8. FREQUENT CHANGES OF SOCKS AND SHOES help keep the feet in good condition. Wet or moist socks can cause problems. Changing the socks also gives an opportunity to reapply either powder or lubricant and deal with any hot spots before they become blisters. Sometimes shoes are also changed as they become overly dirty or wet.

The next post will look at how we found the right combination of blister prevention components that will work for us.

Understanding Shear

This is part II of a series on blister formation and prevention. If you’ve missed the first post, I encourage yo to go back and read it to get a foundation on blisters. Here the link: Blister Formation.

In this part II, we’ll look at shear. For years we didn’t understand the concept of shear and its effect on blister formation. So let’s start with a story.

In Fixing Your Feet I tell the story of a runner at Badwater whose feet I patched. In short, he had run 90 miles of the 135-mile race, on pavement, in extreme heat. He had Elastikon tape on both balls of the feet. His feet were hurting to the point of quitting. I replaced the Elastikon tape with smoother kinesiology tape, which allowed movement between the tape and his sock, greatly reducing the shear movement between the layers of skin and the bones of his feet. I also added a large ENGO Blister Prevention Patch on each insole under the ball of each foot. By reducing the shear level, the runner was able to finish the race with less pain. Try to picture the following: as your foot moves through its foot strike, the bones of the foot move against the layers of underlying skin—then you apply a tape that is not smooth to the skin, pull on a sock, and finally put your foot inside a shoe. The tape sticks to the skin. As you run, the foot naturally moves a bit inside your shoes.

However, the sock cannot move freely against the coarseness of the tape. The sock and tape move as one, which stresses the outer layer of skin against the inner layers. The only movement is the shearing effect between the layers of skin.

That experience was the first time I made the connection to shear, although I didn’t know it by that name. All I knew is the stickiness at the sock–shoe interface, the tape–sock interface, and the tape–skin interface—and one, or all three, had created this major problem for the runner. I never forgot the story. His skin was stuck to the Elastikon tape, the coarse tape didn’t move against his sock, and the sock didn’t move against the shoe’s insole. With the smoother kinesiology tape and the new slipperiness between the tape and the sock, the coefficient of friction was reduced and in turn shear was reduced.

Shear is a new concept for most athletes, especially as it relates to blisters. Shear is defined as a strain in the structure of a substance when its layers are laterally shifted in relation to each other. Applying the definition to the above example, shear happened between the layers of skin as the bones of the foot moved through the foot strike. The internal layers of skin were connected. But those connections can break under the stress of shear and the cavity fills with fluid—and you have a blister.

To understand shear, try this. Place the tip of your index finger against the skin on the back of your hand. Keep it stuck to the same bit of skin while you move it back and forth while. See how your skin stretches? The skin on your hand has moved against the underlying bones. That is shear that causes blisters.

Note that nothing has rubbed against the skin. Your finger did not rub the skin. J. Martin Carlson, the founder of Tamarack Habilitation Technologies, has championed shear as the cause of blisters. Tamarack has a long history of providing innovative orthotic-prosthetic componentry and materials. Their focus on friction management, especially for amputees, has won them many awards and much recognition. This knowledge in turn led to the creation of a new product that can be applied to footwear to reduce high friction levels and, in turn, the shear that leads to blister formation: ENGO Blister Prevention Patches.

Shear in Action

After watching a video on Tamarack’s website, I understood more about shear in action. The video showed a cutaway on the heel area of a shoe, showing the sock and foot inside moving through a foot strike motion. In one video, the cutaway showed a sock and foot on an insole where there were high levels of friction. The sock and foot were distorted as they were held against the insole. It was as if they were stuck together. In another video, the sock and foot were on an insole with an ENGO patch underneath. No distortion occurred as the sock and foot moved easily through the foot strike, over the slippery surface of the ENGO patch.

It’s important to grasp how shear happens. As described above, shear results in distortion occurring between the skin and soft tissues underneath. This shear distortion is what causes blisters. The bones in our feet move back and forth as they move through each foot strike. When the skin at the bottom of the foot is stuck by high friction (stickiness) to the sock and shoe, the middle tissues are distorted. When this is repeated over and over, traumatic levels are reached and a blister forms. This distortion can happen anywhere on the foot: in an up-and down motion in the heel, the sides of the foot, and between toes; in a side-to-side motion at the ball of the foot, under the heels, and at the bottom of the toes; and in rotation as the foot moves through its foot strike. As we walk, run, and pivot in our shoes, the surface of our skin incurs a shearing force.

Certain amounts of shear are normal, and our feet can deal with a lot. However, with repeated traumatic levels of shear, blisters will develop. How much is too much? It varies from person to person, and some people are simply more blister-prone than others.

Part III will look at the five factors of blister formation.

The Year’s Best Blister Horror Story

You may have seen the news articles either in your newspaper, or on Facebook, or on TV. Let me paint you a word picture of some of the headlines and quotes:

  • Blister sparked tears
  • “I got a really bad blister.”
  • “My mind was ‘blocked with pain’ of a blister.”
  • Pain and tears
  • Blister caused meltdown

Marin Cilic let the tears come midway through the second set after calling for medical attention for a nasty blister on his left foot. The former US Tennis Open champion had tried to play through the pain, but couldn’t stop Federer from winning the tournament. Cilic said, “I got a bad blister in the semi-final against Sam Querrey. Fluid just came down under my callous in the foot.” The medical staff helped him over a period of 30 hours and did as much as they could. He said, “I still felt the pain. Every time I had to do a reaction fast, fast change of movement, I was unable to do that.” Cilic was challenged emotionally because of everything he had gone through in the months before Wimbledon. “It was very, very difficult to deal with it. It didn’t hurt so much that it was putting me in tears. It was just that feeling that I wasn’t able to give the best.” Here’s the full story.

Wimbledon 2017: Devastated Marin Cilic Reveals Blister Sparked Tears

What did this cost Cilic? It cost him the championship at Wimbledon and the fame and fortune that goes with it. Putting it into language that athletes would understand, If this had been you, it could have cost you a completion of a hundred mile race, an adventure race win, a marathon win, a through hike, and more.

So here’s what happened. We know that Cilic had a callus on the ball of his left foot. A blister developed under the callus, and then popped. A fluid filled blister hurts and when it’s on a pressure point area of the foot, it hurts even more. Then with the fluid removed, the blister’s roof moves against the inner layer of raw skin, causing even more pain. Movement, especially when doing sudden pivots and push-offs, as required in tennis, becomes impossible. That’s it. One blister. But a blister in a vital spot – at the head of the metatarsal at the base of the large toe on the left foot can ruin your day – or your chance for the 2017 Wimbledon trophy.

In the picture you can see white stuff on the bottom of Cilic’s foot. That’s tape residue from the layers of tape they put on his foot. The residue builds up into a sticky mess and can become an irritant. Look closely and you’ll see a callus or blister just under the ball of his big toe. That’s a typical callus area too and I’d bet he had a thick callus there. Cilic mentioned fluid that came out from under the callus. Try as they could, the doctors and medics were unable to patch his foot so he could play the way he needed to play. Since his play was compromised, he ended up losing.

So what’s the lesson here?

  1. Callus buildup is bad. It’s one of my main things I talk about. Calluses. Spend the time it takes to reduce your calluses. If Cilic did not have a callus, he might not have developed a blister.
  2. Treat it right from the start. We can only speculate what treatment Cilic received. How did they lance the blister? Did they get all the fluid out? Did it refill? What did they put over the callus and blister? Did the blister extend beyond the callus? What kind of tape did they use? What did he do to his foot during the 30 hours? How many times did they try to tape it. Why didn’t they remove the tape residue?
  3. Was this a recurrence? In other words, had he had a blister in the same place before?
  4. What was the surface of his insoles like? Coarse and rough? Smooth? Did they change insoles?
  5. What kind socks was he wearing? Did he change to a different pair as the injury progressed?

What would I have done? My treatment is based on what I read through the news stories and saw in the pictures.

  1. I would have checked his insoles and if they had a rough surface, I would have replaced then with a pair that had a smoother surface.
  2. I would have put a large ENGO Blister Prevention Patch on the insole under the callus and ball of the foot. This would have reduced the friction dramatically.
  3. If the callus over the blister is rough and coarse skin, I’d file it down to remove some of the coarseness and bulk.
  4. I would have made sure there were at least three lanced holes in the blister, in spots were pressure through the foot strike would have forced fluid out. And made sure all the fluid was out.
  5. I’d put a small dab of antibiotic ointment over the blister and apply a strip of kinesiology tape over the whole ball of the book, making sure the skin was clean, with a tincture of benzoin base and an added strip of benzoin to the tapes edges.
  6. I’d then add two figure 8s from Hypafix or Coverall tape between the toes to anchor the forward edge of the kinesiology tape at the base of the toes.
  7. Finally, roll the socks on the foot to avoid pulling any edges of the tape loose.
  8. Optionally #1, If the pain was almost unbearable, I would have applied cushioned adhesive felt over the ball of the foot and then the kinesiology tape over that.
  9. Optionally #2, I would have the athlete wear a double layer sock or two light weight socks to allow for movement between the two socks layers and reduce pressure on the ball of the foot.

Over the years, I have found most doctors, nurses, physical therapists, and even podiatrists, do not know how to patch blisters on athlete’s feet in order to get them back into the race or event.

I know I was not courtside, and don’t know what Cilic’s medical people saw. But the above treatment plan is still what I would do regardless of other things. You are welcome to weigh in on what you think.

Making Overlapping Toe Separators – Part 2

This second version of a toe separator is a more complicated to make and apply. It uses a large or small ENGO oval, depending on the size of the toes. The idea is to pinch the patch into an upside down T where the base of the T goes between the two problem toes. The patch is stuck to your insole in a position where it keeps the two toes apart. The slippery surface of the ENGO patch will prevent rubbing and the upward base of the upside down T will keep one toe from going under the other toe.

Toe separator #2 on an insole

Toe separator #2 on an insole

How to Make Your Own Toe Separator # 2

Using a utility knife, score two cuts, about one inch apart on the backside of the patch. Make them only deep enough to cut through the paper backing – do not cut through the patch itself. Try to have the one-inch wide space in the middle of the patch. Make the width of the cuts wide enough so the folded separator will be tall enough to match the height of the toes it will go between. This is important – a separator used between middle toes will have to be taller than ones used for pinky toes. Men’s toes may also require taller separators. Using the tip of the knife, remove the one-inch strip. Fold the patch in half so the sticky sides match to each other. The two end of the cut backing should meet in the middle. You can now open the two ends and cut the patch into the needed shape based on where the patch will go on the insole and the length of your toes.

Separator # 2 Height and Length

Toe separator between toes with Injinji socks

Toe separator between toes with Injinji socks

Separators for pinky toes need to be shorter in height and length than ones for the middle toes. You may have to make more than one separator based on the size you need to find the right fit.

How to Use the Separator # 2

To use the separator in your shoe, remove the insole for the foot with the overlapping toes. The smoother the insole the better the patch will stick. Clean the surface of the insole of all lint, dust or other things that could interfere with the patch adhering. Make sure the insoles are dry. Put the insole on the floor and stand on it so your foot falls into any indentations. Usually, an insole will have indentations under the heel, ball of the foot, and some of the toes. Using a pen, make a mark between the two affected toes. Put on a pair of Injinji socks and make sure the marking is still in the right place.

Once the placement has been confirmed, with sock on, place the separator between the two toes to make sure it fits. The best way to do this is with your foot on the insole. The height should come up to the top of the toes with sock on. If the height is too high, trim it with a scissors. If it’s too low, make another separator where the pinched section is higher.

Toe separator between 2nd and 3rd toes with Injinji socks

Toe separator between 2nd and 3rd toes with Injinji socks

The length needs to be long enough to cover the body of the toe – without hitting the crease between the toes. If the separator touches the crease, it could rub and cause problems, especially if the foot moves forward in the shoe. If it’s too long, trim it with a scissors.

Once the fit has been checked, you can place the separator on the insole. Line it up so the upward part is in the correct place. Then remove the protective backing to expose the adhesive and place the patch on the insole with the upward part over the line on the insole. Rub the separator to make sure it is firmly secured to the insole. Use a scissors to trim any part that extends over the sides of the insole. Use a blow dryer for a few

If the patch does not stick, you probably have an insole with a surface that is not smooth enough or too soft with too much fabric that does not allow the adhesive to hold. In this case, you may want to try another insole with a better surface. They can be peeled off the insole if they are placed wrong, but will probably not stick as well if you try to reattach them. The patches will not stick to a wet insole. For easier removal, use a blow dryer or heat gun to heat the patch.

If the Separator # 2 is Too Weak

It’s possible that the pinched section of the ENGO patch will be too weak or thin to keep the toe from going under the next toe. If you can tell the toe is going under, here’s an idea to make it stronger. Take another ENGO Patch and cut a strip the width of the top of the separator, remove the adhesive backing, and pinch it over the existing separator so it reinforces the upward part of the separator and extends onto the base. This will strengthen the part between the toes and make it stiffer and better able to keep one toe from going under the other.

Sources

Injinji socks and ENGO patches can be purchased at Zombierunner.com. The patches can also be purchased at the ENGO website. Disclosure: I have an affiliate relationship with Zombierunner.

Making Overlapping Toe Separators – Part 1

January 3, 2016 by · 2 Comments
Filed under: blister care, Foot Care, Foot Care Products, Footwear, Health 

This is part one of a two-part blog post.

Over the past few years, I have seen many athletes with a common toe problem – overlapping toes. Some people may call then underlapping toes or call them some other name. When a pinky toe goes under the 4th toe, both toes can be negatively affected. Skin is pinched. Hot spots and then blisters form. Often callus develops as the skin is constantly under pressure from the overlapping toe.

While most common to the 4th toe and pinky toe, overlapping toes can affect any two toes. This is not necessarily a problem limited to running shoes or hiking footwear. It can happen in everyday footwear too. The cause of over-lapping is unknown. Many experts suspect that they are caused by an imbalance in the small muscles of the foot.

There are some easy solutions, which may or may not help, because toes are different. You can switch to Injinji toe socks, giving each toe it’s own little sock and some degree of protection. You can cut out a portion of the insole under the toe that goes under the other toe, giving the toe some extra space. Another option is to tape around the toe or toes to give some protection too.

This is an idea to help runners, adventure racers, and hikers with the problem of overlapping toes. You will need Injinji toe socks, ENGO Blister Prevention Patches (large ovals), and removable insoles. There are two types of separators you can make. This post will cover the first of the two.

Toe Separator Number 1

I use an ENGO Blister Prevention Patch as the toe separators. They make a small and large oval, but I like the large because of its size.

The first toe separator is easy to make and use – and it uses one large ENGO patch. Take a scissors and cut a long oval into a strip, about ¾ inch wide and 1¾ inches long. If you are cutting this for a middle toe or for large toes, it may have to be 1 to 1 ¼ inches wide and a bit longer. Round all corners. Cut one of the remaining sections into a small strip, ¼ inch wide and 1¼ inch long. Take the large oval and remove half the backing from one end. Wearing Injinji socks, put the large oval between the two affected toes. Put the end of the large oval with the exposed adhesive over the toe next to the toe that goes under it. The blue side will go from the top of one toe, run between the toes, and under the toe that normally goes under the other one. What you have is an S shaped patch from the top of one toe, between them, and then under the next toe. Take the small strip and remove the backing, and put one end of the adhesive on the white backing that is underneath the toe at the bottom of the S. The other end of the strip can be stuck onto the top of that toes sock. The small strip is needed to hold the bottom of the S under the toe when you put your foot in your shoe. The S shaped patch will keep the toes apart. Obviously, these are single use. If the patch seems too weak, use two strips to make the S patch stronger.

Toe Separator #1 - top view

Toe Separator #1 – top view

Toe Separator # 1 - bottom view

Toe Separator # 1 – bottom view

Injinji socks and Engo patches can be purchased at Zombierunner.com. The patches can also be purchased at the Engo website.

ENGO Blister Prevention Patches

Today’s post will cover a great way to prevent blisters using ENGO Blister Prevention Patches. It’s a repeat of a post from mid-2013.

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.

ENGO in Footwear

ENGO in Footwear

ENGO in Footwear

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.

ENGO Applied

ENGO Applied

ENGO Applied

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 Patch in Shoe

ENGO Patch in Shoe

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.

ENGO in a Shoe's Heel

ENGO in a Shoe’s Heel

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.

Patching Heel Counter Wear in Shoes

Holes in Heel Counter

Holes in Heel Counter

Occasionally I see runner’s shoes that have wear holes in the material in the heel counter. This picture from Dan shows his shoes with holes to the outside of center on both heels. I emailed the following suggestion.

ENGO Back of the Heel Patch

ENGO Back of the Heel Patch

I’d try an ENGO Back of Heel Patch. They are made to shape to the curve of the back of the heel counter. Put them in when the shoe is dry. Rub them a bit in a curving motion to help them form to the shape of the shoe. Then peel off the paper backing and apply from the center outwards to the sides. Rub well so they adhere to the shoe’s material. You could also try the large ovals if the hole is small. The blue ENGO patches are very slick and can take a lot of wear. Once the blue wears down to expose white, replace the patch. Sometimes the holes are on the sides of the heel.

Heel Patch in Shoe

Heel Patch in Shoe

Heel Bump

Heel Bump

Last summer at Western States, I had a runner whose shoe was rubbing her heel raw. You can see from the image that she has a prominent heel bump. This, of course, contributed to her problem. This is the kind of problem one needs to plan for before it becomes a major issue – especially at the event the magnitude of Western States.

Cut Shoe Heel

Cut Shoe Heel

We decided to cut a notch out of the outside of her shoe’s heel. This allowed the back of the shoe to spread apart for her large heel bump. Then I applied an ENGO Back of the Heel Patch to the inside of the shoe’s heel counter. This provided some protection to her heel bump.

The large ENGO ovals can also be used when there is a small area to be covered.

I have been a fan of ENGO Blister Prevention Patches since I first discovered them years ago. The ovals are perfect for the common areas at the side of the heel where blisters form at the junction of insole and heel counter. The large rectangles are great to put on insoles underneath the ball of the foot, another common problem area.

Check out the ENGO website for more information. ENGO products are available through Zombierunner. If you are in Australia or New Zealand, ENGO products are available through Rebecca Rushton’s Blister Prevention website.

Disclosure: Tamarack Habilitation Technologies supplies me with ENGO Patches as I need them for races.

Your Event Homework for Foot Care

Several months ago I had the good fortune to work on the medical team at the Jungle Marathon Amazon. My specific role was foot care of the 78 runners and to work with the others on the medical team to teach them good foot care techniques. I learned some things that I am calling, Your Event Homework…” By that I mean, your homework is to consider these five things that, if you learn them, can help you be more successful in the event.

Over seven days, I got to know most of the runners. The race offered a one-day, four-day, or seven-day event, and runners were required to carry all their gear and food in a backpack. Hammocks were mandatory and everyone had to carry a mandatory kit of emergency supplies. Because of all the gear and food, some runners limited their medical supplies to the most basic (read: as small as possible). Others had large plastic bins or bags of their mandatory gear. Most had planned well.

An Insole with an ENGO Patch

An Insole with an ENGO Patch

As runners came through the pre-race check-in to have the mandatory gear inspected, I talked to a lot of them about their shoes, socks, and – their feet. While doing this, I applied ENGO Blister Prevention Patches into many shoes. While I had a good supply of the patches, this would be the only time to get them into runner’s shoes. Once the race started, their shoes would be wet and the patches would not stick. I noticed that there was a good mix of shoes even though the runners were from around the world.

Then the race started.

Three miles into the race, there was a stream crossing. After that, their feet were almost always wet or full of sand or grit. Here are the five main things I saw.

  1. At the end of day one, one runner asked for help with his insoles. The sand and grit had worn holes in both heels. I could tell, however, that they were well worn even before he started. We dried out the insoles and I cut away any rough edges. Fortunately, the sun had dried the insoles enough to apply ENGO patches over the holes.
  2. Some runners had chosen shoes that were minimalist in design, and some did not hold up well in the rough trails in the jungle, where rocks, roots, and plants tore at the shoes’ uppers. Two runners’ shoes were shredded at their sides. The handiwork of one of the runners saved the shoes as he sewed the uppers back together with dental floss.
  3. Several runners had made bad choices in socks. All cotton socks have no place in any athletic event, much less anything over a 5km race. One runner in particular had low-rise cotton socks suitable for walking in the park, but not a seven-day race in the jungle. Another runner had only two pairs of socks, and the first pair had holes in both heels at the end of the first day.
  4. Some runners experienced problems with toenails that affected their race. Long nails, untrimmed nails, and nails with rough edges cause problems, which can lead to toe blisters, and black toenails.
  5. While some of the runners managed their feet by themselves, many came to the medical team day after day. While we were there to help, time and supplies were limited – especially time. Runners that can patch their own feet are ahead of the game. Some had the right supplies, while many others with small mandatory gear kits, did not have the necessary equipment. The medical team worked hard to patch feet as we could. Whenever we could, we made sure the runners saw what we were doing so they learned how to do it themselves. By the end of the race, I saw more that a few runners that were working on their feet and helping others.

Lessons to Learn:

  1. Make sure your insoles are in good shape. Many runners fail to remove their insoles and inspect they – to see if they need replacing. Most standard insoles are flimsy and should be replaced after several hundred miles. For a $25-$30 investment of new insoles, you’ll gain support and comfort. Investing in a marathon, ultramarathon, multi-day race, can be costly. Yes, there’s the money side, but there’s also the gear required, time spent in training, and travel. This is not the time to skimp on footwear. Chose good, high-quality shoes – preferably a design you have worn before and know works on your feet. And whatever you do, don’t wear old shoes that have seen better days.
  2. Invest in good, high-quality socks – new socks – not some dug out of your socks drawer that are threadbare. Find the right socks for your feet. Try Injinji socks if you have toe blister problems. Try a thin liner with a bit heavier outer sock. Try several types of socks to find the right amount of cushion and support.
  3. Learn how to care for your toenails. That means how to trim them and file them smooth so they don’t catch on socks or hit on the top or front of the shoe’s toe box.
  4. Runners can help themselves by learning how to manage their feet and treat any blisters that might develop. While some events have medical personnel and staff experienced in foot care, many don’t. Or they don’t have the best choices in supplies. Better to be prepared and know what your feet need – and how to manage your own feet. Then if there are people providing foot care, you can use them, and tell them if you need or want certain things done.

In the same way you train for an event, and invest in clothes and packs, and food, you must invest in your feet.

ENGO Blister Prevention Patches

September 8, 2013 by · Leave a Comment
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.

ENGO in Footwear

ENGO in Footwear

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.

ENGO Applied

ENGO Applied

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 Patch in Shoe

ENGO Patch in Shoe

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.

ENGO in a Shoe's Heel

ENGO in a Shoe’s Heel

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.

ENGO Patches can be purchased at the ENGO website, Zombierunner.com, and Rebecca’s Blister Prevention website.

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.

%d bloggers like this: