Today’s post is a thru-hiker’s story about her experiences with her feet. It’s one that make you grimace when you hear the details and see the pictures. I share the story because there are lessons to be learned. Here’s her story.
“This past April, I started the Pacific Crest Trail intending to thru-hike northern-bound to the Oregon/Washington border. I’m an experienced long distance thru-hiker and frequently hike 20-25 miles without issue.
“Rarely do I get blisters, and I have no calluses. The day I started at Campo, California, I hiked a 20-mile day and was shocked to find my toe pads laden with deep blisters at the end of the day and a couple smaller surface blisters on my little toes. This is how the trip started! I did my best triage but wasn’t very familiar with how to treat such ailments, and so continued hiking.
“By the time I’d reached mile 350 on the trail, my feet were an absolute mess. Blisters had become wounds, wounds became infected, toenails were falling off and each foot was severely compromised. At one point I sat on the edge of the trail so frustrated I was in tears! What was wrong with my feet?
“Only after my feet got good and angry did I switch to a larger size shoe in hopes of accompanying the swelling. I think one of my mistakes early on was that I used gauze and Neosporin along with athletic tape and made mummies of the feet. Add to this 90-degree heat through the desert and my feet looked like big balloons, which barely fit in shoes. They were so painful that one day while walking, I took my socks off to give my feet more room. That caused heel blisters. But aside from cutting the sides out of my shoes, I had no other choice. I was in a remote area hardly able to walk despite taking NSAIDS.
“After I hit Big Bear Lake, I rested for 4.5 days in hopes of curing my issues. When I set back out on the trail I switched to Altra Olympus 2.0, in a half size larger than normal (for swelling issues) since they offered more cushion. I hiked for two days, but my feet were not healed all the way and I suffered terribly during that timeframe. Blisters popped up in places they’d never been, likely because my gait was compromised and I was still in pain. I was finally able to hobble down to a highway and hitchhike to a town where I put on flip-flops, rented a car and flew home.
“I’d never had these issues before in all my years of long treks. When I got home, I started researching foot care online and came across your book, which I downloaded. I read it cover to cover and feel it’s the part of the puzzle that I never knew I needed and also, the solution moving forward. I’m following your advice with the tapes and have been practicing with bandaging as you suggest, including the betadine prep and a dab of zinc oxide on the new recovering skin. I also purchased some powders and lubes and will take the whole shooting match with me when I get back out on the trail.
“I’m also trying Injinji liners to see if that helps, although my feet aren’t particularly sweaty. I believe that the deep blisters in my toe pads were due to the heavy water weight I had to carry through the desert, which was different than how I trained since I underestimated how much water I’d need in such a harsh environment. I did wear trail gaiters, but my shoes were Altra Lone Peak 2.5’s and they allowed dirt to come in. There was a lot of abrasive mica in the desert soils and it’s hard to keep feet clean with little water available. I used wet wipes but it was still hard to get the grit out. My pack’s base weight is very low at 14 pounds, so I’m doing everything I can to keep the pack as light as possible and have lots of experience with backpacking. Nothing else hurts – no hip, knee or ankle pain – just these silly feet.
“I did not make any changes to my shoe or sock choices before starting. I used the same combination I’ve used for years without problems. Things I did not do which I probably should have: take more breaks, start out slower and not push huge days, wipe my feet off several times a day with wet wipes, change socks more frequently, stop more for hot spots, listen to my body, and take preventative measures to not get blisters.”
I initially asked the thru-hiker my usual questions. Did you change footwear, socks, conditioning, etc? Were you wearing good socks? Was the weather a factor? Do you wear gaiters? Do your shoes/boots have a mesh upper that allows grit and dirt inside? It sounds like your feet rebelled at what you wanted them to do. We traded emails several time with her providing answers and my giving suggestions.
The lessons I mentioned at the start of the post? Here are a few that pertain to thru-hikers, hikers in general, runners, ultrarunners, and adventure racers.
- Know your event. Carrying extra water, food, and other supplies in a weighted fannypack, hydration pack or backpack can put extra stresses on your feet.
- Know any possible weather issues. Heat, rain, and humidity can all cause problems.
- Know any possible trail/road issues: water, stream crossings, desert sand, grit, and rocks.
- Know about any special accommodations necessary for like swelling feet, and grit or sand getting into your shoes’ mesh uppers.
- Know what to do when you have problems with your feet and have the supplies to fix them. Practice ahead of time to refine your skills.
- Know how to get your blistered feet back into hiking/running condition.
Providing foot care for athletes at ultramarathons and multi-day events is a huge responsibility. Their feet are what keep them going, and if you are known for providing foot care, the athletes will be appreciative of whatever you can do. If you are simply helping one runner, you might be a bit more casual. But if you will be part of a foot-care team, you need to be prepared.
In 2015 race directors of several multi-day ultramarathons in Europe were overwhelmed by shear volume of runners seeking medical attention for blisters. They said it took upwards of 30 minutes per foot to treat most of the runners, which caused a significant drain on the ability of the medical team to look after more serious problems. Beginning in 2016, these races are introducing a triage system for medical care. Patients will be assessed prior to treatment with the most needy being treated first, regardless of how long others have been waiting. If the assessment indicates “minor” blisters, advice will be given and runners will be expected to treat their own feet. All runners must have their own blister treatment kit as part of their mandatory gear kit. They candidly state that foot care is easily divided into several phases, what they call the 6Ps: “Proper Preparation Prevents Piss-Poor Performance” and provide a thorough list of preparation, prevention, assessment, and treatment suggestions. “Proper Prevention” means in the months before the event, “Prevents” means during the race, and “Piss-Poor Performance” is what happens if you fail to follow the first three Ps.
Rebecca Rushton, an Australian podiatrist and owner of blisterprevention.com.au, and I agree that foot care at multiday events is vital. I consider a 100-mile ultramarathon a multi-day event. The problem is that many runners have become dependent and expectant that events will have medical personnel providing even the most basic foot care. Participants have come to treat foot care services at events as a perk of the event. While it’s nice to have, it’s not practical and sustainable long term. Race directors need volunteers with the time and expertise in foot care techniques, and the budget for supplies and equipment. The larger and longer the event, the more volunteers are needed and the more costly it becomes.
I wrote in a blog post that, “… at some events participants will move along the trail from aid station to aid station, and at each one, require some degree of foot care. What was patched at an earlier aid station didn’t work or didn’t hold up and they want someone at the next aid station to redo their feet. That’s a lot of work and supplies.” Many athletes also fail to take care of their feet and fail to plan, and in many cases fail to take common sense action (reduce calluses, trim toenails, do self-care, etc) that could have prevented or reduced the problem. Rebecca and I support what we call assisted self-management. In the aid station, provide a table and a few chairs, and basic foot care supplies. Medical personnel will be available to give advice and tend to more serious treatment. It could even be that runners are shown how to patch the first blister and then they manage the rest. It’s a workable model and builds on today’s popular DIY (do-it-yourself) method of learning new skills.
This leads to a new mindset among many medical professionals that manage medical direction at races and multiday events that is worth considering. An article in the April 2014 Sports Medicine summarized it well. “Although participants in ultra-endurance events should be educated and prepared to prevent and treat their own blisters and chafing, blister care will likely be the most frequent use of medical resources during ultra-endurance foot races.” The mindset is that participants need to shoulder some of the responsibility for managing their feet. Medical staff at aid stations can quickly become overwhelmed even to the point of running out of supplies. We can help promote and support this new mindset in several ways:
- Give participants tips to prepare their feet in advance of the event. (Refer to “Foot Care in Multiday Events” in chapter 16.)
- Give participants tips on the best footwear selections for the event (types of shoes, gaiters, oversocks, camp shoes, and so on).
- Give participants a list of foot-care gear they must carry. A section on mandatory foot-care gear can be found at the end of this chapter. Even runners in a 100-mile race can carry a small Zip-lok bag pinned to their bib number or in their hydration pack.
- Advise participants whether or not foot care services will be provided and if so, to what degree. This includes no foot care and supplies, limited self-management, or full service.
- Provide a self-service table of supplies for runners to use in DIY patching of their feet. This can speed up their in and out times at aid stations.
- Stress the importance of knowing how to work on one’s feet (by reading this book or through other sources, or workshops).
- Stress the importance of runner’s having crews knowledgeable in foot-care work and prepared with a well-stocked foot-care kit.
How you implement the principles of self-management or whether you decide to provide full service foot care services depends on several factors: The number of participants, the difficulty, the remoteness, the number of medical volunteers, the availability of supplies (and being able to absorb the cost) and the number of aid stations and how far apart they are. It should be a well-thought out and joint decision between the race director and the event’s medical director.
Please comment how you feel about foot care services at the races you run or help with, or as a race director. We’d love to hear your thoughts.
Filed under: blister care, Books, Foot Care, Foot Care Products, Footwear Products
This summer will see the release of the 6th edition of Fixing Your Feet: Injury Prevention and Treatment for Athletes. The exact date is still up in the air, but I’d expect it sometime in late July or early August.
The 5th edition was released in February 2011 and it was due for an update. Nothing in foot care remains static. New products and techniques are constantly being identied.
The new edition will be fully updated with new material, websites, new foot care products and product information, and new techniques and learning’s in footcare. I have been working with the publisher since last summer in talking about ways of improving the content. Every paragraph on every page has been evaluated to determine whether the content could be made clearer, or whether it is dated and needs to be removed. Much of the content has been expanded to provide more benefit.
The sixth edition has an important new chapter, Blister Prevention – A New Paradigm. It contains new information about blister formation and introduces the concept of shear, which in turn, changes the way we look at blister prevention and treatment. This chapter itself is worth the cost of the book.
It’s available for preorder at Amazon with their pre-order price guarantee. You can order now and if the Amazon.com price decreases between your order time and the end of the day of the release date, you’ll receive the lowest price. Here’s the link: Pre-order Fixing Your Feet, 6th edition on Amazon.
The cover is still being worked on and will likely change.
Disclaimer: the above link contains my Amazon affiliate code and a purchase through it earns me a few pennies.
Feet are a big part of my life. For the past 19 years, Fixing Your Feet has introduced me to great people. I have enjoyed helping runners at events like Western States; Badwater in Death Valley; Primal Quest in Colorado, California and Washington; Raid the North Extreme in BC Canada; the TransRockies in Colorado; Racing the Planet Atacama in Chile; the Coastal Challenge in Costa Rica; the Avon Walk; the Susan G. Komen 3-Day Breast Cancer Walk; The Amazon Jungle Marathon, and others. In all these events, I’ve worked on thousands of feet. In addition, I’ve responded to an uncounted number of emails from folks asking for foot care advice.
The best part has been the people I have met. Runners, hikers, adventure racers, walkers, and their crews. Athletes walking a fine line between making a cutoff in a race, front runners, back of the pack runners, short and long distance hikers, solo and in groups – all ages. Athletes with a simple blister and others with blisters all over. Athletes in pain, and those wanting to quit.
I can recall many of these people. I remember their stories. Some of you are in my stories. I have learned a lot from each person whose feet I have patched. I don’t pretend to know everything about feet. Together we have learned a lot. I thank each of you for what you have contributed to the Fixing Your Feet story.
I wish all my readers a fun, bright, delicious, warm and cozy, and loving Merry Christmas. I hope you can spend time with family and friends – and maybe give your feet some nice soft socks.
Several weeks ago I was interviewed by Gabriella Boston, a reporter for The Washington Post. She emailed me asking whether I was available and when could we talk. When she called we talked for about an hour. She asked all kinds of questions about foot care based on my experiences for runners.
The article came out on the 17th and is worth reading. The title is How Runners Can Keep Their Feet Happy. Sections include, run training, proper footwear, cross training, and foot care. Gabriella interviewed two podiatrists, a physical therapist, and me. Fixing Your Feet is also mentioned in the article. Click on the link in the paragraph above to read the full article. My bet is that you’ll learn something new.
Filed under: blister care, Books, Foot Care, Foot Care Products, Footwear, Footwear Products, Health, Sports
I love reading the unsolicited email and testimonials from athletes who have discovered Fixing Your Feet. They help motivate me to keep going. Here are two. The first is a simple sentence. The second is a personal story I received last week. Thanks everyone who has passed along their story.
I’m pretty sure Fixing Your Feet has saved most of us at one point. ~ an email from Deb Bosilevac.
Then Billy Pearce (husband, father of 3 boys, nurse and ultrarunner) shared his story:
My many years of ultrarunning with a three shoe size difference in feet caused by a traumatic injury as a child has always been a challenge with shoes and blisters. So I choose ultrarunning as my passion! I have had two DNF’s in the Australian classic Coast to Kosci 240km beach to Australia’s highest peak. So this year my attempt to get a finish was one of real attention to where things had gone wrong before.
This year I had my podiatrist and friend on my crew, (Brad White, from Footcare Woden, Canberra ACT Australia). I attend his clinic monthly as routine and we have planned all year for this race. Brad is also a gifted runner.
Best footcare ever. In over 42 hours 26 minutes of running I needed two stops to attend to feet – totaling less than 15 minutes for both stops! I gave him a copy of Fixing Your Feet and I think we have created a new passion for him.
I found your work after a 48 hour race when my feet become so bad I was reduced to painful shuffle for last 24 hours then weeks of healing. I am now able to race 24 hours on a track without a scratch and as we say, “If you do not have a plan for your feet, you do not have a race plan.” Thanks heaps for the help and advice you give so freely.
Do you have the 5th edition of Fixing Your Feet? Last summer while working on feet at the Michigan Bluff aid station of Western States, a runner’s crew member came up to ask me if I’d sign his copy of Fixing Your Feet. While I signed it, I told him he had a very outdated book the 2nd edition! Every edition has gotten better and larger with a lot of new and updated information. Maybe I am biased, but the 5th edition is the best ever.
If you have older editions, you owe it to yourself to invest in the 5th edition. You can purchase it through my website, Zombierunner, and most online bookstores. At Amazon, it’s available in either print or Kindle formats.
Filed under: Foot Care, Foot Care Products, Footwear Products
What better time of the year to pamper your feet than Christmas. Our feet are encased in heavy socks and footwear. We take them for granted. Here’s a look at my favorite things for your feet this year. My suggestion is to check out these items at Zombierunner.com. Don and Gillian support athletes with great service. You can click on their link and at their website, click on Foot Care or any other items. Zombierunner has everyone of these items, except a callus file.
Engo Footwear Patches – these slick patches go in your shoes to reduce friction. A must for any foot care first aid kit.
Drymax Socks – my favorite socks that hate moisture. Their micro-fiber technology is a sweat removal system to keep your feet dry.
Injinji Socks – the original toesocks that are perfect for many sports, and a must for those who are prone to toe blisters.
Sportslick Lubricant – Prevents blisters, chafing and skin rash during sporting activities. This skin care product also cures jock itch, athlete’s foot, and other skin conditions.
Stuffitts Portable Drying Solutions – for shoes, gloves, helmets to defeat wet and stinky gear. Their soft, lightweight forms combat moisture and kills odor in personal wearable gear.
BlisterShield Powder – a great powder, especially for those who prefer powder over a lubricant.
Kinesio Tex Tape – a great tape that breathes and conforms to the shape of any part of your feet. 1, 2, and 3 inch widths.
Leukotape – one of the stickiest tapes available. 1 ½ inches wide.
Superfeet Insoles – one of the best insoles for support. They are available in a number of options.
Toenail Clippers – everyone needs a good clipper to tame their toenails.
Callus File – a callus build-up can lead to problems that can result in blisters underneath this hard layer of skin.
Natural Running – this is a great book that teaches you to run the way nature intended, mimicking the healthy, efficient barefoot style you were born with, while keeping feet safe from rough modern surfaces.
Fixing Your Feet, 5th edition – my best-selling book that covers all aspects of footwear and foot care.
Here’s the Amazon link for the Fixing Your Feet print edition.
Here’s the Amazon link for a Fixing Your Feet Kindle edition.
I hope you’ll consider one or more of these as gifts either to yourself or a friend.
Disclaimer: I am an affiliate of Zombierunner and make a few pennies when you buy through my link.
Lets talk about expectations for foot care at races. I like this subject because being prepared is important. It can make my work easier and likewise that of everyone helping with medical and foot care at races. This coming weekend is Western States and there will be a lot of runners needing help with their feet.
Over the years I have seen everything at 100-mile races. Runners with holes in their socks or socks so worn you can see through the material, severe Athlete’s Foot, long and untrimmed toenails, huge calluses, no gaiters, the use of Vaseline as a lubricant, the use of Band-Aids on blisters, existing injuries that have not healed, shoes that should have been tossed out, huge blisters caused by not treating hot spots, and lots more.
I see runners with crews that manage everything for them – including foot care. These are typically runners who have experience in longer races. They also seem to have some degree of foot care expertise. They will come through an aid station and meet their crew and all is well. If they need foot care, they have the supplies and they or their crew knows how to use the materials. They are prepared.
Other runners are less prepared. They might have crews, but they don’t have the foot care supplies, much less the expertise in how to do what they needed. They count on someone being there to fix their feet.
Many of these runners expect a lot from the podiatrity staff – sometimes, they want a miracle. There are four issues to get past. First, many times there are no “official” podiatrity people at the aid station. No podiatrist anyway. Second, what they get is someone who is maybe a nurse, paramedic, EMT, or even a full-fledged MD, who is volunteering as the aid station’s medical person. Third, often this person(s) has limited skills in fixing feet. And finally, fourth, often they have limited supplies.
So what do you get? You get a person who really wants to help but may be hindered by their limited skills and resources. Don’t fault them if the patch doesn’t work or it feels wrong. You might try and give them directions on what to do – with limited success.
What’s wrong here? Your expectations are wrong. You cannot expect every race to have podiatrity people at every aid station, with supplies to fix hundreds of feet. Some races have medical staff while other races have none. A majority of races do not have podiatrist on hand. Is it their job to provide it? Only if they advertise such aid.
This means you should be prepared at any race you enter, to have the foot care supplies and knowledge to patch your own feet – or have crew that knows how. Does that sounds harsh? Maybe so, but you entered the race. You spent money on travel, a crew, food, new shoes, lodging, new shorts and a top, water bottles, and more. But did you spend a few bucks on preparing a good foot care kit?
Why take a chance that I or anyone else is there to fix your feet? I find lots of runners who have my book (Fixing Your Feet) but I am amazed at the large numbers who haven’t heard of it.
Many of us don’t mind fixing your feet. In fact I love to do it. But we can’t be everywhere – at all aid stations, at all hours, and at all races. Can you do me a favor? Tell some else about Fixing Your Feet and this blog. Make their life a bit easier and help them finish their race with happy feet.
I’ll be in the medical area at the Michigan Bluff aid station. In back of the scales and food tables. If you need me, I’ll be there.
Those of you who are fans of Fixing Your Feet will probably agree that the 5th edition released in the Spring of 2011 is the best one yet. Of course I am biased, but I have seen each edition become better that the previous ones.
Yes, I think the 5th edition is the best one.
My publisher, Wilderness Press, released it as a trade paper version. So imagine my surprise when I received word that it would be released in a special edition hardcover edition for Rodale Press and Runner’s World. Several months ago, in a deal with my publisher, they did a test, offereing Fixing Your Feet to their subscribers. Because the test was successful and the interest was good, they decided to go with a hardcover edition.
If you are interested in Fixing Your Feet in hardcover, click on the link. As you can see from the ad below, they did a great job with the marketing.
Last weekend I worked the Michigan Bluff aid station at the Western States 100 Mile Run. The 2011 running of this amazing footrace over California’s High Sierras was different for several reasons.
This was a huge snow pack year, resulting in many runners with wet feet and footwear for long periods of time. The temperatures were particularly mild, resulting in the highest finisher rate since 1993.
As I worked the medical aid station, feet were my first responsibility. Somehow that’s the assignment I draw, and the rest of the medical staff are quite happy to let me do my thing. I don’t mind, it’s what I do. Push come to shove, many of them could do an acceptable job of patching a blister – but they are not knowledgeable with the best techniques.
So I set up my canopy, two chairs, stool, a card table with all my gear, my foot care kit, and several containers of extra supplies. I was ready. Over the course of the front-runner to the last runner, there was about an eight hour spread.
I didn’t count runners that I helped. I never do. I just move from one to the next as they come in for help. Strangely, this year I might have had one time when I had two runners in at the same time. Most years, there are runners waiting. And the runners I treated had less serious problems. So what did I see?
Two runners come to mind. I was amazed at how these two runners treated their feet. The first runner had come in for some minor blister repair. After I checked his feet and made a few minor repairs, I asked him whether he had clean socks. He pulled a pair out of his drop bag and handed them to me. One was fine. The other had a hole over the tip of the big toe. He laughed and told me they were his lucky socks, and asked whether I could put a Band-Aid over the hole. Really!
The second runner came and complained of heel problems. One heel had a quarter-size blister directly on the bottom and I cleaned and drained it, and then applied tape side to side under the heel. The other foot had no identifiable fluid or blister. I asked about clean socks and he said he didn’t have any. So I powdered his damp socks and put them back on his feet. When I picked up his shoes, I was amazed to see that both insoles were worn through in the heels – exactly where he was having problems. The insoles had essentially fallen apart in the heel, creating a hole into which went the flesh from his heel. No wonder he had heel problems. I added an Engo Blister Patch on top of the indentation on each insole. After I had him set to go, he remembered he had extra socks in his drop bag, which he had forgotten about.
I saw several other things that could lead to problems.
For one thing, a majority of runners were not wearing gaiters. Those who know me have heard me preach the benefits of gaiters to keep junk out of shoes. Don’t use them and you take chances with small rocks and debris getting kicked up into the shoes, which can lead to hot spots and blisters.
Another huge issue was runners with wet socks. Failing to change socks for 65 miles leads to softened and macerated skin. More than one runner saw their day end because of this problem. When your feet hurt because of maceration, you slow down – and that leads to longer times between sia stations, and ultimately leads to missing a time cutoff. Some of these had gone through aid stations and not changing socks. Taking five minutes at an aid station to change socks can save you from slower and slower times when feet turn painful. Knowing ahead of time that snow would be an issue, failing to plan with additional socks, and even shoes, is puzzling.
Working at Western States is always an experience. I always come away having learned something new. This year I learned that no matter how many people I think I have reached and influenced with good foot care tips, there are still many who need to hear the message.