Feet at Primal Quest

September 6, 2015 by · 2 Comments
Filed under: blister care, Foot Care, Sports 

The 2015 Primal Quest Expedition Adventure Race concluded a few days ago, after nine days of challenges to the 11 four person teams. This was an unsupported race, meaning there was no crew support. Race organizers, medical staff, and general volunteers all worked together to provide levels of support that were awe-inspiring. People worked together to help the racers get through over 400 miles of a variety of disciplines: trekking, orienteering, white water kayaking and rafting, mountain biking (sometimes referred to as hike-a-bike), ascending and rappelling, sleep deprivation, extreme heat and more. Through all this I am fairly certain that everyone had fun.

At the eight TAs (transitions areas), where racers changed from one discipline to another, were a number of volunteers. Medical staff included doctors, podiatrists, nurses, paramedics, physical therapists, athletic trainers, and more. Our job was to care for whatever medical needs the racers had, including anything and everything. Even though the teams carried mandatory medical gear, most relied on the medical staff for their advanced foot care skills and materials. Khristy Gavigan, an RN and the medical volunteer coordinator, had done an amazing job of assembling extensive medical kits for each TA.

I worked two TAs – TA3 and TA6. At each TA, we set up and area where the teams checked in, arranged their gear so they could get to their gear and bike boxes, and decided on an area for medical and foot care. Generally we went through all the medical bags to see what supplies we had.

Checking Katie's feet

Checking Katie’s feet

Because the four person teams were seen at each TA, there was a lot of foot care required. Many times we worked on all four team members in assembly line fashion. There was a mix of problems, but it seemed we saw more toe blisters and toenail care required than usual. Many toes had the skin torn off the top of blisters. While there was a lot of heel blisters, there didn’t seem to be many ball-of-the-foot blisters. Treatment was with kinesiology RockTape and in some instances, Leukotape.

Teams might receive some foot care at one TA, and the next, and the next, and so on. That’s the nature of an adventure race with multiple disciplines.

Some of the teams were short coursed – meaning they bypassed one or more discipline due to overall time cutoffs. This reduced the number of racers with maceration from one of the kayak sections, and reduced more foot issues from the following 50-mile trek. All in all, I think feet were pretty much what I expected. The majority of teams were prepared with supplies to repair their feet, which is always nice to see.

Blister Repair – Your Way or Their Way?

March 7, 2015 by · 1 Comment
Filed under: blister care, Foot Care, Health, Sports 

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.

Foot Problems at Western States

June 25, 2013 by · Leave a Comment
Filed under: blister care, Foot Care, Health, Sports 

This weekend close to 400 runners will start at Squaw Valley and make the trek over the Sierras towards Auburn – 100 miles away. It’s the Western States 100 Mile Endurance Race. I love the race, having completed it three times in the late 80’s. It’s tough and throws a lot at the runners. Cold, heat, extreme heat, streams running down the trail, rocks, dust and grit, water crossings, long ups and long down through numerous canyons – and for many runners, a second sunrise with renewed heat.

Toe Blister

Toe Blister

I will again be working at the Michigan Bluff aid station doing foot care. Later, I will be at the finish line taking care of feet as people finish. Having worked this race for years, I have a good idea of what foot problems to expect. Here’s what I commonly see and a few tips.

First, here are common problems:

  • Toe blisters. Under the toenail, on the tips of toes, between toes, and under toes.
  • Heel blisters. Either at the rear of the heel or at the sides.
  • Ball of the foot blisters. Either in a certain area or across the whole foot.
  • Side of the foot blisters.
  • Stubbed toes. From hitting rocks or roots.
  • Sprained ankles.
  • Sore feet.

Here are some tips:

  • Cut toenails short and them file them smooth. No rough edges to catch on socks or hit the toebox of your shoes.
  • Reduce your calluses as much as possible. This close to the race, don’t file too much off. Aim to get reduce the thickest rough patches.
  • Use Engo Blister Prevention Patches in problem areas – sides of the heels and ball of the foot. They will greatly reduce friction and shear.
  • Pretape any problem areas.
  • Check your insoles for thick edges at the sides of the heel – always a problem area. Thin these down or change insoles. Most side of the heel blisters are caused by these edges.
  • Don’t use Vaseline as a lubricant. Stick to SportSlick, BodyGlide, or a similar lube.
  • Change socks frequently and clean your feet. Today’s trails shoes often have mesh uppers, which allow sand, dirt, and trail dust inside the shoe, on and into your socks, and on your feet.
  • Know how to manage your feet and patch blisters on your own – or your crew should have these skills. You can’t count on aid station people knowing what you need or want or doing it on your time schedule. There may be other runners in front of you or they may be out of supplies.
  • If you feel something inside your shoe, stop and clean it out. Even a small rock can cause problems.
  • Wear gaiters to keep rocks and trail grit and dust out of the top of your shoes.
  • Build your own quality foot care kit. Stock it with what you need and learn to use everything.

Maybe I’ll see you at Michigan Bluff. I hope it’s just to say Hi as you run through.

Have a great race.

An Introduction to Shear and Blister Formation

June 17, 2013 by · 2 Comments
Filed under: blister care, Foot Care, Health, Sports 

This is a guest post by podiatrist Rebecca Rushton from Australia. She has looked at blisters, how they are formed, what causes them, and how to prevent them. For years, the common thinking about blister causes has been friction, heat, and moisture. Rebecca’s research has led her to identify shear as a leading cause of blisters. Read the article and then check out her website. Over the next months, Rebecca and I will take an in-depth look into blisters, their formation, and treatments. Her website Blister Prevention has a lot of valuable information on blisters (more on that at the end of this post). Here’s Rebecca’s article.

An Introduction to Shear and Blister Formation

Foot blisters continue to wreak havoc with endurance athletes’ feet in spite of their best preventative efforts.

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.

Rubbing Causes Abrasions

Most of us use the term rubbing to mean two surfaces moving across one another – like when you rub your hands together.  The type of skin injury that rubbing causes is abrasions. An abrasion is where the top layers of skin are rubbed off – you end up with a red raw sore. Blisters (from shear) and abrasions (from rubbing) are completely different entities – they have different mechanisms of injury and affect different layers of the skin. Here’s a video on blisters versus abrasions on the feet.

Is the distinction important? Yes it is. The lack of understanding of blister causation is at the heart of why foot blisters continue to plague athletes.

Achieving True Blister Prevention Success

There are 3 factors that influence shear. Impacting on these is how we can minimise shear and prevent blisters.

1) Type of skin

Thinner and more mobile skin (like we saw earlier on the back of the hand) will abrade before it blisters.  In contrast, thicker and less mobile skin (like on the palm of your hand) is the type of skin more likely to form and maintain a blister.  Do the same experiment we did before but with your index finger on your palm – the skin is noticeably thicker and less mobile in comparison. (This is why blisters are most common on the soles and palms)!

Apart from the thickness and mobility characteristics which determine the ability to blister (and which you can’t do an awful lot about), shear is influenced by two other factors: friction and bone movement. You need both, not just one, to create skin shear. The good news is that these things we really can change! Change one or more of these, in one of many ways, and you can successfully prevent foot blisters.

The cause and influencing factors of foot blisters

The cause and influencing factors of foot blisters

2) Friction

Friction is the force that resists the movement of one surface against another. It’s the degree of slip or grip between surfaces. Low friction (slippery) is when two surfaces glide easily against each other. High friction (sticky) is when the two surfaces tend to grip together.

The moist in-shoe environment during exercise causes high friction levels between the shoe, sock and skin. This causes these materials to stick together … yes the shoe sticks to the sock and the sock sticks to the skin … for longer.  They all stick together for longer because of high friction.

3) Bone Movement

Meanwhile, as we run the bones move back and forth. With the skin remaining stationary (for longer) and the bones moving back and forth as far as they can go, the soft tissue in between stretches – that’s what shear is.

This concept of friction and bone movement leading to shear is depicted in the diagram below and in this video demonstrating shear.

Orange = shoe | White = sock | Brown = skin | Purple = section of soft tissue undergoing shear
Orange = shoe | White = sock | Brown = skin | Purple = section of soft tissue undergoing shear

The purple area is a section soft tissue between the skin surface and its underlying bone. Although the heel itself has not lifted within the shoe due to high friction levels, the bone has moved up relative to the skin surface causing shear to the soft tissues in between.

About Rebecca

Rebecca’s website Blister Prevention has a lot of valuable tips and techniques, and information on blisters. Take some time and explore the site, subscribe to updates and receive a copy of her ebook, Blister Prevention for Active People. Rebecca is a podiatrist in Australia.

Next Up? More on Shear and Blister Treatments

Over the next month or two, we will talk more about shear and common blister treatments – including what works and doesn’t work. Make sure you are a subscriber to this blog to receive each post. You can do that at the box at the upper right side of this page.

Ball of the Foot Blisters

December 29, 2011 by · 1 Comment
Filed under: blister care, Foot Care 
A large blister on the ball of the foot

Here's a big blister on the ball of the foot

Ball of the foot blisters are quite common. Often they are more common when runners change to walking. Let take a look at these blisters.

Challenges with Ball of the Foot Blisters

There are three problems with ball of the foot blisters that make them more problematic than blisters elsewhere on the foot. Look at the image and you’ll see the large amount of area it covers. And yes, there’s blood in the blister section between the big and first toe.

  • They often extend up into the skin between one of more toes
  • They can spread out to cover a large area side-to-side and further down to the mid-foot
  • They can easily tear at the front most area at the base of the toes

Preventing Ball of the Foot Blisters

I have learned several things about preventing ball of the foot blisters

  • Keep your feet as dry as possible.
  • Pre-tape if you are prone to these blisters
  • Check your insoles for rough surfaces and change to a smoother insole
  • Make sure your shoes fit and you don’t have a lot of movement of the forefoot inside the shoe

Patching Ball of the Foot Blisters

  • Drain any blister, with a slit cut where ongoing foot pressure during the foot strike will expel extra fluid out
  • Patch the blister with your favorite product and tape
  • Apply tape from up one side of the foot to up the other side – not too high but over the edge
  • Use one or more strips to cover the problem area
  • Cut a figure 8 out of a piece of tape and apply it first to the forward edge of the tape between two of the toes, and pull it between the toes, securing it on the top of the foot.

The larger these blisters, the harder they are to patch. Try to patch them before they grow into monster blisters.

Here’s a link to a page on FixingYourFeet.com about Taping for Blisters.

These photos are courtesy of Ron Jones and were taken as I patched a runner’s feet at Badwater.

Blister Prevention – Things You Put Around Your Feet

April 20, 2011 by · Leave a Comment
Filed under: blister care, Foot Care 

What you put around your feet is one of the most important factors in blister prevention. The wrong type of socks or footwear that fits wrong can create pressure points and blisters. This is an area where trying different ideas can really pay off.

  • Use an ENGO patch inside your shoe or on your insole to reduce friction.
  • Wear two pairs of thin socks, a liner sock under a heavier sock, or double layer socks.
  • Always use moisture-wicking socks – no cotton.
  • Wear SealSkinz WaterBlocker socks for really wet conditions.
  • Wear Injinji toe socks if you have frequent toe blisters.
  • For bottom of the feet and heel blisters, try another insole.
  • The heel is the first part of the sock to wear thin. Get new socks before they get too threadbare.
  • Be sure to smooth the heels of your socks, and check the heels of your insoles and the inside of your heel counters for folds and worn or torn material.
  • Replace worn-out shoes.
  • Use shoes that are tested for the event, distance and the elements: cold versus hot, roads versus trails, and wet conditions.
  • Try another pair of shoes-many shoes breathe better than others and are easier on your feet.
  • To drain water, use a red hot nail to burn drain holes on the sides of your shoes right at the sock liner height where the shoe bends.
  • Well-made and well-fit orthotics will help prevent blisters.
  • Wear gaiters to keep rocks, dust, and dirt out of your shoes.

Blister Prevention – Things You Apply to Your Feet

April 11, 2011 by · Leave a Comment
Filed under: blister care, Foot Care 

Most athletes hold a common misconception about blisters-that blisters are simply a fact of life that one must learn to live with. Most athletes try tips that they have learned from others. If those don’t work, they move on to another idea. Most try for a while, then give up and spend the rest of their life fixing their inevitable blisters. The fact is there are many ways to prevent blisters.

There are many things you can apply to your feet to help prevent blisters. Lubricants and tape are two of the most popular. Powders are a distant third. Remember that whatever you apply to your feet will react to what you put around your feet. When you apply a lubricant, your socks will pick up some of it, and more applications will be necessary. Tape works well, but tape applied poorly can be pulled loose as you pull on your socks.

In the 3rd and 4th editions of Fixing Your Feet, I had a chapter about 175 Ways to Prevent Blisters. Occasionally, I heard from people about how many of the ideas were confusing and seemed to contradict themselves. So for the 5th edition, I changed the chapter to reflect the best ideas in the different categories. The ideas below are the best in the Things You Apply to Your Feet section.

  • Use a callus cream to soften calluses and prevent friction and resulting blisters.
  • Use one of the popular lubricants to reduce friction. Body Glide, Hydropel Sports Ointment, Bag Balm, BlisterShield Roll-On, Brave Soldier’s Friction Zone, and Sports Slick are the most popular. Reapply each time you change your socks.
  • Use powder to reduce friction. BlisterShield, Zeasorb, Odor-Eater’s, or Gold Bond foot powder
  • Use one of the popular blister patching products: Spenco 2nd Skin. Blist-O-Ban, Bunhead’s Gel Toe Caps
  • Use one of the popular tapes to pre-tape known hot sports or problem areas before your event: Kinesio-Tex. Leukotape, Elastikon, duct tape
  • Use Certain Dri Anti-perspirant or Ban Roll-On on your feet to control perspiration.
  • Use a slick energy gel wrapper between your sock and shoe to reduce friction.
  • Avoid Vaseline – it’s too sticky, attracts grit and hardens on socks.
  • For wet conditions, coat your feet with Hydropel Sports Ointment, Desetin Maximum Strength, or Sudocrem twice a day during a big race. Primarily designed to prevent diaper rash, this antiseptic healing cream leaves an oily trace on your feet and lasts for ages.
  • Put a patch of lamb’s wool on a bruised, sore, or blistered area, and secure it to the foot with tape.

Try one or two. Give them a chance and maybe try a few more.

Unusual Blister Patch Jobs

November 15, 2010 by · Leave a Comment
Filed under: blister care, Foot Care, Foot Care Products 

I have written a lot about patching blisters. Many of these patch jobs are what I would call routine. But every so often I get to try something new. Today’s post is about one of those times.

Kinesio Tex tape at the base of the big toe

Kinesio Tex tape at the base of the big toe

At the TransRockies six-day stage race this past August, a runner came in with a blister in the crease of skin at the base of the big toe.

The photos show my patch job from two angles. After draining the blister and prepping the skin, I started with a two-inch strip of Kinesio Tex tape.  I cut the tape so the finished piece was about three inches in length. I rounded each end and made it a small oval on one end with a larger oval at the other end. The tape was applied over a dab of zinc oxide. I applied the tape at the base of the toe to start and then slightly stretched each end of the tape – the small oval end going up and between the big and first toe, and the larger oval side going around the outside of the big toe. The two ends did not touch on top of the toe.

Kinesio Tex tape at the top of the big toe

Kinesio Tex tape at the top of the big toe

The beauty of this tape job is that the Kinesio Tex tape is soft and easily forms to the curves of the toe. Another plus is that it will not bunch up in the crease of the toe. Try this with another tape, Leukotape, duct tape, Elastikon, or white athletic tape, and you’ll see how those tapes do not form to the curves of the foot and will have creases and folds in the tape.

This tape patch can be done to any toe and any other part of the foot. With care in the skin prep phase, and putting sock on and taking them off, it will stay on for several days. Be sure to rub the tape for 20 to 30 seconds so its adhesive can bond with the skin.

Kinesio Tex tape is available at Zombierunner.com.

Patching Heel Blisters

August 30, 2006 by · 9 Comments
Filed under: Footcare, Footwear, Health, Sports, Travel 

Ok, it’s time to get back to what I promised a few posts back – patching heel blisters. If you spend any amount of time with bad feet, you’ll notice that probably 80% of heel blisters are on the sides of the heel, towards the back of the foot. The exact location is easy to see. They start where the shoe’s insole connects with the shoe’s upper. From this point, they grow upward and to the sides. This was explained in my Heel Blisters post on August 5.

     Patching them is fairly easy and yet can seem complex. There are several steps basic to all blister patching.

Read more

When Blisters Go Bad

June 15, 2006 by · 3 Comments
Filed under: Footcare 

Blister on the feet are very common, whether on children, teens, or adults. They can occur from all types of footwear in all types of situations, from everyday activities to extreme sports. Occasionally, blister go bad.

2591234_cwank1web      Several years ago Hillary Swank was filming Million Dollar Baby and while training, developed a blister on one of her feet. She ignored it and it festered into a raging infection. Hillary ended up in the hospital for treatment. Ignoring the simple blister could have resulted in the loss of her foot from infection.

    Then last week, the British Medical Journal published evidence of two cases of children suffering toxic shock syndrome from blisters on their football boots. They describe two cases of toxic shock syndrome (TSS) in children after playing football in new boots. Both developed friction blisters over their Achilles tendons. The blisters contained Staphylococcus aureus, which in one case was found to express the toxic shock syndrome gene (TSS1).

     In the first case, a 13-year-old girl developed friction blisters over both heels after playing a competitive game of football in new boots. She was admitted to her local hospital after developing a range of symptoms including fever, rash, abnormally low blood pressure (hypotension), vomiting and diarrhea. Further examination revealed a blister, 2cm in diameter, over each of her Achilles tendons containing the bacterium Staphylococcus aureus with the toxic shock syndrome gene (TSS1). A diagnosis of toxic shock syndrome was made and she was treated with antibiotics.

     In the second case, a healthy 11-year-old boy played football in a new pair of boots, causing a blister on his right heel. Over the next two days he developed fever, vomiting and diarrhea, and a rash. Within hours of admission to hospital, his condition deteriorated and his blood pressure fell. Again, pus from the blister on his heel contained Staphylococcus aureus. He also developed a secondary rash during convalescence.

     Toxic shock syndrome has become less common since the link with tampon use was recognised in the 1980s, write the authors. And in children, for whom this association does not apply, the syndrome is rare. But these cases show that the syndrome may follow relatively trivial skin trauma.

Images_8      The lesson here is that blisters are an injury and must be watched for signs of infection. I’d wager that 99.9999% of all blisters heal fine. But if that .0001% is on your foot, or on the foot of someone you know or love, you’d be more careful. Remember, happy feet are blister free feet.

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