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


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.

Doc on the Run

September 19, 2017 by · Leave a Comment
Filed under: Foot Care, Foot Care Products, Footcare, Health, Sports 

I recently attended a conference where I had the opportunity to meet Dr. Christopher Segler. He’s an award winning foot and ankle surgeon and podiatrist who is a runner and 15-time Ironman finisher. His practice is in San Francisco and the Silicon Valley in California. His focus in on helping runners, triathletes, and athletes to stay active and keep running.

Christopher is unique in that he is literally the Doc on the Run – i.e., he makes house calls. His website is a wealth of information on everything foot related, his Runner’s D.I.Y. advice, products, videos, courses, and ways to connect with him. Even if you don’t live in the area, you can get a consultation over the phone or through Skype.

Doc on the Run

Take a look at his Doc on the Run website and read some of the articles. His Runner’s D.I.Y. page has information on arch pain, ball of the foot pain, ankle sprains, and five other areas. The Advanced Treatments page has information on Platelet Rich Plasma injections, stem cell therapy, neuroma treatment toenail fungus treatment and more. Many pages have videos.

There’s also a Doc on the Run podcast with 58 episodes. Many are under 30 minutes in length. Show topics include sprained ankles, neuromas, tendon injuries, shin splints, toe and toenail injuries, plantar fasciitis, and more. You can subscribe to his podcast in iTunes or on his website to receive notice of new episodes. If you haven’t discovered podcasts yet, Christopher’s show is an excellent place to start.

Finally, he has a book Runner’s Heel Pain: Self-Diagnosis and Self-Treatment available as an ebook.

I encourage you to check out the Doc on the Run website and podcast. Every athlete at some point suffers from injuries. Dr. Christopher Segler will help you get healed and keep on running.

He also has a Facebook page and videos on YouTube.

Feet at Western States

July 2, 2017 by · 2 Comments
Filed under: blister care, Foot Care, Footcare, General, Health 

On June 12 I wrote a blog post Running a Wet 100 Mile Trail Run.

On June 24, I found out many runners ignored my advice, to their detriment. Maybe they didn’t read it, or didn’t see it, or simply read it and ignored it.

A typical year at WS has our foot care team at Michigan Bluff lancing and patching a goodly number of blisters. On toes, heels, ball of the foot, arches, and more. Maybe 50 to 75 blisters. Maybe more. We really don’t count.

This year I lanced and patched one blister. Yes, that’s right – ONE.

But this was not a typical year at WS. Instead of dry conditions, there were miles of snow, and mud, combined with heat so runners soaked themselves in streams and poured water over their hears and down into their shoes.

Maceration WS100I predicted the outcome. Maceration.

Runners came in to see us complaining of blisters and were surprised when we told them there were none. Just macerated feet.

So we powdered their feet, asked them if they had dry socks. And hopefully, dry shoes. We fixed and changed what we could and sent them on their way – wishing them well.

Were this year’s conditions not known in advance? I don’t think so. Runners and crews knew of the record snowpack. They should have expected water and wet conditions. For whatever reason, many ignored the warnings.

It’s unfortunate that so many runners jeopardized their opportunity for a buckle and a successful race on something that was manageable.

I’d love to hear from runners about what they thought. Send me an email.

In the meantime, click the link and read Running a Wet 100 Mile Trail Run.

Running a Wet 100 Mile Trail Run

In less than two weeks is the running of the Western States 100-Mile Endurance Run. I will be at the 55.7-mile Michigan Bluff aid station, along with Tonya Olson and others on the medical team. Our aim is to make sure you are healthy to continue on towards Placer High School and a good finish.

For the past six years, the mountains have been dry and the trails dusty. Feet get caked with dirt. Blisters are caused by the dust and dirt as an irritant inside shoes and socks.

2011 was the last snow year. I have looked a bit online and am unclear on snow conditions this year. But this much I am certain, there will be snow and feet will be wet. How much snow remains to be seen.

I am 100% certain that runners will have long sections of wet trail, either from the snow, snow run off, water on the trail, and stream crossings. That equals miles of running with wet feet. I’m also 100% certain that we’ll have lots of wet feet, blisters, and maceration. In fact maceration could easily be a bigger problem than blisters. Don’t forget to avoid pouring water over your head where it will run down your legs into your shoes, contributing to maceration. Lean forward rather then standing straight up.

A blister can be lanced and taped, and runners can continue without to many issues. Maceration is a different story. Once your feet are macerated – the skin shriveled like a prune, there is no quick fix.

With prolonged exposure, the skin on your feet goes through four stages as the maceration progresses to severe cracks and tears in the skin—that can be race ending. As the skin on your feet moves through the four stages, the skin folds over on itself and can crack or tear. This can be painful. Many runners come into aid stations complaining of bad blisters only to be told they don’t have any – it’s severe maceration.

I expanded the section on maceration in the 6th edition of Fixing Your Feet. Starting on page 188, are 12 pages with sections about Cold and Wet, Maceration, Trench Foot and Chilblains, Frostbite, and Snow and Ice. Included are tips and products to help with those conditions. If you have a copy, read the sections – and have you crew read them also. On page 101 is a section on High-Technology Oversocks like SealSkinz and Hanz, Serius, and eZeefit waterproof type socks. Another sock worth mentioning is ArmaSkin socks, which is used as a sock liner and fits tightly against your feet. They would be my choice for a wet race. I’d also wear gaiters to keep snow, dirt, and grit out of my shoes.

As far as skin preparation, here’s what I would do – expecting wet feet. My drop bags would have clean socks, small containers or baggies with powder to help dry wet skin, and container or tubes of any of the following: RunGoo, Trail Toes, Desitin Maximum Strength Original Paste, Boudreaux’s Butt Paste, or a strong zinc oxide paste. I’d also carry some in my hydration pack. I would apply a liberal coating of one of these from toes to up the heels and then roll my socks on. Rolling socks on will help prevent smearing and thinning the paste on areas of the feet.

Since proactive care is better than reactive, I’d check my feet at most aid stations, adding paste as necessary. If my feet were feeling bad at an aid station, I’d apply some powder to help dry the skin, and have some food while letting the powder do its job. Then apply more paste and clean socks. If your feet are badly macerated, it will take drying them, coating them with powder, and rubbing it in and letting it sit for a while, then stripping off the powder and adding more of your choice of paste. That may easily mean 15 minutes or more. If you don’t take care of macerated feet, they’ll get worse over time, requiring more care and longer time – and there may come a point when it’s irreversible in the time you have.

The time you take in aid stations does add up and it can quickly erase any time cushion you may have to finish within an allotted time. But skip quality care, rush too fast, ship hydration or eating, and you’ll pay the cost.

Remember your first line of defense should be your crew. They should know what you want for foot care and how to do it correctly. There aren’t enough medical people to take care of everyone’s feet and we may be busy with others, adding more time to your aid station visit.

Yes, as I said earlier, I will be at Michigan Bluff and Tonya and I will do our best to help you. But heed my warning. We cannot work miracles when you have failed to take care of your feet from the start. In the same way we cannot take away the pain and problems with black toenails and toe blisters caused by your not trimming your toenails, we cannot repair badly macerated feet when you have not tried steps to control the maceration.

I ran Western States in the late 80s and one thing I learned is the outcome of the race in your hands. Whether is your training, conditioning, choice of footwear, choices of food, what’s in your head, your choice of crew – lots of things affect your race. I encourage you to take the time necessary to care for your feet.

Miles on Your Feet

April 17, 2017 by · Leave a Comment
Filed under: Foot Care, Footcare, Health, Sports 

I have worked medical and provided foot care at hundreds of ultramarathons, adventure races, walks, and multiday races and have seen the same thing over and over—runners who do not have a good training base.

Of course there is not a set number of miles you need to run to do well at a race. Conditions vary. Some may get by with minimal miles a week, others run over 100 miles or even over 150 miles a week as they ram up for a big event. By and large though, the runners with more miles on their feet do better that those that have fewer miles.

I’ll take this a step further and say that the more miles on your feet, the better your feet will be.

At the Western States 100 Michigan Bluff 55.7-mile aid station, for example, the top 20 to 30 runners come through without needing any type of foot care.

There may be one of two that get some type of foot care from their crew down the road, but if so, is generally pretty minor. Most often, if anything, they just change socks or shoes. As the race progresses and more runners come through, we begin to see runners needing help with foot care. The farther back the runners are, the more foot care they need. Not every runner, but many of them. And many of them have multiple issues. Not just one blister, but quite a few. The more problems they have, the more complex the repair, and the longer it takes to complete the fix. This becomes a huge issue if they are trying to stay ahead of the cutoffs at each aid station. I remember a runner several years ago that we patched up. At the next aid station, she need more care and wanted to get out of the aid station quickly to avoid the cutoff. That meant not doing a quality patch job—and she came back to the aid station after going a bit down the road. She knew her race was over.

So the point here is that you need to put lots of miles on your feet in order to train them for long conditions. You can run 10 miles a day, day after day, and then try and do a 50-miler, and odds are—you’ll have problems. You have 10- to 15-mile feet—not 50-mile feet.

Doing Your Own Foot Care

Doing Your Own Foot Care

This applies to walking, running, adventure racing, hiking, any activity where you use your feet. It all boils down to how many miles you are putting on your feet. It’s about conditioning your skin, muscles, tendons, and finding what shoes and socks are the best, and finding the best fit—everything about your feet. We all can’t be the top runners. Many runners don’t have unlimited time to train. So what can the rest of us do? Make sure you get some long runs, especially closer to your race. Make sure you have the best possible fit in your shoes. Make sure you wear quality socks. Reduce your calluses. Learn proper toenail care.

Every sport has this. In the summer I ride a 24-hour road bike charity event where you ride as far as you can in 24 hours. How far I go hinges on several things. How well my legs are trained, how my stomach holds up, how my back feels. But the most important, for me anyway, is how many miles I have on my butt. That’s right. When I ride over 250 miles in 24 hours, every part of my body has to be conditioned. If you get saddle sores, they can be painful with every pedal stroke.

If you want to finish a race, your feet have to be in the best condition possible. That means knowing what they need for shoes and socks, skin and nail care, and having the right foot care kit—and how to use the stuff in it. It also means putting the miles on your feet. That’s what will carry you to the finish line.

Fixing Your Feet 6th Edition Available

After 14 months of revising and updating, editing and then editing again, and issues with the cover, the 6th edition of Fixing Your Feet is available.

While it has been available for pre-order in Amazon, they now have the print version in stock and ready to ship. Amazon currently has the 6th edition priced at $13.64, well below the retail price of $19.95 – a great buy. Here’s a link if you want to order a copy.

The Kindle ebook version will be released in about two weeks.

As I meet runners and crews at races, I find many have an older edition. I encourage you to bite the bullet and get the 6th edition. It’s well worth it.

Every new edition has all products and URLs verified. In addition, the text has been tightened up to eliminate redundancy of topics, and remove out-dated information. Many topics have expanded and new information. Every chapter has been reviewed and some degree of change made.

The chapter on Extreme Conditions and Multiday Events includes new information on the growing problem with maceration, as well as new information on trench foot, chilblains, and frostbite, all possible in the adventures we participate in.

A new chapter is Blister Prevention – The New Paradigm. The chapter revises the thinking that moisture, friction, and heat are the causes of blisters. After much study by experts in the field, I introduce the concept of shear as the underlying cause of blister formation. Several charts show the relationship of moisture, friction, and heat to shear, and how new things like bone movement, skin resilience, and pressure; along with the usual things like fit, socks, insoles, lubricants, and more, influence blister formation. The chapter also stresses the value of ENGO Blister Prevention Patches.

Fixing Your Feet, 6th Edition

Fixing Your Feet, 6th Edition

I would be remiss if I didn’t comment on the new cover. The first cover mock-up had an image of an athlete trying to patch her feet, but it did not capture my view of doing foot care and blister patching well. I arranged a photo shoot with a local photographer and Tonya Olson, a physical therapist and well-trained foot-patching expert as our model. Thanks Tonya. I’ll let you be the judge, but I like the cover and the design.

If you have an older edition, you will benefit from the new edition. Even if you have the 5th edition, you’ll find value in the new 6th edition. Order the 6th edition through Amazon.

Once you have the new edition, I’d be appreciative of a review in Amazon when you have time. Reviews are important and help other buyers make informed decisions.

Note: The links above are my Amazon affiliate link.

12 Foot Care Tips for Success at 100’s

June 18, 2016 by · 4 Comments
Filed under: blister care, Foot Care, Foot Care Products, Footwear, toenails 

Next week is the Western States 100 Mile Endurance Run and all the fun and hoopla that goes with it. I ran the race from 1985 – 1989 with a best time of 24:32. It was a challenge but I had fun every year. Ever since then I have been associated with the run in some capacity and for the last 16 or so years have provided foot care help at an aid station or two and the finish line. In that time I have seen a lot of runners come through aid stations needing foot care.

Feet at the finish line of Western States

Feet at the finish line of Western States

This year I decided to make a list of my top 12 foot care tips for success at 100’s – whether Western States or any other 100-mile run. You don’t want feet like in this picture.

  1. Make sure your shoes fit. That means a bit of room in the toe box and good grip in the heel. It also means that the shoes are in good shape.
  2. Make sure you wear good socks. That means no cotton, but only moisture wicking or water-hating socks. If you are prone to toe blisters, consider Injinji toe socks.
  3. Trim your toenails short and then file them smooth so when you run your finger over the tip of the toe, you don’t feel any rough edges or points. This goes for thick toenails too – file them down.
  4. Reduce your calluses with a callus file and moisture creams. Trust me, you don’t want blisters under calluses.
  5. Wear gaiters over the top of your socks and shoes. This keeps dust and grip from going down inside the shoes and inside your socks. Understand though that the mesh in today’s trail shoes does allow dirt and grits inside the toe box, even with gaiters.
  6. Use a high-quality lubricant like SportsShield, Sportslick, RunGoo, Trail Toes, or ChafeX. Do not use Vaseline.
  7. Know how to treat a hot spot and blister between aid stations – and carry a small kit in your hydration pack. Early care is better than waiting until a blister has formed or until the blister has popped and its roof torn off.
  8. Just as you have trained by running and conditioning, you need to know what your feet need to stay healthy and blister-free during the race. Just as you have learned what foods you can tolerate during a race and during the heat, you need to be prepared for foot care problems. Your feet are your responsibility.
  9. Make sure you have a well-stocked foot care kit(s) with your crew and they know, in advance, how to care for your feet. Trailside, at an aid station, is not the time to learn or to train them what you like done.
  10. When you pour water over your head and body to cool off, lean forward to avoid water running down your legs and in your shoes. Getting wet feet or waterlogged socks can lead to maceration very fast.
  11. Consider using RunGoo or Desitin Maximum Strength Original Paste liberally on your feet and toes to control moisture from excessive sweat, stream crossings, snow melt, and water poured over your head that runs down into your shoes. Reapply at aid stations. Maceration can quickly lead to skin folds, tender feet, skin tears, and blisters.
  12. Finally, DO NOT assume that every aid station has people trained in foot care or have the supplies necessary to treat your feet. If you have a crew, have them work on your feet. Many times the medical personnel are backed up or dealing with more serious medical emergencies. And, truth be told, blister are not a medical emergency. Heat stroke, heat exhaustion, dehydration, and the like are more serious than blisters.

Every year I am amazed at the number of runners who are ill prepared. They put extra socks in their drop bags – that have holes in them. The have open Athletes foot sores between their toes. Their shoes are shot and should have been replaced. They have not done good toenail care. They have thick calluses. They start the race with old unhealed blisters. Their shoes don’t fit. They wear full-length compression socks and then are amazed when we can’t get them off at the aid station to work on their feet. Tight fitting compression socks may feel good but are almost impossible to get off and even worse to get back on over patched feet.

While medical people will always try to help you, we can’t work miracles with your feet when you have neglected caring for them from the start. Again, your feet are your responsibility.

A Pep Talk on the 6P’s of Foot Care

May 20, 2016 by · Leave a Comment
Filed under: blister care, Foot Care, Footcare, Sports 

A month ago I wrote a blog post about two multi-day races in Europe that are implementing a triage system for medical care at aid station – the outcome of their being overwhelmed by the amount of treatment and time that their participant’s blistered feet were requiring. Here a link to that post about Providing Foot Care for Athletes.

In this post, I want to expand on a quote from their website that I included in the original post. It was about the 6Ps of foot care.

They stated that foot care is easily divided into several phases, what they call the 6Ps: “Proper Preparation Prevents Piss-Poor Performance” and provided 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. Let’s talk about these one-by-one.

Proper Preparation – In the months leading up to your race, and even race to race, you, and you alone need to be responsible for learning proper preparation. You need to learn how your feet respond to being wet and maceration starts, to being in sweat soaked and dirty socks, and when your feet are caked with dirt and grime. You need to learn about the best lubricants and/or powders, and insoles. You need to learn what causes the hot spots and blisters and what steps you can take if or when they develop. You need to practice taping or whatever strategy you plan to use. This is your job – not your crew’s job – and not the medical or non-medical people at aid stations.

Doing Your Own Foot Care

Doing Your Own Foot Care at Raid the North Extreme in northern BC Canada 2007

Prevents – You need to know what to do when you develop hot spots and blisters, and have the materials and tools, and even more importantly, the skills, to fix your feet. This focus on “prevents’ needs to happen in the months before your race and during the race. It’s about proper toenail care, skin care, callus reduction, shoe and sock selection, whether to wear gaiters, preparation for a variety of weather conditions, and of course, putting the required and necessary training miles on your feet. This also is your job – not your crew’s job – and not the medical or non-medical people at aid stations.

Piss-Poor Performance – This is what can happen when you fail at any of the first three Ps. Your performance suffers. Your race may be over. In many races, medical volunteers will try and help patch your feet. Some races do not have the luxury of dedicated medical volunteers for all the aid stations, much less the finish line. You cannot and should not count on a race having medical personnel to help with your foot care needs. Just because there is a doctor, nurse, or EMT at an aid station, that doesn’t mean they know how to patch feet. You cannot and should not count on races to have the foot care supplies that you want for your feet. If you will have a crew, work with them so they know how to work on your feet with your supplies.

Some runners may feel I am being too harsh as I tell you these are your responsibilities. Let me share a story from years ago. In 1985 I ran Western States for the first time. After crossing the river at Rucky Chucky, I had blisters in the arch of one foot. Someone at the far side offered to help patch my feet. After lancing the blisters, I had a wad of gauze taped to my arch, which changed my gait. I finished the race, but learned a lesson. The treatment, while well intended, was not the best for my foot. I learned to take responsibility for my own foot care. For the next three years running Western States, I managed my feet – and I’m sure that experience helped fuel my interest in foot care.

So my point in expanding on the 6Ps in this blog post is to reinforce the notion that foot care of your feet is your responsibility. If there are medical volunteers at a race, and they know how to patch feet, and have the supplies – and the time, consider yourself fortunate – but don’t count on them being there.

Please feel free to agree or disagree with my position, and share by commenting below,

Providing Foot Care for Athletes

April 22, 2016 by · 1 Comment
Filed under: blister care, Foot Care, Health, Sports 

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, 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.

Credit: Oxfam TrailWalker Melbourne and Rebecca Rushton

An example of self-assisted foot care. Credit to Oxfam TrailWalker Melbourne and Rebecca Rushton

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.

Science of Ultra Interview

A while back I was interviewed about foot care by Shawn Bearden of Science of Ultra website and podcast. Here’s the link to the Science of Ultra website.

Shawn asked great questions and got deeper into foot care than any other interview I have done. We talked about the essential components of good foot care, from shoe fitting to blister care. Then we wrap it up by defining the essential features of a good minimalist foot care kit for your next run or adventure. The whole episode is about an hour and 22 minutes.

I encourage you to listen to the interview on the Science of Ultra website and then check out his website and other interviews. Podcasts can be subscribed to in iTunes and Stitcher Radio. By subscribing, you’ll received shows on your device (smart phone or tablet) as they are released.

Science of Ultra

Science of Ultra


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