When you enter a road or trail race, or start an adventure race, or plan a group or solo event, whether single day or multi-day, do you think about blister management?
There can be many responses to this question. Here are my guesses at the most common three responses.
For many, I’d guess the answer would be no. What happens, happens. They may have a simple first aid kit or blister kit. A bit of tape, maybe a pin and an alcohol wipe.
Others, if participating in an organized event, will count on aid station personnel to have the supplies and knowledge to fix whatever problems develop. They don’t understand that some aid stations do not have the right supplies or medical people, or if they do, they have little to no understanding of how best to treat blisters.
The third bunch takes a full hands-on approach. They have a fully stocked kit and either they or their crew know how to work on feet.
Then there’s the same question put to race directors and event organizers. When you put together the plans for your race, how much thought and planning goes into foot care for the participants?
Again, I think there are three typical responses.
The first is they don’t think about it. It’s either they simply don’t even think about it or they decide to let the runners deal with whatever problems develop.
The second group puts together simple kits of typical first aid equipment and puts them out on tables at the aid stations. Most likely, no one working the aid station knows what to do, or if they do, it’s hit or miss repair. Supplies often are minimal and sometimes not even helpful. I worked an event, a long multi-day race that fell in this category. Runners were hurting.
The third group is wiser. They have medical people and a well-thought out kit. Some, at larger events, have dedicated foot care people.
I need to say here that you don’t have to be a medical person to provide good foot care. I have worked at many events where non-medical people had excellent foot care skills.
You Can Help
So here are my questions for you.
- As a runner or adventure racer, what do you want to see at a race?
- What do you expect to see?
- If the race website and material does not specific what kind of aid or foot care is provide, do you assume it will be there?
Here’s my reason for asking.
A few days before Western States next month, I will be presenting a session about Blister Management at the 2nd Annual Medicine & Science in Ultra-Endurance Sports Conference in Squaw Valley. Plus two hands-on workshops teaching foot care skills.
I have my presentation pretty well planned. I’ve done this long enough and have learned a lot of material and skills. But sometimes I am puzzled at what I see from the race participants. Ill-prepared runners and crews and even some dumb decisions by runners (socks with holes, brand new shoes, serious athletes foot, bad toenails, and more).
My audience will be medical personnel and race directors from many ultras and adventure type races. The aim of my presentation will be to teach them about blister management during a race.
What I need to know is a bit about your expectations about blister management at races as a runner. Send me an email. You can copy in the three questions above and answer all three or as many as you want.
Thanks for your help.
Many of you have participated in a 50-mile race, a 100-mile race, an adventure race, or some other type of multi-day race. Some multi-day races are non-stop while others are stage races. A lot of these races provide medical care at aid stations – and some also provide foot care.
If you have received foot care aid at these aid stations, you have been helped by the generous people I’ll call the “heroes” of foot care.
The picture shown here is from the Amazon Jungle Marathon this past October. Every one of the 15 members of our medical team helped with foot care. No one said they didn’t want to do feet. You can see the working conditions: sand everywhere, water bottles as footrests, a tarp to protect the runners and our knees (that quickly filled with sand), and supplies strewn all over and shared between medics. What you don’t see are the flies and bugs that were constantly in our faces, and the sweat running down our faces from the humidity. Now keep this up for hours, well into the night.
These are the heroes of foot care.
Most races have them. They volunteer their time and even supplies. They often go to races at their own expense. They work often under adverse and uncomfortable conditions. They want to do the best patch job possible. They are dedicated to getting you back into the race. They want you to have a great race experience. In short, they care.
I’ve been at races that have well-organized foot care services and others that have nothing. Some people providing their services are podiatrists, doctors, nurses, paramedics or EMTs, physical therapists, chiropractors, or other medical specialists. Other times they are simple people who have learned foot care techniques on their own or from someone else.
I know you appreciate these foot care people.
So how can you thank them? Let me share a few ideas.
- Simply say thank you.
- Make sure you have done everything possible to have healthy feet going into the race.
- Trim your toenails short and then file them smooth.
- Reduce calluses as much as possible.
- Wear quality shoes and socks.
- Know how to do your own foot care just in case we aren’t there or there’s a line for our services
- And finally, be patient. Good foot care and blister patching takes more than a minute.
We love helping runners and always welcome your appreciation.
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.
I’ve been on vacation much of the past two weeks and given my time away, have turned to a good friend, Alene Nitzky, an experienced and well qualified ultra runner who wrote an article published at the Coloradoan website. You have heard me go on and on about the importance of god foot care. Here’s another slant, from an ultra runner who has run Badwater and many other ultras.
Runners spend all kinds of money on entry fees, clothing, travel to races, nutritional supplements and race foods. They spend all kinds of time on training, body work, stretching, weight training or cross training.
They worry about their weight, hydration, nutrition, sleep, and preparing for race-day conditions. And most of all, they obsess about finding the right shoe.
But in all this obsession, the two things they forget are the most essential tools they have to carry them from start to finish and go into those expensive running shoes.
Your feet are your base of support. They are the vehicle that carries you forward and through the distance. You can’t run without them. So why do so many runners neglect them?
You can do all the right training and preparation, wear the right shoes and gear, but if your feet fail you, it can ruin months of hard work.
The problem is lack of foot care. Blisters are just a symptom of the problem. Friction and moisture are the two culprits in creating blisters. Improper hydration plays an important role, too.
Blisters are caused by layers of skin and fabric or debris trapped inside the shoe or sock, combined with friction from running motion. Creases in socks, rough edges inside shoes, and dirt contribute to these rough spots. Calluses that are allowed to develop on feet and are not removed can lead to deep, painful blisters. Rough or jagged toenails can catch on socks, causing the fabric to bunch and rub against the toes.
The role of hydration, especially too little sodium relative to fluid intake, also contributes to blistering. Fluid travels out of the blood vessels into the tissues and separates layers of skin, making shoes tight and contributing to more friction. Check your hands while running. If your hands are swollen, your feet are swollen, too. Popular sports drinks often don’t have enough sodium to replace what is lost during long, hot weather events.
Regular pedicures are helpful. If you don’t want nail polish and all the extras, you can do much of it yourself. Softening and removing calluses over time reduces the likelihood of blisters under these trouble spots. Soften rough, dry spots with lotion when you’re not out running. Keep your toenails trimmed and filed. Underneath the ball of the foot, most people don’t realize they have callouses, and these are a common trouble spot.
Moisture is another problem, even in our dry climate. If you are running trails with stream crossings or crossing snow banks at high altitude, you are also at risk for developing blisters. But even without water crossings, your feet sweat, and moisture in socks and shoes can become a problem.
Keeping your feet as dry as possible helps. If you have a dry pair of shoes and socks to change into after the stream crossings are behind you, that will help.
Use a good sock that wicks moisture away. There are many different brands at specialty running stores. Keep your shoes and socks clean. If you’re running a road marathon, don’t race in shoes or socks you wore on trails. The dirt will stay inside and cause friction.
A foot kit should be part of every runner’s supplies. You can learn how to give yourself a pedicure, how to stock a foot kit and tips for avoiding blisters and other foot problems by doing some research.
Band-Aids are fine for knees and hands, or even on feet that aren’t being used, but they are not meant for use on feet while running. They don’t hold up to friction, moisture and shearing. The Band-Aid will soon bunch up and crease, and any dirt in your shoes and socks will stick to them, causing more friction.
Two excellent resources for learning how to take care of your feet are John Vonhof’s book, Fixing Your Feet, 5th Edition, Wilderness Press, 2011, and website fixingyourfeet.com. You can also get a free subscription to his fixing your feet blog with helpful tips.
I encourage you to check out Alene’s websites. She’s a great person with a big heart.
Filed under: blister care, Foot Care, Footcare, Health, Sports
Last weekend I worked the finish line at the Ohlone 50KM Trail Run in San Francisco’s East Bay hills. This is a tough trail, very exposed to the day’s sun, and every step is either up or down. Some people say, and I believe that if you finish Ohlone, you have a great chance of finishing Western States.
One runner who I admire and consider a close friend is Catra Corbet. She has proven herself as the “owner” of this trail. Many years she will run an Ohlone 100 or more just because she loves the trail so much. This year, Catra did 200 miles on the trail!
In talking to Catra after she completed the 200 miles, she mentioned that she had no blisters. I remember years ago taking a picture of her taping her toes. She used to tape every toe. I have a photo of her with a heel blister too. Now though, Catra runs blister free. What’s the difference?
I believe Catra’s success with blister free feet came through the miles of running she puts on her feet. She doesn’t run short runs, she doesn’t run a couple of times a week – she runs a lot. Many of you know Catra, or have heard of her – and know how much she runs. She also has found the right shoes for her feet – Hokas. She also wears Drymax socks – a favorite of mine.
But it’s not just Catra. I have worked medical and provided foot care at hundreds of ultramarathons, adventure races, walks, and multi-day races and have seen the same thing.
At the Western States 100 at 55.7 miles, for example, the top 20 to 30 runners come through Michigan Bluff 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 that 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 will have problems. You have 10-15 mile feet – not 50 mile feet.
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.
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. Change your socks and shoes as necessary for the conditions of your run or race.
Over the years, I have talked to too many runners who think blisters are naturally a part of running and racing. They don’t have to be. Make smart choices and put miles on your feet, and your feet can be blister free.
Filed under: blister care, Books, Foot Care, Foot Care Products, Footwear, Health, Sports
A few weeks ago I was interviewed by Scott Warr and Don Freeman from Trail Runner Nation. I was honored they asked me and we had fun doing the interview. The subject? What else but feet!
You can listen to the interview on their website, download the MP3 file, or better yet, subscribe to their podcast series through iTunes. Here’s the link to their webpage: FEET – Injury Prevention and Treatment with John Vonhof.
Here’s what they wrote on their website:
One of your most important tools as a runner is your feet. You need to take care of them or your training/race may be foiled. John Vonhof literally wrote the book on how to take care of your feet: Fixing Your Feet. This book is now in the FIFTH edition! John joins The Nation to discuss the basic principles of foot care:
- How you can have healthy & happy feet
- Blister prevention and treatment
- What to keep in a foot care kit
- Taping your feet
The interview is 62 minutes in length, but my interview starts about five minutes in. Enjoy the interview and then subscribe to Trail Runner Nation’s podcast.
Thanks Scott and Don for giving me the opportunity to share a bit of my passion for feet on your podcast.
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: blister care, Foot Care, Foot Care Products, Footwear, Footwear Products, Sports, toenails
Several months ago I had the good fortune to work on the medical team at the Jungle Marathon Amazon. My specific role was foot care of the 78 runners and to work with the others on the medical team to teach them good foot care techniques. I learned some things that I am calling, Your Event Homework…” By that I mean, your homework is to consider these five things that, if you learn them, can help you be more successful in the event.
Over seven days, I got to know most of the runners. The race offered a one-day, four-day, or seven-day event, and runners were required to carry all their gear and food in a backpack. Hammocks were mandatory and everyone had to carry a mandatory kit of emergency supplies. Because of all the gear and food, some runners limited their medical supplies to the most basic (read: as small as possible). Others had large plastic bins or bags of their mandatory gear. Most had planned well.
As runners came through the pre-race check-in to have the mandatory gear inspected, I talked to a lot of them about their shoes, socks, and – their feet. While doing this, I applied ENGO Blister Prevention Patches into many shoes. While I had a good supply of the patches, this would be the only time to get them into runner’s shoes. Once the race started, their shoes would be wet and the patches would not stick. I noticed that there was a good mix of shoes even though the runners were from around the world.
Then the race started.
Three miles into the race, there was a stream crossing. After that, their feet were almost always wet or full of sand or grit. Here are the five main things I saw.
- At the end of day one, one runner asked for help with his insoles. The sand and grit had worn holes in both heels. I could tell, however, that they were well worn even before he started. We dried out the insoles and I cut away any rough edges. Fortunately, the sun had dried the insoles enough to apply ENGO patches over the holes.
- Some runners had chosen shoes that were minimalist in design, and some did not hold up well in the rough trails in the jungle, where rocks, roots, and plants tore at the shoes’ uppers. Two runners’ shoes were shredded at their sides. The handiwork of one of the runners saved the shoes as he sewed the uppers back together with dental floss.
- Several runners had made bad choices in socks. All cotton socks have no place in any athletic event, much less anything over a 5km race. One runner in particular had low-rise cotton socks suitable for walking in the park, but not a seven-day race in the jungle. Another runner had only two pairs of socks, and the first pair had holes in both heels at the end of the first day.
- Some runners experienced problems with toenails that affected their race. Long nails, untrimmed nails, and nails with rough edges cause problems, which can lead to toe blisters, and black toenails.
- While some of the runners managed their feet by themselves, many came to the medical team day after day. While we were there to help, time and supplies were limited – especially time. Runners that can patch their own feet are ahead of the game. Some had the right supplies, while many others with small mandatory gear kits, did not have the necessary equipment. The medical team worked hard to patch feet as we could. Whenever we could, we made sure the runners saw what we were doing so they learned how to do it themselves. By the end of the race, I saw more that a few runners that were working on their feet and helping others.
Lessons to Learn:
- Make sure your insoles are in good shape. Many runners fail to remove their insoles and inspect they – to see if they need replacing. Most standard insoles are flimsy and should be replaced after several hundred miles. For a $25-$30 investment of new insoles, you’ll gain support and comfort. Investing in a marathon, ultramarathon, multi-day race, can be costly. Yes, there’s the money side, but there’s also the gear required, time spent in training, and travel. This is not the time to skimp on footwear. Chose good, high-quality shoes – preferably a design you have worn before and know works on your feet. And whatever you do, don’t wear old shoes that have seen better days.
- Invest in good, high-quality socks – new socks – not some dug out of your socks drawer that are threadbare. Find the right socks for your feet. Try Injinji socks if you have toe blister problems. Try a thin liner with a bit heavier outer sock. Try several types of socks to find the right amount of cushion and support.
- Learn how to care for your toenails. That means how to trim them and file them smooth so they don’t catch on socks or hit on the top or front of the shoe’s toe box.
- Runners can help themselves by learning how to manage their feet and treat any blisters that might develop. While some events have medical personnel and staff experienced in foot care, many don’t. Or they don’t have the best choices in supplies. Better to be prepared and know what your feet need – and how to manage your own feet. Then if there are people providing foot care, you can use them, and tell them if you need or want certain things done.
In the same way you train for an event, and invest in clothes and packs, and food, you must invest in your feet.
I have a large file of feet pictures on my computer. Pictures of toes, heels, balls of the feet, and arches. Pictures of blisters of all shapes and sizes. In addition, I see all kinds of feet when I work events. Over the years, I have worked races ranging from short distances to ultramarathons, to multi-day stage races.
I am probably one of a limited number of people in the world who gets excited at photos of bad feet. I like them because they tell stories.
The first full multi-day event I worked was Racing the Planet’s Atacama Desert six-day stage in the high desert of Chile in 2004. The stressors of being on your feet for long distances day-after-day for six to seven days often bring out the worst in feet.
A lady in that race wanted us to remove her toenails at the end of day two. Another runner had the worst case of trench foot I have ever seen. That was nine years ago and my techniques have changed for the better, but the feet remain the same – bad!
I believe that feet tell a story.
The photo here is from the Racing the Planet Iceland. I don’t know the owner of the feet. I don’t know the level of training and experience the person had prior to this race. I also don’t know what experience this person had with foot care planning before a race and during the race.
Here are my observations about the story behind these feet.
- Almost every toe has something going on.
- The photo was posted online for stage five, meaning the runner had to tolerate these toes for four plus days.
- These blisters don’t typically happen in one day. My guess is they started on day one, progressed to blisters on day two and then got worse.
- My bet is the shoes’ toebox was too short in length and/or too low in height.
- The runner may have worn two pairs of socks, which could have made the fit too tight.
- The toenails don’t look too long but it’s hard to see if they have any rough edges or are thick, both of which can lead to toe blisters.
- These toes scream pain – especially if they are encased inside shoes.
- It’s possible the toes received some degree of care, but it is hard to tell from their condition.
- Four of the toes have major trauma.
- We cannot see what is going on under the toes, but from the outside edges of the big toes, you can see blistered skin of the left one and maceration on the right one.
- The left big toe has blood showing in the blister on the outside edge.
That’s a lot of information pulled from a photo. I wish I knew the toes’ owner. It would be nice to learn more about his/her race. What shoes and socks they wore. How the trauma to the toes progressed day-to-day. What care they received. Whether they finished the race.
My guess is that with proper care, much of this could have been prevented. That care could have included lubricants, moisture control skin protect, tape, modified shoes, and nail care.
What story do your feet tell?
Here’s the link to the Racing the Planet’s Iceland race. Racing the Planet does four desert races every year called The 4 Deserts: the Gobi in China, the Atacama in Chile, the Sahara in Egypt, and Antarctic. Every year they add a new location for that year. Past sites have included Australia, Nepal, Namibia, Vietnam, and 2014 will be in Madagascar. You can check them out at Racing the Planet.
Last Saturday and Sunday I worked medical at the Western States 100 Mile Endurance Run. I spent Saturday at the Michigan Bluff aid station at mile 55. With the help of Tonya Olson, we patched a bunch of feet. Some had blisters, one needed shoe modification, one had severe heel blisters that had split, and lots of maceration. We saw more maceration than in many past years.
After we closed our aid station at 9:45 pm, I went to Foresthill and talked to George Miller, who was doing foot care there. He had a pretty calm afternoon with nothing unusual.
I found a nice parking space near the finish line at the Auburn High School and spent an uncomfortable few hours trying to get some needed sleep. About 5 am, I headed over to the podiatrity tent and set up my gear. By then, 24 hours into the race, even with about 100 runners in, the tent was quiet.
Around 7 am, things started to pick up. As runners finished, there was a large washtub for them to wash off the dirt. Then they could move to one of the kiddy pools with cold water and ice to soak their feet. Only after that did we see them. As they moved from place to place, Dave, assigned to work finish line podiatrity, and Tonya and I (from Michigan Bluff) looked over their feet and answered any questions. This went on until well after the race ended at 11 am.
This year’s Western States was hot. I’d guess hotter than normal. To my knowledge, there wasn’t that much water on the course. However we saw a large number of runners with severe maceration.
Here’s a photo of one runner’s foot. This was repeated over and over as we evaluated runners at the finish. Most were convinced that they had large blisters that we needed to lance. In fact, with one or two exceptions, there were no blisters. Just wet, macerated feet with lots of skin folds, creases, and waterlogged skin.
We told the runners that time would heal their feet and to go home or back to their hotel and start a regiment of Epson Salt soaks. The salts help to dry the skin. Powders and airing the feet help too.
Some of the runners had blister with blood inside – some were tinged with pink, indicating blood traces. The decision was made not to lance these blood blisters. When runners have dirty feet and have not showered, and will be walking around in dirty shoes or sandals for a few hours during the awards ceremony, we didn’t want to increase the possibility of infection. In these cases, we gave them the same instruction to do Epson Salt soaks and watch for signs of infection.
A good question is why there was so much maceration. In the heat of the course, often time runners take advantage of every opportunity to keep cool. This includes going through streams, using water soaked sponges at aid stations, pouring water over their heads, and whatever else they can think of. Sometimes well-meaning crew and volunteers squeezed soaked sponges over the heads of runners. The problem is that the water runs down the legs and into the shoes. This helps maceration.
I have seen some runners coat their feet with zinc oxide or SportSlick to help hold moisture at bay. Changing shoes and socks can help, and can be important when maceration has started. Drying the feet and using powder in fresh socks is also important.
Here are four blog posts about maceration and wet feet. Read them to know more about this condition and gain insights about how to manage your feet when wet.
Maceration – June 23, 2011
Training for Blisters in Wet Conditions – September 15, 2012
Training With Wet Feet – May 5, 2013
A New Kind of Foot Coating – September 25, 2011