My October issue of Backpacker magazine featured an article about Bil Vandergraff, a Search and Rescue (SAR) Ranger. He served as a ranger for 25 years in the Grand Canyon backcountry. In the article he shared tips on surviving in the backcountry – especially in the harsh and unforgiving Grand Canyon with its heat and extreme elevation changes.
His tips on dealing with the heat are right on: wear the right clothes, embrace the sweat, go slow, stick to mornings and evenings, and know when to stop.
He stresses the importance of helping yourself and to study up – studying the route and conditions.
The one line that struck me was this:
“I don’t take care of blisters. I refuse to. If you can’t take care of your own blisters then you don’t belong in the canyon.”
Wow. I like that.
That same philosophy could be applied to runners, adventure racers, hikers – in short, anyone venturing into the outdoors on their own. Badly blistered feet can stop you in your tracks, can make it hard to climb out of the Grand Canyon, or off a mountain or out of any trail.
Can we apply that to races too? That’s a hard question. A huge question!
If a race has crew access, should the crews be responsible for foot care? Some races don’t provide specific foot care. Others have it in limited form based on whatever foot care knowledge any aid station volunteers or medical personnel may have and based on whatever supplies they have.
I know that at some ultras and adventure races 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 a lot of supplies.
What compounds this question is that many athletes fail to do what SAR ranger Vandergraff stressed, helping yourself and study up. Anyone who has worked an aid station knows full well that many of the participants fail to take care of their feet to start with, fail to trim toenails, fail to reduce calluses, fail to wear the right socks, fail to wear gaiters, fail to replace worn shoes, insoles and socks, fail to learn how to do self-care, fail to educate their crew on good foot care techniques, and fail to have adequate foot care supplies. So then, when they run into problems, they want help. Their failure to plan, and in many cases, take common sense action that could have prevented or reduced the problem, then creates work and expense by others.
I remember an old quote by Benjamin Franklin, “If you fail to plan, you are planning to fail.”
Many events would see their finishing rate drop dramatically if they eliminated foot care. There is a definite need for medical care to ensure that participants don’t get into trouble that could cause them serious injury or bodily system failure – but is foot care one of those?
I’ll repeat Vandergraff’s statement. “I don’t take care of blisters. I refuse to. If you can’t take care of your own blisters then you don’t belong in the canyon.”
Again, can we apply that to races too? That’s a hard question. A huge question!
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.
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.
Filed under: blister care, Foot Care, Foot Care Products, Footcare, Footwear, Footwear Products, Health, Sports, toenails
The seven tips below are written for the Primal Quest Expedition Adventure Race starting next week. They are also applicable to any race you may have coming up.
Primal Quest is less than two weeks away and here are seven things you can do to improve your chances of finishing with healthy feet.
1. Wear the best fitting shoes you can. Have a bit of space in front of your longest toe and enough height in the shoe’s toe box to avoid squishing the toes from the top.
2. Bad toenail care can result in toe blisters and black toenails, where fluid or blood is under the nail. Trim your toenails short and then use a nail file to smooth the tip of the nail. File the nails from the top over the edge down toward the tip of the toe. The goal of the trimming and filing is to remove any rough or sharp edges. File the nails so when you run your fingertip up and over the tip of the toe no rough edges are felt. It’s even better to file the nail so that no tip of the nail is felt. If you have thick nails, file the top of the nail down to reduce its thickness.
3. Any time you can, remove your shoes and socks to dry and air your feet. Your feet will be wet from water disciplines, stream crossings, cooling yourself off by pouring water over yourself, and simply sweaty feet. When stopping to eat or rest, remove your shoes and socks. Lay your socks in the sun to dry and switch to a clean dry pair if possible. Issues caused by wet feet will multiply over time and can end your race or at the least, result in extremely painful feet.
4. Do everything in your power to prevent and reduce maceration. This means not letting water poured over your head get into your shoes by bending over before dousing yourself. If means following the tips outlined in # 2 above. Use a moisture-controlling agent to help prevent the skin on the bottoms of your feet from macerating. Several include Desitin Maximum Strength Original Paste (available at drug stores, Walmart, etc), zinc oxide, Chafe X, SportsSlick, Trail Toes, and RunGoo. Apply liberally and before all water segments to help prevent damage to your skin. Once serious maceration happens, only drying your feet and letting them air, with the help of powder and warmth, will reverse the condition. If left unchecked, the skin can fold over on itself, split open, and tear layers of skin off the bottom of your feet.
5. Use gaiters to prevent pebbles and rocks, trail dust, and other debris from getting inside your shoes and socks. These become irritants and can lead to hot spots and blisters.
6. Take care of small issues before they become larger problems. Lance and drain small blisters whenever you feel them to keep them from becoming larger. Put a dab of ointment over the blister and then apply a strip of tape over the top to protect the skin.
7. Finally, make sure you have the supplies to treat your feet out on the course. Waiting to get to a TA to repair a blister can make a small problem much larger.
Last Saturday was the Western States 100 Mile Endurance Run over the California Sierras. As you probably know, California is in year four of a severe drought. Most of us expected the trails to be dusty and dry. From everything I heard, they were.
So in a dry Western States year, why did so many runners have macerated feet from being wet?
There are several reasons. First, runners often cool themselves off by pouring or squirting water over their heads and on their body. We all know water runs downhill – right? So the water naturally runs down the legs and into the shoes. Socks become wet and as I often say – the skin of one’s feet prune up. In other words, they look like a wrinkled prune. Better to bend at the waist and let the water run off the head and shoulders rather than down the body.
Secondly, runners sometimes cool off by getting into the water at any stream. Several runners talked of sitting in the streams. While this can cool the runner, it is the worst thing a runner can do to their feet.
When they remain wet long enough, the skin becomes soft, often creating creases. Many times these creases are deep and in severe cases, the skin can split open.
Most often the runners complain of badly blistered feet. In fact, there are no blisters, just macerated skin on the bottom of their feet. This condition can be very painful. Walking and running hurts one’s feet.
There is no fast cure. They say time heals all wounds and with maceration, it takes time for the skin to dry and return to its normal state. Putting powder on the skin can help, as can clean fresh socks, gentle massage, and letting the skin air-dry.
I saw a lot of macerated feet at Michigan Bluff, mile 55.7. More than I expected. And of course there were lots of runners wanting treatment for bad blisters at the finish, and it was maceration.
The picture here is of a runner who completed the race, I think sometime around 28-29 hours. I don’t know his story but at some point before the race or in the race, he had his right foot wrapped in what appeared to be a self-adherent wrap, with a thick pad of some kind at the heel. Then that was wrapped with layers of what seemed to be silk type medical tape. Tonya and I had to use trauma shears to cut the thick wrap off his foot. Once it came off we saw the extent of the damage to his foot.
If anyone knows the runner or recognizes him, I’d love to find out more. It’s possible that because of maceration the skin at the heel had sheared off and someone at a medical aid station, or crew, had cut the skin and put on the wrap.
What we did at the finish was to apply a coating of antibiotic ointment to the open and raw skin, cover it with a wound care dressing, and wrap with a self-adhering wrap. We gave him instruction on how to care for this in the days after the race.
Look closely at the picture. He’s happy. He has his finisher’s medallion and knows he’s getting his buckle.
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.