Back on June 17 I introduced the concept of shear with a post by podiatrist Rebecca Rushton from Australia who has studied blisters and identified shear as a major factor in blisters.
It’s best to start by refreshing our memories about what was shared on the previous article. Here’s the link in case you want to see the full post: An Introduction to Shear and Blister Formation. Otherwise, here’s a short piece from that post:
Poor blister prevention outcomes are due in no small part to the misunderstanding of the cause of this obstinate injury. The force that causes ‘friction’ blisters is not friction. And it’s not rubbing. It’s shear. But if you ask 100 people the question “what causes blisters”, nobody would answer “shear”. Shear is the sliding of layers across one another – internal layers that are structurally connected. Those connections can break and when fluid fills that cavity, you have a blister! What Does Shear Look Like? Try this … Step 1: Place the tip of your right index finger on the back of your left hand. Step 2: Wobble it back and forth but keep it stuck to the same bit of skin. Notice how your skin stretches? This is shear and this is what causes blisters. Shear might look like rubbing but it’s not. Notice how your finger tip has not moved relative to the skin of the back of your hand? But your hand skin has moved relative to the underlying bone. This is shear. Your skin doesn’t need anything to rub over it for blisters to form. It just needs shear (this stretching of the internal tissue layers) to be excessive and repetitive.
Managing shear is key to managing blisters. Let’s look at several ways to reduce shear.
The first way is to make sure your footwear fits. Many people buy shoes that seem comfortable in the store but don’t make sure they feel ok by wearing them around the house for a few days. Make sure they have enough room in the toe box both in height and length. Make sure there is not undue pressure on soft tissues over any bony spots (sides of the forefoot, ball of the foot, sides and back of the heel, over the instep, etc.). Make sure they are not too loose, allowing too much movement leading to skin abrasions, hot spots, and then blisters.
Using a cushioning product is a second way to reduce shear. This might be a gel pad under the ball of the foot or under the heel bone, or a replacement insole meant to pad and cushion.
A third method is to manage skin moisture. This can include skin-drying strategies and skin lubrication. Studies have shown that you can reduce the incidence of blisters by keeping the skin either very dry or very wet. Drying the skin can be done with powder, benzoin, alcohol wipes, and antiperspirants. Lubricants can include SportSlick, BodyGlide, BlisterShield, and other popular products. Zinc oxide is also effective at controlling moisture. The method of having runners train with wet feet has been successfully used by Shirley Thompson and Vicky Kypta of the Jungle Marathon Amazon. They have found that the feet of their race participants have been better with this suggestion given to runners before the race.
The fourth method of controlling shear is with socks. This may include double layer socks or wearing two pairs of socks – a thin liner and usually, a thicker second sock. This allows movement between the two sock layers. Injinji toe socks are great for those with toe blister problems.
Next time, we’ll talk about a fifth way to reduce shear – Engo Blister Prevention Patches.
In the mean time, check out ZombieRunner for many products that can help with cushioning, skin-drying and lubricants, and socks.
For years, the norm has been to avoid getting your feet wet. When feet get wet for extended periods, usually the feet have skin that is soft and macerated. In long events, and especially in multi-day events, that can lead to trouble. Taping or patching wet feet, or macerated feet, is very difficult. So it is best to keep your feet as dry as possible.
This has always been the rule.
In the past few years, adventure style races have become popular, which puts runners in conditions where wet feet are the daily norm. Most often, these races are six to seven days in length. The race often includes running through the jungle or mountains with stream crossings, wet foliage, wet trails, mud, and extremely humid conditions. In these conditions, your feet are always wet.
If you think this doesn’t apply to you because you are doing a “dry” race, please consider this. Even dry races with no water crossing can produce wet feet. Dumping water over your head at aid stations to cool off will get water in your shoes. Plus our feet naturally sweat and this buildup can result in wet feet.
Shirley Thompson, the Race Director of the Jungle Marathon told me, “We always advise runners to train with wet feet so that they can focus on a strategy before they get to the jungle. As far as footwear is concerned, we always emphasize trail shoes with good grip, and that comfort is the main factor.”
So how can we do that? For training runs, soak your shoes and socks before heading out. Step in puddles or use a hose if they dry out. Try to keep them wet as long as possible. If you feel a hot spot or blister start, stop and adjust your shoes and add tape, lube or your favorite blister prevention product. Take time to find the best shoe and sock combination for your feet when wet.
Personal Foot Care of Wet Feet
Because your feet will be wet, often at the start of each stage, it makes sense to do some of your training with wet feet. Use the same shoe and sock combination that you plan to use for the race – and get them wet. Walk and run in them. Not just a 30-minute run, but hours! Put some distance on your wet feet that is the same you expect to do during the race. Try to also to do back to back wet feet training days. It’s that simple.
As said earlier, stop and deal with any hot spots as soon as you feel them. Check for folds in your socks, friction from dirt or sand, pressure inside your shoes – and get rid of these irritants. Lube the area or apply a piece of tape or blister prevention patch to help. This may seem like common sense, but many people ignore this simple step.
At the end of each day’s stage, remove your wet shoes and socks, dry your feet and air them as much as possible. If your feet have tape on them, remove the tape to dry the skin underneath. Wear sandals or Crocs around camp to keep your feet away from the wet ground and dirt and sand. Walking around barefoot will often aggravate wet, cold, and soft macerated skin. Later in the day or the next morning, re-tape your feet and patch any blisters.
Because you cannot count on medical people patching your feet the way you want them patched or that they will be available, you must learn how to patch your own feet. I have helped at events where I have patched feet all afternoon and evening, and then had people line up in the morning for more work. Sometimes the medical staff is stretched thin or cannot get to everyone. Be prepared to do your own patching and have your own equipment. Better safe than sorry.
Many times at races, I have seen athletes who have not trained their feet for the event. They enter a race and don’t put the necessary miles on their feet, don’t have the right shoes, don’t know how to manage and patch their feet. I encourage you to take the time to train with wet feet and condition them for the extremes of your race.
I spotted a small ad in one of my magazines that looked interesting. The product was IceSpike. They are a system of patented composite-material, cold-rolled tool quality steel, heat hardened ice spikes, which provide superior grip and long lasting durability. Their tagline is, “The ultimate non-slip shoe system, for all outdoor activities.” Of course, since it relates to footwear, I had to check it out.
IceSpikes are rated to last 10 times longer than commonly used sheet metal screws. Average runners will get 500 miles out of a set of IceSpikes. The terrain and conditions will affect the life of the spikes. Unlike other traction products, these are low profile under the shoe. The thread design is fine and sharp. The design has a wider and deeper slot to promote self-cleaning of ice and debris. Extra wide washers offer better stability on the sole of the shoe and their locking serrations that firmly anchor them to the rubber of the sole to prevent loosening of the spikes. They will not break or crack with intense cold or use.
The suggested installation is three on each side of the heel and three on the inside ball of the foot side of the shoe or boot. A tool is available to make installation easy or use a ¼ inch hex bit in your drill.
A package includes 32-patented IceSpikes. The deluxe package includes the installation tool. With each shoe getting 12 spikes, you’ll have eight extra spikes for replacements. Heel spikes tend to wear faster.
You’ll find that IceSpikes are a semi-permanent traction system that can be mounted on any running or walking shoe, hiking or work boot.
In case you are wondering why not just use sheet metal screws, think about this. Sheet metal screws are made of a softer material and will wear out many times faster and decrease their traction ability. The slots in sheet metal screws fill with ice and debris faster and are not self-cleaning, which affects traction. Sheet metal screws have a rough thread design.
This is the kind of product that makes me want to find snow and ice for a run. Unfortunately, California’s central valley gets neither. If you live in a region where they make sense, I encourage you to give them a try.
In choosing footwear, fit is everything. You may buy a new pair of shoes, not get a good fit, and use them for short runs or races without much problem. But the longer you’ll be wearing them at a time, the more important the fit.
Here’s a trick to help get ensure a good fit.
Rich Schick, a physician’s assistant and ultrarunner, shared that he believes the key to getting the proper size shoe is the insert – often called insoles. “If the foot does not fit the insert, then the shoe will have to stretch to accommodate the difference or there may be excessive room in the shoe, which can lead to blisters and other foot problems.” He thinks there is too much confusion about straight lasts, curved lasts, semicurved lasts, and so on.
Rick suggests, and I agree, that you don’t need to know any of this if you use the insert to fit your shoes. The same holds true for the proper width of shoe. Simply remove the insert from the shoe and place your heel in the depression made for the heel (in the insert). There should be an inch to an inch and a half from the tip of your longest toe to the tip of the insert. None of your toes or any part of the foot should lap over the sides of the insert. If they do, is it because the insert is too narrow or is it because of a curved foot and straight insert or vice versa? The foot should not be more than about a quarter inch from the edges of the insert either. This includes the area around the heel, or the shoe may be too loose. Check to see if the arch of the insert fits in the arch of your foot. Finally, if all the above criteria are met, then try on the shoe. The only remaining pitfalls are tight toeboxes and seams or uppers that rub.
Remember to take into a account the type and thickness of socks you’ll be wearing. If you are going to replace the stock inserts that come with the shoes, make sure to follow this tip.
Last week I worked the Gold Rush Adventure Race. We had 11 teams working their way through paddle, trek, bike, trek, bike, trek, ropes, raft, and finally a last trek. The full course was 285 miles, although some of the teams were short-coursed because of time.
I started at TA2 (transition) where racers went from trek to bike, then TA3 – from bike to trek, TA4 – from trek to bike, and lastly, TA5 – from bike to trek. I saw the same teams, TA after TA.
I did not count the number of racers on whose feet I worked. I didn’t matter. My goal, as always, is to get the racer back in the race. I worked on some of the racers feet multiple times.
I quickly noticed a problem.
Racers would come into the TA and remove their shoes. They needed to change footwear – from bike shoes to shoes for trekking and visa versa – and change clothes too. TAs also meant dismantling and packing their bikes, or unpacking and assembling them. This was often done in the sun – and it was hot.
We had tarps set up for the teams to change on. It kept some of the dirt off their feet – but not all the dirt. The tarps were dirty and there was small twigs, bits of leaves, pinecone pods and seeds, and small stones. A lot of stuff to be walked on and stick to socks.
I usually patched blisters and applied tape as a preventive measure. I advised them to keep the tape as clean as possible and not get it wet.
Then I watched as they worked on their bikes, walked around, and sometimes went down into the river. They walked as gingerly as possible over the rocks and sticks. I don’t fault them; they did what needed to be done. I would have done the same.
The problem I noticed was that racers were compromising their feet, and any patch or tape job, by walking around without anything on their feet.
They had bike boxes for their expensive bikes and large gearboxes for their footwear, clothes, food, and whatever gear they wanted to pack. Of all the racers, I remember only a few who had the foresight to pack flip-flops. An inexpensive set of flip-flops might cost $5 – that can easily help your feet.
So here’s my recommendation. If you are involved in a multi-day race, any race with transitions, or even a one day event where you will have rest times, invest in a pair of flip-flops to protect your feet and any patch job or tape on them.
The same goes for hikers and backpackers. Lightweight flip-flops weigh next to nothing. Another option is to wear Crocs. They provide protection of one’s toes and tops of the feet, which flips-flops do not offer.
There is something to be said for taking your shoes and socks off when resting during a race, multi-day run, or long hike. Your feet like to be aired and if there is macerated because of water, airing them will help dry out the skin. But do yourself a favor and pack a pair of flip-flops or Crocs.
Life has been busy this past month and I apologize for not posting more often.
As I read the my magazines, I find shoe reviews. As I open emails, I read people’s experiences with their shoes. As I check newsletters, websites and blogs, I read reports and reviews of shoes. And then, of course, there are the ads – everywhere.
The thing is, they all point out the features and benefits of their shoes. Is there one shoe for you? Yes, there is one – and many more that will also work. Some work better than others.
My feeling after all these years of providing foot care is that you could easily slip into a number of shoes and they would work. You read the ads, the emails on forums from other runners happy with their shoes, and you hear other runners in one-on-one conversations recommending certain shoes. Maybe you’re happy with your current shoes and simply want to try out another pair. Or maybe you find the shoes you like have been discontinued.
Everyone wants the perfect shoe – and some people find them. Others try on shoe after shoe, looking for the elusive “best” fit.
You could run a 5K or 10K or even a marathon in many shoes and not have a problem. But move up to an ultramarathon or a multi-day event and you could have problems. A small thing when training or running can be multiplied many times over with more miles and cause problems. When changing to a different shoe, pay attention to any changes in how your feet and ankles feel. Does anything feel funny or seem bothersome? Do you feel a twinge the next day – telling you that something is wrong? At some point, if this continues, you need to consider the shoes. Change back to your old shoes and see if the problem goes away.
Where this affects athletes the most is moving from regular shoes to minimalist shoes or even no shoes (barefoot). Changing to these takes time and a gradual slow process. Wearing minimalist shoes puts added stressors on the feet until they get used to the change. Give it time. Slowly. Recognize you should be changing the way you land on your feet and your overall stride.
There are lots of shoes that will work for you. Give them a try. I bet you’ll find several you really like.
I started running in the early 80’s and bought my first pair of shoes from New Balance. They were a great company that made great running shoes. They still are a great company. The shoes worked and I bought more from them in the following years.
Back then the running footwear scene was dominated by the stalwarts: New Balance, Nike, Adidas, to name a few. The shoes were good, solidly made, and offered in a few different styles. They worked.
Now, we can choose from a bunch of footwear companies that a few years ago were non-existant. It has been interesting watching the new newcomers. My guess is that they saw the trends into running and other outdoor sports and decided to get on the bandwagon.
If you read the shoe evaluations in the popular running and outdoor magazines, these new shoes are quite good. Maybe not all of them, but a many get good write-ups. Runners must be buying some of them, because the companies are still around.
Some of these companies were already making backpacking boots and the expansion into running shoes was a natural move. Others made clothes and the entry into footwear was a bit of
But now we have shoes from Under Armour, a company that makes high end underwear. Here’s an image from their website. I’ll let you be the judge.
When I started running in the early 80’s, there were the usual “brand” name shoes. I remember buying my first pair, New Balance, and that they cost $45.00. Since then, I have owned many pairs of shoes. Some for road and many for trails.
In all that time, there have been only one or two pair that were bad choices. They simply weren’t right. The rest have served me well.
Now, shoes have become more complex. There are many more to choose from. Companies are coming out of the woodwork to get a piece of the running shoe market. They all have their acronyms and fancy names for the features their shoes offer. Some of this makes we wonder how different are some of these features? Many shoes seem to be so similar. Every company wants us to believe that their shoes are perfect for our feet.
Now the tide has turned.
Shoe companies have designed footwear that takes us back to our roots. Born to Run has inflicted athletes with a desire to run natural. In bare feet or something as minimal as possible.
So now one of the big sellers is Vibram’s FiveFingers. With their individual toes, many runners are trying them. People are finding FiveFingers help them walk and run in spite of old injuries that, with “normal” shoes, they could not do.
So, what’s next in footwear?
I found this photo and thought it was great. Maybe this is where we are going. Vibram will offer a new design in their FiveFingers line. You’ll be able to but the shoes in a variety of skin colors, with or without toenails, or with a few black toenails. Maybe even a fake blister painted on.
Would buy a pair. Just for fun?
As a disclaimer, I wish I knew the source of the photo so I could credit it. Sorry.
Yesterday I watched hikers, backpackers, and walkers do their best to pick the right footwear out of dozens of possible choices. It was a madhouse.
I had done a foot care clinic at the Berkeley REI store. It was fun with 40 people attending. Rather than 1 hour, it lasted 1-½ hours. They had lots of questions. Good questions. They ranged from neuromas, taping, blisters, plantar fasciitis, toenails, minimalist footwear, barefoot running, and a few others. The guy in the front row ended up with all fingers on one hand tapes (to simulate toes), plus tape on the palm of his hand (to simulate taping he ball of the foot). Earlier I had talked to the footwear sales staff to give them tips on footwear and answer their questions.
So, as I said, it was a madhouse. The store was packed. REI put together a Foot Wear Festival with 12 footwear vendors on hand to promote their wares – and my free clinic.
Adults, teens and children were there to pick out shoes, boots and sandals. The crowd never stopped the whole day. REI staff worked like dogs, assisted by the vendor reps, to bring out stacks and stacks of footwear. I talked to a few folks who had been in my clinic as they tried to pick the best for their feet.
I had told them to buy footwear based on what they wanted to do, the weight of their packs, experience level, and any pre-existing foot conditions. I watched them look at the footwear from different angles, look inside, feel inside, try them on and walk around, stand on the artificial rocks to try different positions, and more. Many were doing a good job.
I had told them earlier that I believe there is more than one pair of shoes that is correct for their feet. Whether picking running shoes, boots, or sandals, there is more than one for you. Pick your footwear based on function and form, and above all, comfort. After walking around the store in them, then take them home and spend time wearing them for several hours. Make sure they feel right and don’t have any rough spots. Then when you are satisfied, wear them outside – and enjoy them.
Feet, Feet, Everywhere Feet. Sometimes you have to just post a quick fun thing. I spent the past four days at the Florida Christian Writers Conference near Orlando. I was on the faculty and taught seven sessions. When I go to these conferences, I always talk about how Fixing Your Feet has done as a nonfiction book.
Even though I teach on a variety of writing topics, I am known as ‘the foot guy.’ At several workshops, conferees asked asked me questions about their feet. Arch pain, forefoot pain, plantar fasciitis, and more. This offers me the opportunity to share a bit of my knowledge with folks that might not otherwise read my book.
I tell them that everywhere I go, I watch feet. I notice feet. Barefeet, feet in flip-flops, sandals, shoes that look comfortable, and shoes that look very uncomfortable. I wonder why people don’t use more common sense in picking their footwear?
Now I am sitting in the Orlando airport, working on my laptop with four hours to kill – and noticing feet. Too many bare feet. Way too many old flip-flops that should have been tossed out months ago. Uggs and other styles that make your feet sweat. And just plain ugly shoes too.
When you travel, why not wear comfortable shoes? More to the point, why not footwear that is good for your feet? If you must wear flip-flops or sandals, how about making sure your toenails are clean and trimmer. Getting rid of your calluses will also help them look more attractive.