Filed under: blister care, Foot Care, Footwear, Health, Sports, toenails
Which is more important, blister prevention or blister treatment?
For more than 17 years, I’ve taught foot care techniques to anyone who will listen. I have taught classes at running stores, REI stores, events, and more. In addition, I have worked medical at many races, helping provide foot care to participants. These races have been in Death Valley, Chile, Costa Rica, BC Canada, Colorado and Washington, and many in California. This year I will be at Western States 100, Badwater, the Gold Rush Adventure Race, the Jungle Marathon in the Amazon, and hopefully at races in Colorado and Namibia.
I have never counted the feet I have worked on but I would put the number well over 3000. I remember one race in Colorado in 2010 when I saw the same lady 10 times. It was a six-day stage race and she’d come in every evening and morning! I’d patch her feet in the evening and she’d take it off when she went to bed in her tent. She had foot wear issues that gave her blisters on top of blisters. She was never into prevention mode – only treatments.
In this picture, taken from the cover of the 5th edition of Fixing Your Feet, we see treatment taking place. I love the picture. I even know whose foot it is. What I can’t tell you is what he did for prevention. I wish I knew.
My question in this blog post is what should we spend more time on, blister prevention or blister treatment?
Prevention can take many forms: good choices in footwear, the right socks, lubricants and powders, toenail care, skin care, taping, Engo patches, correct lacing, the right insoles, and training and conditioning.
Treatments likewise offers many options: blister draining, many different types of patches, taping, ointments and salves, a multitude of tapes, wraps and straps, silicone pads, Engo patches, toe caps, and lubricants and powders.
So here are a few questions:
- Does prevention last only until the race starts?
- What are your best prevention options?
- How much do you count on aid station personnel to manage treatments?
- Do you know how to treat your feet?
- Do you carry materials to treat your feet?
- What are your best treatment options?
- How well do you understand blister formation and prevention?
For 17 years, athletes have had Fixing Your Feet as a resource to learn important information about foot care. As I patch feet at races, I try to educate the athletes about what I am doing and why, and what could have helped in their feet. If crews come to me for advice, I try to help them too. I have watched athletes and crews work on feet with materials and using techniques I have long preached.
In general, foot care has advanced over the years. Shoes, socks and insoles have become light years better. Lubricants, powders, blister patches, and our tools are better. People interested in foot care are trying new blister patching techniques.
All this is good because every day there are new athletes coming into running, adventure racing, hiking and thru-hiking, walking, and other feet stressing sports. Let’s make sure they understand the importance of prevention before treatment.
In August I worked the Gold Rush Adventure Race in the California Sierras. Throughout the race I worked at three checkpoints. As racers needed foot care, I carried my lounge chair and foot care box to where their team was set up and did what I could.
Most racers had hot spots, blisters and sore feet. A lot of times, athletes tell me that have blisters and yet, after cleaning their feet, none are visible. They may have a very sore spot or a hot spot, but there is no blister. Sometimes I can tape over the area or place a Spenco patch to provide a bit of cushioning. I often add an Engo Blister Prevention Patch to their insole underneath the tender area on their foot.
A lot of the racers needed blister care and taping. My whole aim when patching feet is to get the racers back in the race. I do what I can to drain and patch blisters on any part of the foot.
One of the racers came into checkpoint where they were transitioning from bikes to foot. At this point, they had been on their feet for almost two days. They started with a long paddle, followed with a long bushwack up a canyon, and then a really long bike section. The team was near the end of pack. The four members sat and discussed their options and whether to continue. The next section was a long trek of about 36 miles.
The racer needing foot care took off his shoes. As he sat back in my lounge chair, I removed his socks. His heels were fine, however he had major problems with blisters at the ball of the foot where the toes started. Both feet were the same. I cleaned his feet and did an evaluation.
I wish I had taken a few pictures of his feet but I was too involved in getting his feet patched so the team could continue. At the base of each toe were blisters. Many extended to several toes. Some of the blisters extended up between the toes. The majority had blood in the fluid. There were blisters at the base of the toes from one side of the foot to the other side – on both feet. His feet were swollen so the blistered skin was stretched tight from the fluid. In addition, several of the toes had blisters on the bottoms or sides, several with blood inside.
The blood in the blisters was my major concern and that there were so many of them. I usually drain blood blisters and with clean skin and a dab of antibiotic ointment – in a 24-hour race, I’m comfortable doing that. I always ask the person if they are up to date with their Tetanus shots and give them instructions about infections.
I talked to the racer and gave him my honest opinion – that he not continue in the race. We talked and I gave him my reasons. The next section was about 36 hard miles of cross-country trekking. His feet would get wet, and this would soften the skin and lead to further skin breakdown. The blisters were in a hard area to patch and it would especially be one long patch at the base of all his toes. The swollen condition of his feet was not going to get any better. And most important, the blood in so many blisters, even with the blisters lanced and patch, would increase the chances of an infection. Plus, if his feet took a beating during the trek, the blisters would become a huge open unpatchable mess (for lack of a better term). And of course, his feet would hurt badly.
He took my advice and I wrapped his feet as shown in the photo.
I think I can count on my fingers how many times I have advised racers to stop because of foot problems. Sometimes your feet simply quit. They have had enough.
Could this have been prevented? Based on my experience, I have to say, probably. Changing socks, treating hot spots, earlier blister care, better socks, moisture controlling lubricants, airing feet at checkpoints, and better shoe fit. In a team event, such as adventure races, every member of the team must help the other members with foot care. Every team member must be honest with their teammates about the condition of their feet. In solo races where athletes are racing alone, they need to be constantly aware of their feet. And where there are crews, these important people must ask questions about the condition of the athlete’s feet.
There are no guarantees in a race of any length. Our feet propel us forward, but every so often, out feet quit.
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.
John Vonhof brings a varied background and extensive experience to FixingYourFeet.com. This website and blogt is the synthesis of over 18 years of experience as a runner and hiker.
Over the years he has provided volunteer medical aid at numerous running events and has patched thousands of feet at events like the Western States 100 Mile Endurance Run, the Badwater Ultramarathon in Death Valley, the Raid the North Extreme Adventure Race in northern BC Canada, Primal Quest Expedition Adventure Races, the TransRockies, the Gold Rush Adventure Races, the 4 Deserts Atacama race in Chile, the Coastal Challenge in Costa Rica, the Avon Walk, and more.
This background has provided a wealth of learning opportunities for what can go wrong with feet and ways to fix them.
Having run since 1982, John discovered the challenging world of trail running and ultras in 1984. Over the years, he has completed more than 20 ultras: 50KMs, 50-milers, 100-milers, 24-hour runs, and a 72-hour run. John has completed the difficult Western States 100 Mile Endurance Run three times and the Santa Rosa 24-Hour Track Run ten times.
In 1987 John, with fellow runner Will Uher, fastpacked the 211-mile John Muir Trail in the California High Sierra’s in 8.5 days with 30 pound packs.
As the former race director of the Ohlone Wilderness 50 KM Trail Run (15 years), John worked at providing a quality event for runners of all skill levels. This run is known as one of the most difficult 50 KM trail ultras in Northern California.
An opportunity to change careers in 1992 led him into the medical field where he has worked as an emergency room technician with certifications as a paramedic and orthopaedic technician. He currently works for the Alameda County Emergency Medical Services Agency in the San Francisco Bay Area in Central California.