Lisa de Speville, who lives in Johannesburg, South Africa, is a close friend who often emails with insights on blisters and foot care. Yesterday I received the following email and asked whether I could share it with my readers. Her email contains insights on little toe blisters, issues with minimalist shoes, and fit of shoes modified with gaiters.
Here’s her email.
Last week I ran in the 5th edition of the Namib Desert Challenge. I had the pleasure of running in their inaugural event back in 2009 and so it really was a treat to return. Great event, well-organized, wonderful region of Namibia and a lovely warmth and hospitality from the organizers.
Since about June last year I’ve been running in more minimalist shoes. I’ve always enjoyed a softer, more tactile shoe and I took to the pair of Asics Gel Fuji Racers that I won at a race immediately. I liked them so much that I was even running them on road. I like to keep trail shoes for trail and road shoes for road so in about August I bought a pair of Inov-8s. The brand is relatively new in SA so I thought I’d give them a try (my road shoes have been Addias Response or Supernova for more than 10 years). Let’s see… I’m in the Men’s Road X 255 (6mm lift), which is not flat as a pancake. Both the Asics and Inov-8 are quite roomy and my feet enjoy this.
Certainly over the past three months I’ve felt a change in my soles – more firm and muscular, which stands to reason if they’re strengthening and working harder. It is muscle after all. Before I started adventure racing and running ultras my feet were 1.5 shoe sizes smaller and I have a feeling that my feet are another half-size bigger in recent months.
So, the time comes for the Namib Desert Challenge and I get my favorite race shoes stitched with Velcro for my desert gaiters. Everything is ready. I hadn’t worn these shoes for a while. They were still relatively new – perfect for going into a multi-day race - as I’d bought two pairs of the same at an end-of-range special many months ago. I’d flattened the first pair so they were in no condition for this race.
When I put my foot into the shoes in the days before the race to get a feel for them again they felt a little tight, especially across the width of my forefoot. And more than just newness. This is why I figure my feet are a certainly a half-size bigger. Nothing that some lace-loosening wouldn’t sort out.
I started to develop what I call ‘triangle toes’ almost immediately. This is the one thing I avoid like the plague because I hate having sore little piggies. Triangle toes is where the underside of the little toe – and sometimes the neighbor next door – becomes pointed. A blister forms here and can result in a ‘toe sock’ – where the skin of the whole toe comes off, almost like a sock. It’s nasty and I not very fondly recall some incidents of almost toe sock about 10 years ago in adventure races. Since then I take special care pre-race to make sure my little toes stay ’rounded’ and that any harder, potentially triangular skin, is filed off regularly.
I dealt with the resulting blisters – stage 2 or 3 they came up on both little toes - by draining, leaving overnight to dry and then added some tape for the stages. I tried to flatten the triangle under the tape, but it ended up triangular again at the end of the stage. For the most part they gave me little trouble.
At the start of the 55km ultra stage on Day 4, I was debating whether to remove the inner soles for give my feet more room so that the little toes would have more width. It felt odd so I started with them in and my laces not too tight. By the first waterpoint I needed to change something so I took out my innersoles. I had to re-tape a toe a little way further because the change in space altered something. After this, no problem.
I’ve never run in shoes without innersoles and it really changes the feel of the shoe. The Adidas Response TR shoes really suit my feet – I’ve been running in them for 13 years! Taking out the innersole changes them to the Inov-8 feel. Flat and bland inside, which isn’t a bad thing – just different. It also makes the sole feel so much more flat and less cushioned – I felt like I was running in a non-cushioned shoe… for 47km!
Fortunately I was none the worse for wear but, for sure, if my feet hadn’t been conditioned from 10 months of running in ‘flat’ shoes my feet would have felt it. I ran the 5th and final stage without the innersoles too.
Aside from the triangle toes, my only other foot ailments included an injured big toenail on my left (not sure why? perhaps from a kicked stone?). The toenail developed a blister underneath, which was easily solved by drilling into the nail to relieve the pressure. I only discovered this one after the second stage when inspecting my feet. The other blister came up on the long stage under the ‘joint’ of my left big toe, where it connects to the foot. I have some scar tissue there from when I sliced my toe open many, many years ago. It occasionally twinges and at this race, on the long day, I caught exactly this spot so many times on rocks – prodding in. I couldn’t have purposefully aimed as many times in that exact spot! Again, not a bother (fortunately!) and easily solved by draining. On the final stage I didn’t hit it once and so it didn’t flare up again. For the rest, beautiful feet after 230km.
As I haven’t had triangle toes for years, this confirmed for me that width-ways just-that-little-too-tight squeezing of the forefoot is almost guaranteed to cause triangle toes and the resulting underside blisters, with the potential for toe sock, somewhere you do not want to go. In fitting shoes we tend to focus on the amount of space at the front of the shoe but definitely need to pay attention to left-right wiggle room.
Finally… one of the runners had really badly injured toenails (most of them) and the tops of his toes. The reason… too small desert gaiters for his shoes! I don’t know what kind they were (not mine) but they were Velcro attached (around the shoe) and pulling at the top and front of his shoe and causing toe injury. Live and learn.
Lisa de Speville
Johannesburg, South Africa
Adventure Racing: www.ar.co.za
Last week I wrote about prevention and being proactive. I emphasized that you are the key to prevention. I want to share an email I received from a friend that is a great example of this in action. Lisa told me about her friend and gave me permission to share the story:
My friend ran a 50km x 2 (100km total, over two days) race a few weeks ago. Over the past six months he has put a lot of work into his running training and has been running beautifully.
I was away so when I got back I dropped him a text to see how his race went. He told me what happened and in the conversation said that he would be losing many of his toenails. I ask why and he said he forgot to cut his toenails.
As you can imagine I didn’t reply to this at all because I would have thrown some insulting words his way.
He has been trail running for more than a decade and been doing adventure racing for over a decade. He spent a fairly sizable amount on his race entry and it must be about 900km to travel to the race. He put in six months of training to get stronger and faster. And he forgot to trim his toenails! This is more than elementary and is totally stupid. It’s tough to have sympathy (I have none!) when friends do silly things like this. He knows better.
This story speaks for itself. I have often talked about how athletes spend a lot of time and money in preparation for an event but fail to plan for good foot care. More times than I care to remember, I have seen athletes quit a race or be pulled from a race because of feet gone bad. It doesn’t have to be that way.
I’ll say it again, you are the key to prevention.
Lisa de Speville, an adventure racer and ultrarunner from Johannesburg, South Africa, and a friend, sends me updates every so often. I value her input because she is good at thinking through problems. I received this in an email in December and decided to share it with you because it is a great example of how to critically think through the cause of your blisters. Lisa wrote:
Here’s a delicious picture of a common blister. Nice and big and hadn’t popped yet – on my teammate’s little toe. We teased him about growing a new toe This developed during the desert trekking stage at the Abu Dhabi Adventure Challenge.
I’m sad to say I got blisters on my little toes and their friend next door – haven’t had these for ages! – during the desert trekking, and they developed early on. My feet have been brilliant for a long time so I wasn’t impressed with these blisters. Essentially the result of ‘triangle toes’ yet, as you know, I’m especially cautious about this and I make sure that I keep my toes smooth with no triangle possibility pre-race. As a result, I have various theories – there has to be an explanation…
First… socks. I was wearing my Asics Gel Trabuco, the same pair I wore during the TransRockies Run in August, where I had no blisters at all. The shoes were relatively new then with not too much more distance in them post TransRockies. The socks I was wearing were my favorites – a local brand, Falke. They make excellent socks and the style is their ‘Adventure sock’, which was discontinued a few years ago. I managed to buy a bunch of pairs directly from them and I’ve been slowly working through them. This pair was a bit older – you know when the fabric gets more coarse? This is my primary explanation – I think these socks had one too many outings and that the coarseness is the reason behind the blisters.
Now I’m sure you’re wondering about sand in my shoes too? I refined my gaiters for this year’s race and they actually did really well. BUT, I did get a bit of sand in my shoes. That stuff in the desert really is powder fine. I generally shook it all out, plus socks, at every checkpoint, which we reached every 4-5 hours. Nothing serious. But, I don’t think sand was to blame; I’ve had worse.
My second theory could be around the attachment of the gaiters themselves. We stitched our gaiters on to the front of the shoe. The fabric (lycra) is pulled snug. Could this change the dynamic of the upper? Mmmm… it is a possibility. I’ve had an even better idea for the gaiters – will be making version 3 over the next few months This is the version of the gaiters we used in the race. This is our team blog site – lots of photos from the race
As an aside… gaiters as much as the shoe itself helps in keeping sand out. Two of my teammates were wearing their Hi-Tec Trail Eruption shoes; I was in Asics and the other was in Salomons (maybe XA Pro… not sure). The Hi-Tec guys, who had sewn their gaiters on exactly the same, got little to no sand in their shoes. Both me and the Salomon one got sand in. Interesting.
Anyway, I wasn’t impressed with the blisters. I’m of the ‘keep ‘em drained’ school and so I drained the blisters at each checkpoint and over the course of the stage managed to mostly ‘reverse the process’, keeping the roof on and the fluid out. I did powder my toes with each treatment.
While sewing gaiters for Abu Dhabi Adventure Challenge, I finally got around to posting instructions on my blog for my regular mini gaiters, which I wear every time I am orienteering or running on trails. Keeps trail debris out and prolongs the life of your socks. Pricky socks is my pet hate because no matter how often you wash them you can still feel prickies.
Lisa’s blog can be found at AdventureLisa.blogspot. Check it out. She’s good.
Lisa de Speville, from Johannesburg, South Africa, is a friend I met at the Washingon state Primal Quest several years ago. She is a journalist and photographer in addition to an adventure racer. She’s pretty much a jack of all outdoor trades. I know I can count on Lisa for great bad feet photos. While you may not like the graphic images, they’re good to teach lessons. Check out Lisa’s website here.
Lisa recently wrote that she had just completed the 5-day, 200km RAW Namibia event. Here is a link to her blog where you can see some photos of the region and by clicking backwards on her posts, you can read more about the race.
She sent me an email saying, “It was fabulous! This one guy from the UK had BAD feet. Here are three sequential photos.
The first picture is after day 2. Day 1 was 41km. Terrain decent. He got grit in his shoes and didn’t deal with it at all. A heavy guy with an unnecessarily overloaded backpack (inexperience). By the end of day one, the foot looked like the photo I took on day 2. The doctor opened up the open part and bandaged him up. He got a dose of methiolate after day 1. Agony, as you know. His maceration was very severe already on day 1. I would have expected this kind of blistering – only later on – progressive. But he did it on the first 39km stage.
The piece of skin was cut off by the doc. I suggested that she leave it on but she took it off and padded the foot with bandages. Your comment on what to do – on or off – with this severity would interesting.
I think the primary problem was that he got sore feet during the stage, a bit of grit in his shoes and he didn’t deal with it then and there. I can’t remember now what shoes he was wearing… I’ll ask him to give you feedback. I have a sneaky feeling they were road shoes… on off-road terrain… I don’t know what socks he was wearing. And then you look at things like shoes being his normal road shoes and perhaps that half-size too small for long off-road stages in the heat; and also he wouldn’t have loosened his laces to accommodate swelling… Recipe for trouble.
Day 2 was about 40km. Also good terrain, mostly even footing. It obviously worked on the raw part of foot.
Day 3 was 44km. again nice terrain. This is picture 2. One river crossing so shoes got wet just over halfway. He was wearing quite thick socks from what I could see. He would have gotten his feet wet once mid-way through the stage. We had one river crossing and I think he went straight through it because even if he took off his shoes there would have been the bandages to deal with. That was the only water place the whole race.
If you look closely, you’ll see the dark spot under the skin under the middle toe. That’s sand inside the blister. How sore it must have been to be walking on the sand, which would have been rubbing on the raw flesh. Ow! I’m not that brave – I would have been out of the race after day1 – I just don’t know how these people manage to keep going with such injured feet!
Day 4 – 50km. Bit of sand. Hot as hell. He took a detour – went down the correct dry riverbed but didn’t get out of it to look for the finish. Must have been parallel to the finish. Turned around and started walking back to last waterpoint. He was found hours later (moving slowly). He didn’t want to be disqualified so they dropped him on the road and he walked to the finish. Almost 16-hour day for him! Picture 3 was taken in the dark, after he’d been out there for almost 16-hours!
He did start day 5 but when it got to climbing big dune he then withdrew. It’s obviously difficult to climb a dune when you can’t put pressure on foot. How he got so far past day 1 is beyond me.
Also check out the progression of the little piggy’s “toe-sock” syndrome.”
John’s comments: Thanks Lisa for sharing these great photos. The images show the destructive power of sand, the raw skin, the extreme maceration – and the worsening deterioration of the foot over several days. Lisa indicated there was only one water crossing so I suspect most of the maceration came from sweating feet. The heavy weight in his pack was a huge factor too as it adds stress to the feet. I don’t know if he wore gaiters. And be sure to check out the baby toe in pictures 1 and 3. You can see the progression of the maceration of the bottom of the toe. Lisa said she thought he wore road shoes in a desert race and that they may have not been large enough to allow for swelling. This too is a huge factor.
Regarding cutting off the skin, I am usually not in favor of doing this as the skin underneath is raw and very tender. I suspect he had callus at the ball of the foot and a blister formed underneath. The thick edges of skin where it was cut shows that the skin removed was not a single layer. I probably would have left the skin intact, applied a coating of zinc oxide and antibiotic mix, and covered it with Kinesio-Tex tape with an anchor figure eight piece on the side and between the toes.