Maceration at Western States

July 7, 2013 by · 1 Comment
Filed under: blister care, Foot Care, Health, Sports 

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.

Maceration

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

About

January 15, 2009 by · Leave a Comment
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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.

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