Feet Tell a Story

August 15, 2013 by · Leave a Comment
Filed under: blister care, Foot Care, toenails 

I have a large file of feet pictures on my computer. Pictures of toes, heels, balls of the feet, and arches. Pictures of blisters of all shapes and sizes. In addition, I see all kinds of feet when I work events. Over the years, I have worked races ranging from short distances to ultramarathons, to multi-day stage races.

I am probably one of a limited number of people in the world who gets excited at photos of bad feet. I like them because they tell stories.

The first full multi-day event I worked was Racing the Planet’s Atacama Desert six-day stage in the high desert of Chile in 2004. The stressors of being on your feet for long distances day-after-day for six to seven days often bring out the worst in feet.

A lady in that race wanted us to remove her toenails at the end of day two. Another runner had the worst case of trench foot I have ever seen. That was nine years ago and my techniques have changed for the better, but the feet remain the same – bad!

I believe that feet tell a story.

Hurting Toes

Hurting Toes

The photo here is from the Racing the Planet Iceland. I don’t know the owner of the feet. I don’t know the level of training and experience the person had prior to this race. I also don’t know what experience this person had with foot care planning before a race and during the race.

Here are my observations about the story behind these feet.

  • Almost every toe has something going on.
  • The photo was posted online for stage five, meaning the runner had to tolerate these toes for four plus days.
  • These blisters don’t typically happen in one day. My guess is they started on day one, progressed to blisters on day two and then got worse.
  • My bet is the shoes’ toebox was too short in length and/or too low in height.
  • The runner may have worn two pairs of socks, which could have made the fit too tight.
  • The toenails don’t look too long but it’s hard to see if they have any rough edges or are thick, both of which can lead to toe blisters.
  • These toes scream pain – especially if they are encased inside shoes.
  • It’s possible the toes received some degree of care, but it is hard to tell from their condition.
  • Four of the toes have major trauma.
  • We cannot see what is going on under the toes, but from the outside edges of the big toes, you can see blistered skin of the left one and maceration on the right one.
  • The left big toe has blood showing in the blister on the outside edge.

That’s a lot of information pulled from a photo. I wish I knew the toes’ owner. It would be nice to learn more about his/her race. What shoes and socks they wore. How the trauma to the toes progressed day-to-day. What care they received. Whether they finished the race.

My guess is that with proper care, much of this could have been prevented. That care could have included lubricants, moisture control skin protect, tape, modified shoes, and nail care.

What story do your feet tell?

Here’s the link to the Racing the Planet’s Iceland race. Racing the Planet does four desert races every year called The 4 Deserts: the Gobi in China, the Atacama in Chile, the Sahara in Egypt, and Antarctic. Every year they add a new location for that year. Past sites have included Australia, Nepal, Namibia, Vietnam, and 2014 will be in Madagascar. You can check them out at Racing the Planet.

A Foot Care Success Story

March 17, 2013 by · 2 Comments
Filed under: blister care, Foot Care, Foot Care Products, Health, Sports 

Every so often I hear a foot care story from an athlete that intrigues me. It’s fun to read their story about their issues with their feet and then the steps they took to find answers.

One of the best examples of this is Nathan’s story on page four in the 5th edition of Fixing Your Feet. He told the story of how he studied foot care techniques and learned hot to manage his feet – and successfully finished Racing the Planet’s Australia race.

Then the other day I received an email from Karen. I liked her story and asked if I could share it with my readers. She agreed. Here is what she wrote.

First, I am extremely prone to blisters. Initially I thought it was friction. I tried Hydropel, but its sticky nature attracted dirt but did nothing to calm my problem. At Fruita one year, Lisa and Jay (Smith) Batchen shared their knowledge in a presentation about the three primary causes and the light bulb went off. Hydration is my primary issue – specifically bloating.  The bloating happens because I’m no longer processing fluids.

After working thru formulas and cause and effect for several years on my own, I finally solicited help from Scott Jurek -I knew him from Coyote events. Mutual friends had helped me focus on running nutrition, but I wasn’t making progress on my own. Scott helped me maintain my ability to process fluids and enabled me to delay bloating and blisters.

When I get blisters, they’ll either start as a hot spot on my pads or a painful toenail. I get them under my toenails (which I keep extremely short) or the entire pad of my foot/feet will get it. Over New Years with a very low mileage base, I went to California and ran/hiked 34 miles. Had a hot spot early that I actually taped, and a blister on a toe but that was it – a sign that I was on the right track!

I’ve also become smarter on dealing with my blisters. I still get them, but they aren’t crippling. Once after my first attempt at the Leanhorse 100, they were so bad they caused me to miss the cutoff, and they got dangerously infected. Two years later, I went back and finished – it was my first 100. I still got blisters but they didn’t prevent me from meeting my goals.

Here’s what I do now for my feet other than monkey with hydration:

  • Work on my calluses and keep my toenails trimmed
  • Get my orthotics re-surfaced at least a couple months before event
  • Keep my shoes and socks current too and only use Smartwool socks
  • Train on the exact terrain I expect and work on the plan for my feet – it’s just as important as my physical and nutritional race plans
  • My starting feet recipe is to use BodyGlide on my feet before putting on socks. Then change my socks every 20 miles if I’m running anything over 50K.
  • Carry a foot kit on my back at all times with a couple Engo Pads for hot spots on my orthotics, a couple of alcohol wipes, blister pads and a safety pin, and duct tape for real emergencies on a pencil or on my water bottle
  • A full fledged foot kit for crew or in a later drop bag with new supplies for my carry kit, Desitin if it’s wet conditions, and tape/scissors/tincture for the next defense. An injection devise and zinc oxide and Second Skin/New Skin as final defense. I had to do all three lines of defense to actually finish Leanhorse, but we did it.

Thank you Karen for sharing your foot care plan.

Rough Country Gaiters – a Review

January 6, 2012 by · 1 Comment
Filed under: Foot Care, Foot Care Products, Footwear Products 

For years I have been a strong advocate for gaiters if you are doing trails. In fact, it has been one of my “absolutes” – things I believe you must do. This post is a review of the Rough Country Gaiters. Most gaiters follow the same design. They cover the top of the shoe and go up to the top of the ankle. The

Rough Country Gaiters cover the whole shoe

Rough Country Gaiters covering the whole shoe

benefit of Rough Country Gaiters over the typical design is how they cover from the top of the ankle to the bottom of the shoe. The beauty of this design is how they cover the shoe’s upper. With so many shoes’ uppers being made of mesh, this design, when correctly applied to the shoe, will keep all dust, dirt, and sand out of the shoe. Period.

Jay Batchen, of Dream Chaser Events, recently talked about Rough Country gaiters. I had been set a pair to try and decided to ask Jay for his opinion and a few questions about the gaiters.

Jay responded, “Having done the Marathon des Sables (MDS) nine times, and volunteering at two others, I have seen many different brands and configurations of gaiters for the desert environment. Here’s a great recap a friend provided after using the Rough Country model at this year’s MDS; I ran with him for the better part of three days and heard many of the same things from others in our group.

The Rough Country Gaiters have the same basic shape as the Raidlight Gaitors. The material used by the Rough Country gaiters is thicker that some other gaiters and is more resilient to tearing as a result. The Rough Country gaiters have an additional seam around the bottom edge where the Velcro attaches. There is an elastic cord that runs through the seam and exits the gaiter through a metal eyelet on one side of the gaiter. The elastic can be pulled tight and run underneath the shoe and connect to a hook on the other side of the gaiter. If you are running on anything other than deep sand, however, the elastic under the shoe can be cut by sharp terrain (i.e., rocks).”

The Rough Country Gaiters are shipped with strips of Velcro that can be sewn or glued to the shoe’s sole. Jay says, “It’s best to have a shoe cobbler sew the Velcro strip along the perimeter of the shoe’s sole, where the sole meets the upper. The key is to make sure the Velcro is as low as it can be in this area so sand cannot get under the gaiter. Be careful that having the Velcro sewn on doesn’t change the fit of the shoe or pinch an area of the toe box so it chinches the area and causes fit problems.”

Another important key is to apply glue to the Velcro strip before sewing it to the sole. He stresses that sewing the Velcro to the sole is the most important point to making the gaiters work. Using glue alone will not work well, especially in a multi-day race. The constant daily abuse of rocks, shrubs, burrs, and sand puts more pressure on the gaiters than the glue will allow.

Jay is quick to point out that he tells people he knows to not just glue the gaiters on – and every year someone shows up whose has not had the gaiters sewn on. They always have problems as described.

Jay’s friend wrote, “The first day of the 2011 MDS was the dune day and I wore the Rough Country Gaiters. The sand would enter the gaiters through the metal eyelets on the sides, and fill the seams. The seams started to balloon out from the sand and it looked like I was running with small hula-hoops on the bottom sides of my shoes. Once the seams ballooned out, the Velcro under the seam of the gaiters started separating from the Velcro sewn on the shoes. This made me carry the extra weight of the sand in the seam through the run and I was constantly adjusting the gaiters through the dunes.”  

Jay said for this reason, he didn’t think the Rough Country design lends itself well to an environment with deep sand. It seems that it would perform better when the majority of the terrain is comprised of rocks and scree.

Rough Country Gaiter eyelet's

Sew a seam to isolate the eyelet's on the bottom side of the gaiters

I have provided foot care at several desert races and like the Rough Country Gaiters for the full-shoe coverage and sand control. So, I would find a way to make them work for these conditions. Here’s my suggestion to control sand going into the seam. The gaiters have a pair of eyelets on each side for the cord going under the arch of the shoe. As you can see in the image here, the eyelets are in the middle of about a 3/8-inch strip, which we will call the seam. My idea is really simple. Have a friend with a sewing machine stitch up and down on the outside of the pair of eyelets. Use quality thread and stitch up and down a number of times. Then run a dab of Super Glue over the threads on both sides of the gaiter. This effectively seals both side of the seam from sand coming in the eyelets.

Eric LaHaie, in a review on the Racing The Planet webpage for Rough Country Gaiters, gives a good suggestion for using the strap, “… when the elastic strap is pulled under the shoe, it tightens the cord that goes around the gaiter and can make the toe of the gaiter peel off the Velcro more easily. Therefore, I recommend using the strap only in emergencies, like if the Velcro starts to come off the inside sole of the shoe. Leaving the strap off leaves the metal eyelets even more exposed.”

I asked Jay about changing socks and whether it’s much of a bother to undo the gaiters on the shoe’s Velcro. He responded, “I don’t think it’s a big deal to work a sock change, but I’m used to the system. I believe it’s worth the effort since the design of the gaiters keeps the sand out.”

On the questions of whether the top could it be loose on someone with a small ankle/calf, Jay had this answer. “It’s possible that it could be too loose (or too tight) on some people. On average folks they should be fine. I’ve seen people add an additional strap if they’re too small.”

They are made of thicker material (80% nylon, 20% Spandex) then other gaiters so they may not breathe as well as lighter weight gaiters. If the temperatures are really hot, the heat buildup inside the gaiter could lead to heat rash on the foot and ankle, and even hot spots. The trade-off is lighter-weight material can tear or torn easier by rocks and branches.

In my opinion, gaiters are a “must” for those doing trails. Rough Country Gaiters would be my pick for an event where one needs protection from sand and dirt that get under most other gaiters. The usual style of gaiters that most runners use go from the ankle over the top of the shoe – but not down to the sole. That style allows sand and dirt, and trail dust, to get into the mesh uppers, which most shoes today are made of. It then gets inside on the socks – and then on the skin. The sand will lead to irritation of the skin as it rubs against the skin. Dirt will lead to the same thing, but not as fast. The best way to keep sand and dirt out of your shoes and socks is to wear a good pair of gaiters. Rough Country Gaiters will do that better than other gaiters.

Racing the Planet sponsors unique, rough country footraces that take place in remote and culturally rich locations around the world. The events consist of the 4 Deserts, an annual series of 250-kilometer footraces in the Atacama Desert of Chile, the Gobi Desert of China, the Sahara Desert of Egypt, and Antarctica, and a 250-kilometer roving footrace that moves to a new location each year. Previous year’s roving races have been held in Vietnam, Australia, Nepal, and Namibia. The 2012 roving race will be in Jordan. In 2004, I worked medical doing foot care at the Atacama Desert event. I know many athletes who have done their events and highly recommend them. Check them out at RacingthePlanet.com.

The Foreword

February 1, 2011 by · Leave a Comment
Filed under: Books 

I want to share the new Foreword to the 5th edition of Fixing Your Feet. With the planning for each new edition, I struggle over who to ask to write the Foreword. Is famous better then credibility? My choices have always been someone who brings something new to the table. A perspective that is new. I met Brian Krabak through emails and his work at some of the Racing the Planet six-day races. I think you will enjoy what he wrote. Thanks Brian.

The Foreword to the 5th edition of Fixing Your Feet

Whether you are participating in a 5-kilometer or 150-kilometer race, all athletes need to train appropriately to hopefully avoid injury. Train correctly and you can experience the wonders of the outdoors or the thrill of competition. Train incorrectly and you may sustain a significant injury that will not allow you to compete or obtain your goal. In extreme situations, where athletes are out in the wilderness, these injuries can have deadly consequences. Good athletes train appropriately and prepare for whatever obstacles might come their way.

Spending years competing as an endurance athlete, including adventure racing and triathlons, has taught me the importance of preparation and prevention. I can remember finishing 24-hours races having crossed several river beds, hiking over mountain passes and through slots canyons – thankful that my feet, though sore, were fine. Unlike the poor soul I passed at a checkpoint tending to a horrific blister requiring him to drop out of a race, I’ve learned the importance of taking care of one of the most important parts of our body, our feet. It’s our feet that connect us to the surrounding terrain, propelling us toward our next destination. Take care of your feet and the world is yours to enjoy. Ignore your feet and life can be a miserable experience.

I’ve witnessed the impact of injuries to the feet as Medical Director for RacingThePlanet. These ultra-endurance running events challenge athletes to cross over 150 miles over seven days through some of the harshest terrains around the world. My research has identified that for the majority of athletes who experience some sort of race injury-it’s an injury related to their feet. Yet, almost 25% of these athletes will not need medical care. How can that be? The answer is training and prevention. Fortunately for those with injures, most are blisters that can be managed appropriately if identified early. In fact, our medical team spends a good amount of timing reminding athletes to protect their feet. Strategies include the use of lubricants, changing of socks, checking of skin for hot spots, staying well hydrated and well nourished. However, mismanage these blisters or other lower extremities injuries and most athletes experience some serious illnesses including skin infections that causes them to drop out of the race.

That is why Fixing Your Feet is such an important resource. The comprehensive book provides some of the most detailed information regarding your feet and how to prevent or treat injuries from one of the experts in the field. Looking through the pages, you’ll learn about the basics of footwear, including new information regarding minimalist and barefoot running verses shod or traditional footwear. Preventive strategies focus on the role of clothing, compounds, taping and impact of various extreme conditions on your feet. Treatment recommendations will help manage the typical foot injuries relating to skin, muscle and ligaments. Throughout, practical tips will help you no matter where you go. It’s why I will typically recommend the book as a resource for any medical personal helping with an ultra-endurance running event or wilderness expeditions. So whether you are an athlete competing in a race or part of the medical team taking care of an athlete, I recommend you keep Fixing Your Feet close by.

Brian J Krabak, MD MBA
Sports Medicine Physician
University of Washington and Seattle Children’s Hospital
Rehabilitation, Orthopedics and Sports Medicine
Medical Director, RacingThePlanet 4 Desert Series

* * * * * * * * * * * * *

I already have decided who I want to write the Foreword for the 6th edition! That’s a long ways off and may never happen, but I remember back in 1997 when Fixing Your Feet was a self-published book done on a shoestring – and a lot of hope. Now, 15 years later, Fixing Your Feet has earned it place in foot care history (if there is such a thing).

Thank you all my faithful readers and followers. Thank you all those who have shared their ideas photos. I pray you enjoy the 5th edition and it saves you pain and discomfort. You are the reason I do this.

Problems with Mesh in Running Shoes

June 20, 2010 by · 1 Comment
Filed under: Foot Care, Foot Care Products, Footwear Products 

Footwear made with mesh is lightweight and many trail shoes use it liberally. Your shoes may be lighter and cooler, but the mesh allows junk to get inside the shoe. It then can increase friction.

Whether or not you wear gaiters, if you are running trails a lot, try to use shoes that don’t have too much mesh. The mesh allows trail dust, grit, sand and other debris to get inside your shoes where it gets under your insoles, into your socks, and onto your feet. This “trail junk,” along with the movement of your feet inside the shoes, can tear up the shoes’ inner material, causing even more irritations to your feet.

To a certain extent, gaiters can help control what gets in your shoes. Typically, gaiters cover the top of the shoes and a bit up the leg. While this helps control debris and grit from entering at the top of the shoes, they often don’t help in controlling it from entering in other areas. When you have a lot of mesh over the toes and instep, you’ll find these mesh areas allow fine grit inside your shoes.

Racing the Planet's 4 Desert Gaiter

Racing the Planet's 4 Desert Gaiter

I know some runners who will apply duct tape over the mesh. Others will make gaiters that attach to the soles of your shoes. One pair of gaiters made for this are the 4 Desert Gaiters from Racing the Planet are made from nylon and spandex and are ankle high. Their uniqueness is the design, which attaches to the shoe’s sole to provide sand protection. They suggest having a cobbler sew the Velcro onto the sole for strength. Make sure the stitching can’t be felt inside the shoe – www.racingtheplanet.com.

If you use lubricant on your feet, make sure you clean your feet when changing socks and reapply another coating of lube.

You may like lightweight mesh running shoes. I do too. But it helps to recognize one of the potential problems with mesh and deal with it. Next weekend I will be at Western States 100, patching feet at Michigan Bluff. I know I will see lots of runners without gaiters – and many will suffer because of skipping this simple choice.

Disclosure: I have no financial interest in Racing the Planet. It is just a good product.

Adventures in Foot Care

June 21, 2007 by · Leave a Comment
Filed under: Footcare, Footwear, Health, Sports, Travel 

Most athletes love adventure – and it takes many forms. It might be a marathon, a trail marathon, an ultra, a fastpack, a triathlon, a long walk, a multi-event, or an adventure race.
     A few days ago, about 50 adventure seeking runners and walkers started the Gobi Desert, a seven-day foot race in the Gobi Desert in China. The event is put on by Racing the Planet, a great company that puts on a series of these seven-day races in places like the Sahara desert, the Atacama desert in Chile, and Antarctica.
     While many of us cannot do this kind of event, we can savor the experience through the Internet. Go to the Gobi Desert website and click on Race Coverage. Pick a day and see what the race involves. The race staff updates the race coverage daily. See the gallery of photos, read about the racers, the country, and the support team. The race started on June 17 and ends on June 23.
     While you are reading this, I am in Prince Rupert, BC Canada. I am there to work on the medical team and provide foot care for the 24 four person teams racing in the Raid the North Extreme Adventure Race. The race starts on Sunday, June 24 and ends on Saturday June 30. The snow pack and its melt have changed the course due to flooding, but we will have a challenge and lots of fun. Here is the Raid the North Extreme website to read more.
    Also, Saturday June 23 is the running of the Western States Endurance Race, a 100 mile trail run in the california High Sierra. The race is one of the most popular 100 mile races around. Here is the website for race day coverage. Enjoy the race whereever you are.
     Each of these adventures will test runners’ and walkers’ feet, and their preparation to do their own foot care. When I return, I will post some of my experiences at Raid the North Extreme.

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