Consequences of Maceration

Macerated feet at the finish line of Western States

Macerated feet at the finish line of Western States

At Western States we saw a lot of negative results from wet feet. Even though we tried to spread the word, many runners did not protect their feet. Runners had poured water over their heads, which went into their shoes, and they sat in streams. Runners were complaining of blisters on the feet, mainly the balls of the feet but it was maceration. In reality, almost everyone had one or more skin folds common to their feet being wet for long periods of time. These might be in the center of the mid-foot or at the ball of the foot near the toes. Some did fine by warming their feet, applying powder, changing socks and shoe when possible, and maybe sitting a bit – and continued on and ran well. Others did not stop at aid stations or get crew help, and ran on with wet feet. Then they reach a pain point at which they cannot continue, or they reach the finish line – and they want help with their feet.

There is no quick fix to maceration. The more severe it is, the longer it takes to return to normal. Maceration can be painful – and yes, feel like one’s feet are burning. The skin is so soft and tender that every step is painful. Many times the skin has folded over on itself or has lifted to form deep creases, which can split open. I have seen maceration go through several stages:

  1. First, the skin begins to soften and becomes tender.
  2. Second, the pruning starts as the exposure continues. The skin wrinkles and softens even more.
  3. The third stage is when the skin can form creases and folds over onto itself. The creases may be shallow or deep, but are painful.
  4. The fourth stage is the most severe. The folds split open and/or the skin may tear.

If there are blisters, they must be drained and covered with a waterproof dressing to help keep tissue swelling under control. Tissue swelling leads to cold and damp skin, swollen and difficult to patch.

There are ways to deal with maceration, but it’s even more important to take steps upfront to prevent it. For instance, change into dry shoes and socks whenever possible, change socks as often as possible. When getting crew aid or at aid stations, remove your shoes and socks to allow your feet to dry, sprinkle with powder and rub it in, warm your feet with light massage, let them see some sunshine, and use one of the moisture control agents.

For moisture control, RunGoo from Foot Kinetics is one of the best. Its thick white paste works wonders on the skin and helps keep moisture at bay and it last a long time. FootKinetics.com has created a great product that works. Other excellent products include Trail Toes, ChafeX. SportsSlick, and Desitin Maximum Strength Original Paste. One thing to look for in these products is how long they last and do they come small packages or could they be packaged small enough to be carried in a hydration pack. My preference for applying any of these is to use them liberally. Then bunch your socks and roll them over your feet. Avoid just pulling your socks on, which can thin the product around your toes and forefoot.

Applying a coating of Hipoglos

Applying a coating of Hipoglos

Having severely macerated feet is not a badge of courage. It’s a sign that you could have made better earlier choices in foot care. Some of the worst feet I have seen have been because of severe maceration.

For 20% off your purchase of RunGoo from Foot Kinetics, use the coupon code “tfk20john.” I’m even using it as a chamois cream when road bike riding. It does last.

In a future post, I’ll talk about treating feet and maceration at a race finish line.

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