Maceration in a Dry Race

August 10, 2014 by · 4 Comments
Filed under: blister care, Foot Care, Footcare, Health, Sports 

Maceration in a Dry Race

Two weeks ago I worked medical at Badwater. This year’s course had some serious uphills and downhills – but the course was dry. Unless one has feet that sweat heavily, there typically would not be any issues with wet feet.

Yes, this post is going to talk more about maceration. I’ve done a number of posts this year on maceration, but the problem won’t go away, so there must be more to learn.

So here’s how maceration happened in a dry year at Badwater and what you need to learn from it.

It’s very simple – really. Runners pour water over their head to cool themselves. Or well-meaning crews douse their runners with water over their heads, or spray them up and down with some kind of tank sprayer. The water runs down the runner’s clothes and body, down their legs, and ends up in the runner’s shoes. Socks and shoes become saturated.

Wet and macerated feet

Wet and macerated feet

Sometimes runners will changes socks and shoes during the run, and this helps for a bit, until more water is poured over the runner’s head and down into his or her shoes.

The water buildup leads to softening of the skin and maceration. In the photo you can see three areas of concern. If you click on the image, you’ll open a much larger copy image where you can see the detail even better.

First, the skin has torn at the base of the fourth toe. There may or may not have been a blister with fluid under the skin on the ball of the foot. My guess is it was not a blister, but simply wet softened skin that was stressed and then tore.

Secondly, notice the fold of skin at the bottom of the baby toe. The toe was probably pinched in the shoe toebox, folding under the fourth toe. This puts pressure on the skin of the baby toe, pushing the skin forward into a fold from the tip of the nail to under the toe. When I see these folds, the skin in usually intact and not torn.

Thirdly, notice the fold of skin going down the center of the ball of the foot. This is the most serious of the three problems. The fold is painful. The skin is not torn, but has pulled up and then folded over on itself.

As the skin goes through the maceration process, it first looks like the skin of a prune – shriveled up. The longer the maceration continues, the more chance for the skin to soften. The foot inside the sock, inside the shoe, can be squeezed and as the runner moves through the foot strike, with his whole body weight carried on his feet, pressure is put on the skin leading to creases in the skin. The creases are most common in a line down the length of the foot rather than across its width. Continuing through the maceration process, the creases of softened skin can lead to the skin lifting up and folding over on itself. In the photo you can see the shadow from the fold – it’s significant and can be quite painful.

In this case, all three problems were caused, by the runner’s admission, his pouring water over his head and allowing it to run down is legs into his socks and shoes.

It seems so beneficial to cool yourself off by pouring water over your head and/or by spraying your body and legs – but there are negative side effects.

The hard part for the runner, besides the pain, is that there is no quick fix to remedy the skin folds. It takes time, sometimes days for the skin to return to its normal state.

In an upcoming post I’ll talk about some products to help protect your skin from wet conditions. For now, avoid pouring water over your head. Protect your feet.

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

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