Filed under: blister care, Foot Care, Footcare, Footwear, Health, toenails
Here are a few foot care tips I wrote to help runners at the Amazon Jungle Marathon. I’ll be there in a few weeks to help with foot care on the medical team. The tips are valuable for anyone doing a 24 hour race, a multi-day event, an adventure race, or a long backpack. Remember, your feet will carry you day to day only if you take care of them.
Start with good toenail care. Trim your nails short and then use a file over the front edge to remove any rough edges. File the tip of the nail so when you run your fingertip over the tip of the toe and over the nail, you don’t feel any rough edges. You can also file the top of the nail if it’s thick. Coming to the race with bad toenails will ensure toe blisters and black toenails.
Make sure your shoes fit well. Have enough room in the toe box for your toes to wiggle. Your feet may swell over the race and you don’t want shoes that are too tight. Some shoes, like Hokas, retain water and become heavy over the days, as they are wet so much of the time. Wet and waterlogged shoes are heavy.
Get good socks. Don’t show up with cotton socks. Socks made with Coolmax or wool are good choices. Injinji toe socks are great. Have several pair and wash then after each day’s stage or have one pair per day. Also don’t show up with old socks or ones with holes in them.
Do whatever you can to reduce any calluses. Getting a blister under a callus can be painful and it’s very hard to find the pocket of fluid for draining. After showering, use a callus file or pumice stone to shave the callused skin from your feet. Then apply some callus cream. This is something that should be done several times a week. Calluses are the result of friction and pressure between your shoes and feet. Make sure your shoes will drain water.
Shoes that hold water inside will increase the maceration effect of your feet being wet to long, leading to wrinkled and soften skin that can fold over, crease, and split open. Check this by filling your shoes with water and seeing whether it will drain out. You can heat a nail (at least 1/8 inch round) or an awl and make several holes at the inside and outside arch, and the heel of your shoes. Learn how your feet respond to being wet for long periods. Do some long walk or runs three to six hours long with wet feet. Try several products like Desitin or similar cream for baby bottoms that works to control moisture on the skin. Google “baby bottom cream” to see many options.
Do not skimp corners on your foot care kit you need to carry in your pack. Have several yards of a good quality tape, several needles to drain blisters, and learn how to drain and patch blisters. The medical team will try and help with your foot care needs, but we can become overwhelmed by the number of people wanting help. Part of your responsibility as a runner is to know how to do good foot care.
Carry a good pair of camp shoes to wear in the camp after each day’s stage. You don’t want to walk around barefoot and doing so will destroy the taping or blister patching done by you or the medical team. Lightweight Crocs, flip-flops, or sandals are easy to strap to your pack. Change into these after running to allow your skin time to heal from the moisture.
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.
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.
For years, the norm has been to avoid getting your feet wet. When feet get wet for extended periods, usually the feet have skin that is soft and macerated. In long events, and especially in multi-day events, that can lead to trouble. Taping or patching wet feet, or macerated feet, is very difficult. So it is best to keep your feet as dry as possible.
This has always been the rule.
In the past few years, adventure style races have become popular, which puts runners in conditions where wet feet are the daily norm. Most often, these races are six to seven days in length. The race often includes running through the jungle or mountains with stream crossings, wet foliage, wet trails, mud, and extremely humid conditions. In these conditions, your feet are always wet.
If you think this doesn’t apply to you because you are doing a “dry” race, please consider this. Even dry races with no water crossing can produce wet feet. Dumping water over your head at aid stations to cool off will get water in your shoes. Plus our feet naturally sweat and this buildup can result in wet feet.
Shirley Thompson, the Race Director of the Jungle Marathon told me, “We always advise runners to train with wet feet so that they can focus on a strategy before they get to the jungle. As far as footwear is concerned, we always emphasize trail shoes with good grip, and that comfort is the main factor.”
So how can we do that? For training runs, soak your shoes and socks before heading out. Step in puddles or use a hose if they dry out. Try to keep them wet as long as possible. If you feel a hot spot or blister start, stop and adjust your shoes and add tape, lube or your favorite blister prevention product. Take time to find the best shoe and sock combination for your feet when wet.
Personal Foot Care of Wet Feet
Because your feet will be wet, often at the start of each stage, it makes sense to do some of your training with wet feet. Use the same shoe and sock combination that you plan to use for the race – and get them wet. Walk and run in them. Not just a 30-minute run, but hours! Put some distance on your wet feet that is the same you expect to do during the race. Try to also to do back to back wet feet training days. It’s that simple.
As said earlier, stop and deal with any hot spots as soon as you feel them. Check for folds in your socks, friction from dirt or sand, pressure inside your shoes – and get rid of these irritants. Lube the area or apply a piece of tape or blister prevention patch to help. This may seem like common sense, but many people ignore this simple step.
At the end of each day’s stage, remove your wet shoes and socks, dry your feet and air them as much as possible. If your feet have tape on them, remove the tape to dry the skin underneath. Wear sandals or Crocs around camp to keep your feet away from the wet ground and dirt and sand. Walking around barefoot will often aggravate wet, cold, and soft macerated skin. Later in the day or the next morning, re-tape your feet and patch any blisters.
Because you cannot count on medical people patching your feet the way you want them patched or that they will be available, you must learn how to patch your own feet. I have helped at events where I have patched feet all afternoon and evening, and then had people line up in the morning for more work. Sometimes the medical staff is stretched thin or cannot get to everyone. Be prepared to do your own patching and have your own equipment. Better safe than sorry.
Many times at races, I have seen athletes who have not trained their feet for the event. They enter a race and don’t put the necessary miles on their feet, don’t have the right shoes, don’t know how to manage and patch their feet. I encourage you to take the time to train with wet feet and condition them for the extremes of your race.
In choosing footwear, fit is everything. You may buy a new pair of shoes, not get a good fit, and use them for short runs or races without much problem. But the longer you’ll be wearing them at a time, the more important the fit.
Here’s a trick to help get ensure a good fit.
Rich Schick, a physician’s assistant and ultrarunner, shared that he believes the key to getting the proper size shoe is the insert – often called insoles. “If the foot does not fit the insert, then the shoe will have to stretch to accommodate the difference or there may be excessive room in the shoe, which can lead to blisters and other foot problems.” He thinks there is too much confusion about straight lasts, curved lasts, semicurved lasts, and so on.
Rick suggests, and I agree, that you don’t need to know any of this if you use the insert to fit your shoes. The same holds true for the proper width of shoe. Simply remove the insert from the shoe and place your heel in the depression made for the heel (in the insert). There should be an inch to an inch and a half from the tip of your longest toe to the tip of the insert. None of your toes or any part of the foot should lap over the sides of the insert. If they do, is it because the insert is too narrow or is it because of a curved foot and straight insert or vice versa? The foot should not be more than about a quarter inch from the edges of the insert either. This includes the area around the heel, or the shoe may be too loose. Check to see if the arch of the insert fits in the arch of your foot. Finally, if all the above criteria are met, then try on the shoe. The only remaining pitfalls are tight toeboxes and seams or uppers that rub.
Remember to take into a account the type and thickness of socks you’ll be wearing. If you are going to replace the stock inserts that come with the shoes, make sure to follow this tip.
In August I worked the Gold Rush Adventure Race in the California Sierras. Throughout the race I worked at three checkpoints. As racers needed foot care, I carried my lounge chair and foot care box to where their team was set up and did what I could.
Most racers had hot spots, blisters and sore feet. A lot of times, athletes tell me that have blisters and yet, after cleaning their feet, none are visible. They may have a very sore spot or a hot spot, but there is no blister. Sometimes I can tape over the area or place a Spenco patch to provide a bit of cushioning. I often add an Engo Blister Prevention Patch to their insole underneath the tender area on their foot.
A lot of the racers needed blister care and taping. My whole aim when patching feet is to get the racers back in the race. I do what I can to drain and patch blisters on any part of the foot.
One of the racers came into checkpoint where they were transitioning from bikes to foot. At this point, they had been on their feet for almost two days. They started with a long paddle, followed with a long bushwack up a canyon, and then a really long bike section. The team was near the end of pack. The four members sat and discussed their options and whether to continue. The next section was a long trek of about 36 miles.
The racer needing foot care took off his shoes. As he sat back in my lounge chair, I removed his socks. His heels were fine, however he had major problems with blisters at the ball of the foot where the toes started. Both feet were the same. I cleaned his feet and did an evaluation.
I wish I had taken a few pictures of his feet but I was too involved in getting his feet patched so the team could continue. At the base of each toe were blisters. Many extended to several toes. Some of the blisters extended up between the toes. The majority had blood in the fluid. There were blisters at the base of the toes from one side of the foot to the other side – on both feet. His feet were swollen so the blistered skin was stretched tight from the fluid. In addition, several of the toes had blisters on the bottoms or sides, several with blood inside.
The blood in the blisters was my major concern and that there were so many of them. I usually drain blood blisters and with clean skin and a dab of antibiotic ointment – in a 24-hour race, I’m comfortable doing that. I always ask the person if they are up to date with their Tetanus shots and give them instructions about infections.
I talked to the racer and gave him my honest opinion – that he not continue in the race. We talked and I gave him my reasons. The next section was about 36 hard miles of cross-country trekking. His feet would get wet, and this would soften the skin and lead to further skin breakdown. The blisters were in a hard area to patch and it would especially be one long patch at the base of all his toes. The swollen condition of his feet was not going to get any better. And most important, the blood in so many blisters, even with the blisters lanced and patch, would increase the chances of an infection. Plus, if his feet took a beating during the trek, the blisters would become a huge open unpatchable mess (for lack of a better term). And of course, his feet would hurt badly.
He took my advice and I wrapped his feet as shown in the photo.
I think I can count on my fingers how many times I have advised racers to stop because of foot problems. Sometimes your feet simply quit. They have had enough.
Could this have been prevented? Based on my experience, I have to say, probably. Changing socks, treating hot spots, earlier blister care, better socks, moisture controlling lubricants, airing feet at checkpoints, and better shoe fit. In a team event, such as adventure races, every member of the team must help the other members with foot care. Every team member must be honest with their teammates about the condition of their feet. In solo races where athletes are racing alone, they need to be constantly aware of their feet. And where there are crews, these important people must ask questions about the condition of the athlete’s feet.
There are no guarantees in a race of any length. Our feet propel us forward, but every so often, out feet quit.
Lets talk about expectations for foot care at races. I like this subject because being prepared is important. It can make my work easier and likewise that of everyone helping with medical and foot care at races. This coming weekend is Western States and there will be a lot of runners needing help with their feet.
Over the years I have seen everything at 100-mile races. Runners with holes in their socks or socks so worn you can see through the material, severe Athlete’s Foot, long and untrimmed toenails, huge calluses, no gaiters, the use of Vaseline as a lubricant, the use of Band-Aids on blisters, existing injuries that have not healed, shoes that should have been tossed out, huge blisters caused by not treating hot spots, and lots more.
I see runners with crews that manage everything for them – including foot care. These are typically runners who have experience in longer races. They also seem to have some degree of foot care expertise. They will come through an aid station and meet their crew and all is well. If they need foot care, they have the supplies and they or their crew knows how to use the materials. They are prepared.
Other runners are less prepared. They might have crews, but they don’t have the foot care supplies, much less the expertise in how to do what they needed. They count on someone being there to fix their feet.
Many of these runners expect a lot from the podiatrity staff – sometimes, they want a miracle. There are four issues to get past. First, many times there are no “official” podiatrity people at the aid station. No podiatrist anyway. Second, what they get is someone who is maybe a nurse, paramedic, EMT, or even a full-fledged MD, who is volunteering as the aid station’s medical person. Third, often this person(s) has limited skills in fixing feet. And finally, fourth, often they have limited supplies.
So what do you get? You get a person who really wants to help but may be hindered by their limited skills and resources. Don’t fault them if the patch doesn’t work or it feels wrong. You might try and give them directions on what to do – with limited success.
What’s wrong here? Your expectations are wrong. You cannot expect every race to have podiatrity people at every aid station, with supplies to fix hundreds of feet. Some races have medical staff while other races have none. A majority of races do not have podiatrist on hand. Is it their job to provide it? Only if they advertise such aid.
This means you should be prepared at any race you enter, to have the foot care supplies and knowledge to patch your own feet – or have crew that knows how. Does that sounds harsh? Maybe so, but you entered the race. You spent money on travel, a crew, food, new shoes, lodging, new shorts and a top, water bottles, and more. But did you spend a few bucks on preparing a good foot care kit?
Why take a chance that I or anyone else is there to fix your feet? I find lots of runners who have my book (Fixing Your Feet) but I am amazed at the large numbers who haven’t heard of it.
Many of us don’t mind fixing your feet. In fact I love to do it. But we can’t be everywhere – at all aid stations, at all hours, and at all races. Can you do me a favor? Tell some else about Fixing Your Feet and this blog. Make their life a bit easier and help them finish their race with happy feet.
I’ll be in the medical area at the Michigan Bluff aid station. In back of the scales and food tables. If you need me, I’ll be there.
Last month I was at my local REI store to conduct a clinic on foot care. At the same time, they held a footwear festival, which had eight footwear companies represented.
I noted something about some of the shoes that is valuable to know if you are shopping for shoes. Specifically, the materials of the shoe’s upper.
I have two photos to share with you. The shoes in these photos are made by Salomon. In fair disclosure, I have several pairs of Salomon shoes that I received as swag for working medical at races. I find they are well made and are easy to fit to my feet.
The first photo shows a shoe that is typical of many shoes today – by most of the companies. The shoe’s upper is made with a mesh material. Whether it is one or two, or even more layers is not important. It’s mesh.
Wearing shoes with a mesh upper will generally help keep your feet cooler. But the mesh allows minute particles of sand and dirt to get inside, onto and into your socks, and on your skin. Those particles can cause friction and over time can cause hot spots and then blisters to develop. Yes you can wear gaiters, but the usual gaiter design covers only part of the front of the shoe’s upper. Stuff still gets inside. The alternative gaiter is a design that covers the full shoes, from the outer sole up over the ankle. A few months ago, I did a review of a gaiter that covers the whole shoe. Here’s the link.
The second photo shoes a different shoe, also made by Salomon, that has an upper made with a non-mesh material. This upper will keep sand and dirt out of the shoe. A gaiter with this shoe will be useful if you are running in a sandy, dusty, or dirty course, where you would likely get stuff into your shoe through the top of the shoe.
To be truthful, I feel strongly that trail runners should wear gaiters regardless of what shoes they wear. Gaiters are good proven equipment.
If you have a race or event on your summer calendar that involves lots of sand and loose dirt, keep the material of your shoes in mind when planning. Something as simple as a non-mesh upper can save your feet.
I just had to share this photo. A few weeks ago I worked at the 21-mile aid station at the Oakland Marathon, which was also the eight-mile aid station for the half-marathon.
Back in the 80’s I ran the old Oakland Marathon and after a few years the event died. Then three years ago, Coorigan Sports took resurrected the run.
So on a Sunday morning, we set up the medical tent. It was me and six nurses from the Alameda County Medical Center. We stood outside the tent and watched the runners and walkers coming by.
I brought my foot care kit in case a runner needed help. I actually got quite a bit of business. The usual hot spot and blister care.
Then a young lady stopped. She wanted a blister patched.
She was wearing two pairs of socks. She took off her socks and I made the necessary blister repairs.
Then I helped put on her socks. Look closely at this picture and you’ll see the the threadbare sock under the ball of the foot. The rest of the bottom of the sock is so thin you can almost see through the fabric.
I told her she needed to toss the socks and gave her a few tips on socks.
It bothers me to see runners and walkers spend money on a race, wear good shoes and the right running clothes, and forget something so simple as a good pair of socks.
Please, take a minute and check your socks. If you have any like this, toss them.
You’ll be doing yourself a favor.
Ok, this is a quiz. Of all the socks in your sock drawer, how many should have been tossed months ago? I’ll bet you have two to three pair of socks that should have been aimed at the wastebasket a long time ago. Maybe even more. So how do you know when to toss out a pair of socks?
- Can you see your fingers through the weave of the fabric?
- Can you see threadbare areas, typically on the heels?
- Are their holes in the toes, or anywhere else for that matter?
- Is the inside starting to unravel?
- Are any areas thinner in cushioning than the rest of the fabric around that area?
- Is the top cuff around your ankle starting to come apart?
- Is the toe seam bothersome?
- Is the top cuff no longer supportive, hanging down your ankle?
If you can answer “Yes” to any of one or more of these eight questions, toss the socks. Socks are relatively inexpensive. Sure some cost upwards of $15.00 to $20.00 but just like other gear, there some a time when it is necessary to clean out your drawers.
Here’s an added tip. Don’t just check your old socks. Check them all. I once ran in a fairly new pair of brand name socks and developed a hot spot on one heel. When I too my shoe off, I discovered the sock was defective and the weave on the heel had separated. I had no more than 60 miles on the socks-but saved them for when I do foot care clinics as an example of a sock to toss.
When you need new socks, head over to Zombierunner and check out their selection. They have a well deserved reputation for quality product selection and service. Don and Gillian have selected only top of the line socks. We need to support our local running and outdoor stores, but for many without local stores, Zombierunner is a good source of products for the serious athlete.
Disclosure: I have an affiliate relationship with ZombieRunner and earn a small amount from referrals.
The question is very basic: Do you know how to put your socks on?
John Wooden, considered America’s “winningest coach” recalls a simple, but decisive routine that he used with each new season’s players during his 27 years of coaching UCLA’s legendary basketball team to unprecedented victory.
John Wooden knew it all began with the socks. On the first day of practice, Wooden would tell his recruits, “Gentleman, today we’re going to figure out how to put our shoes and socks on.” Some players would blanch. Wooden would calmly explain that most players are benched for blisters, and the easiest way to avoid them is to pay attention to the basics. He would meticulously show them how to roll up their socks and tighten their laces. “I wanted it done consciously, not quickly or casually,” he said. “Otherwise we would not be doing everything possible to prepare in the best way.”
So, again, do you know how to put your socks on?
This may seem too basic. However, a crease or fold in your socks can lead to a hot spot and eventually a blister. Putting on your socks is very basic. Run your hands over your feet to wipe away any lint, then roll your socks from the top down to the toes. Slip the socks over your toes and gently pull them up over your heels until they are unrolled.
John Wooden has several books. This story comes from his book, From the Socks Up: The Extraordinary Coaching Life of John Wooden, by Mitch Horowitz.