A month ago I provided foot care at the Western States 100. Then two weeks ago I worked the Tahoe Rim Trail 55KM, 50M, and 100M. And finally this week I worked Badwater in Death Valley. As much as I hate to say it, I saw a negative common denominator as I worked on or saw runner’s feet.
The common negative was runners’ toenails.
I wish I didn’t have to say the toenails were bad, but a lot of them were. While not every runner suffers with their bad toenails, many do. Enough to warrant this blog post.
The picture here is an example of nails that could be better – much better. I won’t identify the runner or the race because I saw these same toes at each of the three events.
Toenails that are thick can be smoothed with a nail file. In severe cases, a Dremel tool can be used to reduce the nails quicker, especially when the nails are really thick and tough.
Your nails don’t have to be thick. They don’t have to be rough. They don’t have to have an upward curl or edge. They don’t have to be wavy. They don’t have to stick over the end of your toes. In short, candidly, they don’t have to look like your toes are 90 years old and you live in a nursing home. If you think you might have toenail fungus, check with your doctor – and take care of it.
An inexpensive toenail clippers will set you back about $5. If you have tough nails, you may want to buy a stronger set of clippers that look something like wire cutters. Then get a file for another $1 or $2.
Toenails that are too long, too thick, have rough edges or corners, will catch on your socks, which will push the nail back into the nail bed and cause trauma, fluid or blood under the nail, or toe blisters. During a race, these nails become painful to touch – meaning you can’t trim or file them without pain.
So we see you at an aid station, and you are hoping we can fix your feet. If there is fluid or blood under the nail, we can drain them. We can run a strip of tape over the tip of the nail to provide a bit of protection to the nail. But we cannot fix the discomfort and pain.
I can patch most anything on your feet, but I cannot fix a thick toenail that sticks up way above normal. I cannot smooth the rough edges if you cannot tolerate the filing. I cannot trim the nails if you cannot tolerate the pressure.
Caring for one’s toenails isn’t that hard. Once a week, use a clippers and nail file to trim them. Clip them fairly short and then run the file over and down the tip of the nail, removing any rough edges. The goal is to have nails that you can’t feel when you run your finger over the front edge of your toes.
If you have lost a toenail, as the new one comes in, file the top of the nail thin. Wrap a Band-Aid around the toe to help train the nail to curve naturally to the shape of your toe.
Toenails are not complicated. But just as you care for other parts of your body, you need to care them them too.
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.
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.
Filed under: Foot Care, Foot Care Products, Footwear Products
What better time of the year to pamper your feet than Christmas. Our feet are encased in heavy socks and footwear. We take them for granted. Here’s a look at my favorite things for your feet this year. My suggestion is to check out these items at Zombierunner.com. Don and Gillian support athletes with great service. You can click on their link and at their website, click on Foot Care or any other items. Zombierunner has everyone of these items, except a callus file.
Engo Footwear Patches – these slick patches go in your shoes to reduce friction. A must for any foot care first aid kit.
Drymax Socks – my favorite socks that hate moisture. Their micro-fiber technology is a sweat removal system to keep your feet dry.
Injinji Socks – the original toesocks that are perfect for many sports, and a must for those who are prone to toe blisters.
Sportslick Lubricant – Prevents blisters, chafing and skin rash during sporting activities. This skin care product also cures jock itch, athlete’s foot, and other skin conditions.
Stuffitts Portable Drying Solutions – for shoes, gloves, helmets to defeat wet and stinky gear. Their soft, lightweight forms combat moisture and kills odor in personal wearable gear.
BlisterShield Powder – a great powder, especially for those who prefer powder over a lubricant.
Kinesio Tex Tape – a great tape that breathes and conforms to the shape of any part of your feet. 1, 2, and 3 inch widths.
Leukotape – one of the stickiest tapes available. 1 ½ inches wide.
Superfeet Insoles – one of the best insoles for support. They are available in a number of options.
Toenail Clippers – everyone needs a good clipper to tame their toenails.
Callus File – a callus build-up can lead to problems that can result in blisters underneath this hard layer of skin.
Natural Running – this is a great book that teaches you to run the way nature intended, mimicking the healthy, efficient barefoot style you were born with, while keeping feet safe from rough modern surfaces.
Fixing Your Feet, 5th edition – my best-selling book that covers all aspects of footwear and foot care.
Here’s the Amazon link for the Fixing Your Feet print edition.
Here’s the Amazon link for a Fixing Your Feet Kindle edition.
I hope you’ll consider one or more of these as gifts either to yourself or a friend.
Disclaimer: I am an affiliate of Zombierunner and make a few pennies when you buy through my link.
Last week I wrote about prevention and being proactive. I emphasized that you are the key to prevention. I want to share an email I received from a friend that is a great example of this in action. Lisa told me about her friend and gave me permission to share the story:
My friend ran a 50km x 2 (100km total, over two days) race a few weeks ago. Over the past six months he has put a lot of work into his running training and has been running beautifully.
I was away so when I got back I dropped him a text to see how his race went. He told me what happened and in the conversation said that he would be losing many of his toenails. I ask why and he said he forgot to cut his toenails.
As you can imagine I didn’t reply to this at all because I would have thrown some insulting words his way.
He has been trail running for more than a decade and been doing adventure racing for over a decade. He spent a fairly sizable amount on his race entry and it must be about 900km to travel to the race. He put in six months of training to get stronger and faster. And he forgot to trim his toenails! This is more than elementary and is totally stupid. It’s tough to have sympathy (I have none!) when friends do silly things like this. He knows better.
This story speaks for itself. I have often talked about how athletes spend a lot of time and money in preparation for an event but fail to plan for good foot care. More times than I care to remember, I have seen athletes quit a race or be pulled from a race because of feet gone bad. It doesn’t have to be that way.
I’ll say it again, you are the key to prevention.
Have you ever had a foot massage?
I had never had one until late in June. A while back I bought a Groupon coupon for a “reflexology” foot massage.
Some of you are asking, what’s refexology? Here’s what Wikipedia says, Reflexology, or zone therapy, is an alternative medicine involving the physical act of applying pressure to the feet, hands, or ears with specific thumb, finger, and hand techniques without the use of oil or lotion. It is based on what reflexologists claim to be a system of zones and reflex areas that they say reflect an image of the body on the feet and hands, with the premise that such work effects a physical change to the body. A 2009 systematic review of randomised controlled trials concludes that, “The best evidence available to date does not demonstrate convincingly that reflexology is an effective treatment for any medical condition.”
I had heard of reflexology and read a bit about it. So I decided to spend a few bucks and get one for half off. So what did I find?
First, I’ll tell you that I did trim and file my toenails before going. It made sense. Why would anyone go for a foot massage with unclipped toenails?
Second, I made sure my feet were clean. Again, to me that’s just common sense.
Thirdly, here’s what I experienced. I was asked to complete a multi-page questionnaire that focused on my health. Because this was sold as a reflexology session, I expected that. The reflexologist had me remove my shoes and socks and sit in a recliner chair. It started with a warm towel wash of each foot. Then massage oil was applied to my left foot, after which she wrapped it in Saran Wrap – I assume to keep the oil from drying out. Oil was applied to my right foot can she started the massage.
Not ever having a foot massage, I had nothing to compare it to.
Honestly, it was good. She used her fingers to work the tissue on the top, sides and bottom of my feet. I could feel her working between the metatarsals, between the joints and toes, and the fascia at my heel. It was easy to relax. She worked a couple of stubborn hard areas and complemented me on the condition of my feet. Once she was done with the right foot, she moved to the left.
My overall impressions were good. There was little said about reflexology. That may have been because I did not identify any health issues she could have focused on. But that’s okay.
The massage was great. My feet felt wonderful. I can see the value in getting regular foot massages if I was running regularly. The massage would help my feet in the same way that a leg would help the legs.
If you have tight muscles in your feet, cramping, or stress your feet with long runs with little recovery time between, a regular foot massage could help condition them to be as healthy as possible.
Well, not nasty in that sense. Nasty in how they look, smell, or feel. I could have put an image on this page showing nasty feet. Believe me, Google has lots that would turn your stomach. I choose not to make you gag. Instead I have some solid advice.
Some athletes struggle with nasty feet. Years of running and pounding that pavement or dirt with these valuable appendages, quick showers, no showers, sticky socks, calluses, ingrown toenails, long untrimmed toenails, Athlete’s foot, new blisters, old blisters that haven’t healed, scars from deep old blisters, and more.
On top of that, add the possibility of hammer toes, Morton’s foot, flat feet, bunions, and scars from scrapes and puncture wounds and you have quite a challenge.
Here are a few tips on avoiding nasty feet.
Get a foot brush to use in the bath or shower. These are good to rid your skin of dirt and dead skin, especially around your toes and heels.
Get a high-quality toenail clipper. Preferably a flat edged one. Trim your nails as short as possible without exposing the skin at the corner of the nail. Trim straight across. Try and do this once a week.
Get a good nail file. These come in cheap emery board styles or more substantial long lasting files. Use one after trimming your nails to rounds the edges and smooth the corners so they don’t catch on your socks. The clippers show here are high quality. They can be purchased through FootSmart.com for about $12.00. If your nails are thick, you need more than the usual drug store clippers. I recommend these or a similar one.
Get a callus file, PedEgg, or a similar device to keep your calluses under control. Use it after showering when your skin is soft. Avoid going too deep. If you have thick calluses, it will take a while to get them under control, and
Get a high-quality foot cream to apply after you have done all the above.
If you have Athlete’s foot or toenail fungus, treat it. It’s that simple. Don’t treat it and you’ll be heading for more problems down the trail.
By sticking to an easy-to-follow regiment of foot care, your feet can avoid the nasty look.
Continuing the toenail theme, this post covers a question many people ask- should I have my toenails removed?
Only you can answer that question. You know your feet better than anyone else and know the problems you have and what you have tried to remedy your problem with black toenails.
So let’s start with some basic advice. Before have your toenails removed, make sure you have tried some common sense tips. Shoes that are long enough in length and high enough in the toebox. Good toenail care. This means trimming nails short and then filing them smooth. I tell people that after trimming and filing, you should be able to run your fingertip over the edge of the toe and not feel the nail’s edge. Any edge can catch on your sock, and as your foot moves through the footstrike, the sock can force the nail backwards, leading to a black toenail.
After trying to fix the black toenail problem, without success, some people consider have their toenail(s) surgically removed. Others simply keep going, losing toenails time after time.
Tim Jantz, a podiatrist, describes the process of removing a toenail: After the toe is numbed, the nail is removed and the growth plate is treated with 89% phenol (some use sodium hydroxide) to destroy the growth plate. The area is then rinsed with alcohol and dressed with an antibiotic and a dressing. The usual post-operation care is daily soaks and dressing with a topical antibiotic and a Band-Aid for approximately four weeks, sometimes longer. The toe has endured a chemical burn and so heals by draining. It can have a raw feeling for a week or so, and I wouldn’t want to stub it or have anyone step on it for a few weeks. You may also want to wear roomy shoes or sandals for a week. The procedure is about 95% successful. An option is to find a doctor that uses a laser, but the only difference is higher cost.
If you are prone to black toenails and have tried all the options to prevent them, consult a podiatrist about nail removal.
In fair disclosure, I have all ten toenails.
One of the most common questions on online ultra email lists are those about toenail problems, mainly blood under the nail – black toenails. I am often puzzled by these questions because, in my mind, it’s pretty basic stuff.
It’s easy to assume your toenails are fine. You trim them once a month. You really don’t understand the relationship between toenails, socks, toeboxes, and how the foot moves inside the shoe.
First, look at the picture. This runner has thick toenails. Most likely because of a continued loss of earlier toenails. The toenails are not filed down and are too long. I worked on this runner’s feet and was surprised that he did not have worse problems.
Let’s start with trimming toenails. How hard can it be to trim your toenails? I guess for a lot of folks, it’s a huge deal and something they have a hard time doing. In all the years I have been patching feet, I have observed that untrimmed toenails are the number one cause of problems leading to toe blisters and black nails. Socks catch on nails that are too long or that have rough edges. This puts pressure on the nail bed, leading to blisters under the toenails, at the tips of the toes, or painful toenails as they are pushed back into the cuticle. Nails that are too long are also prone to pressure from a toebox that is too short or too low.
Toenails should be trimmed regularly, straight across the nail-never rounded at the corners. Leave an extra bit of nail on the outside corner of the big toe to avoid an ingrown toenail. After trimming toenails, use a nail file to smooth the top of the nail down toward the front of the toe and remove any rough edges. If you draw your finger from the skin in front of the toe up across the nail and can feel a rough edge, the nail can be filed smoother or trimmed a bit shorter. Remember though, the shorter you trim your nails, the greater the likelihood that you will experience an ingrown toenail. Conversely, nails that are too long can rub against the front of your shoes and catch on your socks, which can lead to a black toenail, wear holes in your socks, cut into other toes, and crack the nail when you run downhill. Shoes that are too tight in the forefoot or too short can cause the nail to press into the sides of the toe.
Use an emery board nail file from your drug store. Better yet, invest a few bucks in a nice metal file that will last a long time and serve you well. If you need clippers, there are regular large clippers and for thick nails, and nippers and scissors made exclusively for toenails. If your local drug store or pharmacy doesn’t have them, check out www.FootSmart.com for a great selection.
When you run or walk, your foot moves forward as it moves onto the toes. The toes bend as the toebox bends, moving to the end of the toebox. Many runners’ toes make contact with the front or top of the toebox, and the toes, over time are traumatized. The nail is jammed backwards. Bit by bit, the nail takes a beating and blood forms under the nail or on the sides or bottom of the toe. Toes with long nails or rough nail edges, or Morton’s toes (2nd toe longer than the big toe), will often blister.
A little bit of care in toenail trimming goes a long ways in preventing toe blisters and black toenails, and in making your socks last longer.
I get a lot of emails asking for help . Here is a recent question and my response – about toenail fungus.
Darbla asked a question, “I have an older edition of your book, bought when I used to do adventure racing. But if your new book can tell me how to get rid of toenail fungus, I will buy it! A podiatrist and then several rounds Sporonox, Lamisil, and Penlax helped none at all. I developed my own strategy of grinding them down with a motorized dremel, then rinsing off with bleach water, as the best thing I’ve tried so far. But then I’m not doing that regularly enough to completely get rid of it. I will only do this outside because I don’t want particles of that fungus getting all in my bathroom and shower from the shavings and powder thrown up by the dremel, and then when it’s cold or bad weather I cop out of going outside to do it. So I’ve created this whole big treatment that would probably seriously work, but it’s got too many difficulties to do it as often as it’s going to take to solve the problem. So if you’ve got the solution in your book, please let me know and I’ll buy!”
Here’s my response:
Ah, you want a guarantee to get rid of toenail fungus! I am not sure anyone can offer you that. But there are some good options. It sounds like you have done a good job of trying the medications. A friend, a podiatrist mentioned Carmol as a topical prescription. She also suggests doing both an oral and topical medication at the same time. Not sure if you are still on one, but if you have not done both at the same time, it could be worth trying. Of course, I’d be amiss if I did not mention toenail removal. This allows the topical medication to get to the nail bed. Over 8-10 months, the nails will grow back. Permanent nail removal is another more serious option.
Then there is laser treatments, which are somewhat new and apparently quite good. Figure on about $1000 for all 10 toes. Studies show 88% success after one treatment. Vicks-VapoRub, tree tee oil, manuka oil, and eucalyptus oil, are other topical options. Apply twice daily for at least 90 days. You use of the Dremel to thin the nail is good. That allows the topical medication/oils to get deeper into the nail. Put the medication/oil to the cotton on a Band-Aid and apply it to the nail. Some people try soaking their toes twice daily in Listerine or a mixture of Listerine and white vinegar. One fellow wrote that he use an antiseptic surgical scrub called chlorhexidine gluconate with good results. All that said, the thinning and filing down of the nail’s surface is a huge part of helping any topical treatment be more successful.
Not sure what edition you have. What I wrote above is from the 5th edition. Much in the book has changed from the earlier editions. Good luck and please let me know what happens.