Consequences of Wet Feet at a Dry Western States!  

July 4, 2015 by · 6 Comments
Filed under: blister care, Foot Care, Footcare, Footwear 

Last Saturday was the Western States 100 Mile Endurance Run over the California Sierras. As you probably know, California is in year four of a severe drought. Most of us expected the trails to be dusty and dry. From everything I heard, they were.

So in a dry Western States year, why did so many runners have macerated feet from being wet?

So in a dry Western States year, why did so many runners have macerated feet from being wet? Click To Tweet

There are several reasons. First, runners often cool themselves off by pouring or squirting water over their heads and on their body. We all know water runs downhill – right? So the water naturally runs down the legs and into the shoes. Socks become wet and as I often say – the skin of one’s feet prune up. In other words, they look like a wrinkled prune. Better to bend at the waist and let the water run off the head and shoulders rather than down the body.

Secondly, runners sometimes cool off by getting into the water at any stream. Several runners talked of sitting in the streams. While this can cool the runner, it is the worst thing a runner can do to their feet.

When they remain wet long enough, the skin becomes soft, often creating creases. Many times these creases are deep and in severe cases, the skin can split open.

Most often the runners complain of badly blistered feet. In fact, there are no blisters, just macerated skin on the bottom of their feet. This condition can be very painful. Walking and running hurts one’s feet.

There is no fast cure. They say time heals all wounds and with maceration, it takes time for the skin to dry and return to its normal state. Putting powder on the skin can help, as can clean fresh socks, gentle massage, and letting the skin air-dry.

I saw a lot of macerated feet at Michigan Bluff, mile 55.7. More than I expected. And of course there were lots of runners wanting treatment for bad blisters at the finish, and it was maceration.

Severe results of macerated feet

Severe results of macerated feet

The picture here is of a runner who completed the race, I think sometime around 28-29 hours. I don’t know his story but at some point before the race or in the race, he had his right foot wrapped in what appeared to be a self-adherent wrap, with a thick pad of some kind at the heel. Then that was wrapped with layers of what seemed to be silk type medical tape. Tonya and I had to use trauma shears to cut the thick wrap off his foot. Once it came off we saw the extent of the damage to his foot.

If anyone knows the runner or recognizes him, I’d love to find out more. It’s possible that because of maceration the skin at the heel had sheared off and someone at a medical aid station, or crew, had cut the skin and put on the wrap.

What we did at the finish was to apply a coating of antibiotic ointment to the open and raw skin, cover it with a wound care dressing, and wrap with a self-adhering wrap. We gave him instruction on how to care for this in the days after the race.

Look closely at the picture. He’s happy. He has his finisher’s medallion and knows he’s getting his buckle.

How Important are Gaiters?

Many runners have a love-hate relationship with gaiters.

Some love them and swear by them when running trails. Others never wear them, and dislike them. Which camp do you fall in?

I have regularly promoted the value of gaiters since I made my first homemade set from a pair of old white cotton crew socks. I believe it was one of the first years I ran Western States, maybe in 1985 or 86. I cut the foot out of the socks, leaving the ankle part to pull on my foot and fold over to cover the top of my shoes. I used twist-ties to anchor the socks to the shoes. And – they worked – as primitive as they were.

Then as the years progressed, people with more business sense than I started to make and sell gaiters. Now days, you can get gaiters in a myriad of colors and types.

I still believe in gaiters for trail runners, and in one recent conversation, told a friend that should make them mandatory gear for multi-day trail events.

You have every right to ask why.

Today’s shoes have become increasingly lightweight and many shoes are made with mesh uppers. It’s this mesh that allows all kinds of sand, dust, grit, and dirt into the shoe. These bad things will work their way into your socks and onto your skin. Rubbing and abrasions can occur. If you use any type of lubricant on your feet, the bad stuff will be attracted to the stickiness. The bad stuff can be a contributing factor that can lead to blisters.

A good set of gaiters will cover the tops of the shoes and the toe box to keep bad stuff out.

I’ve included two images of special gaiters that are typically found at the Marathon des Sables (MdS).

Running in sand at the MdS

Running in sand at the MdS

 

 

 

 

 

Gaiters at the MdS

Gaiters at the MdS

 

 

 

 

 

 

 

Here is the link to the myRaceKit for the MdS page that shows two gaiters they support. And a page from their blog that describes the fit and application.

These are highly useful when doing races in the desert, but how about when running trails? I believe the weak point in some gaiters is how they fail to cover the top of the shoe’s upper, thus allowing bad stuff inside.

I have treated many runners’ feet that are filthy with dirt and grit that makes it hard to wash off in order to find, clean, drain, and patch blisters. Blister patches and tape usually does not stick to dirty skin. In addition to making it harder for medical personnel to clean one’s feet, it also means it takes longer, which can affect not only your race, but those behind you that also need their feet worked on.

Back when, I wore homemade gaiters because that’s all there was. Now there are many styles and fabrics to choose from.

If I was going to run a tail race of any length, but especially a 50M or 100M, or multi-day race, I would buy one of the gaiters that attached to the shoe with Velcro and cover the whole shoe.

Still unsure?

Here are two of my blog posts about gaiters.

Blisters and Gaiters – this is by Lisa de Speville and adventure racer and ultrarunner from Soith Africa and her homemade gaiters.

Rough Country Gaiters: a review – this is a review of gaiters and offers commentary by Jay Batchen, who has done the MdS. Here’s a new link to the Rough Country Gaiters mentioned in the post.

In two weeks I will be working foot care at the Michigan Bluff aid station of the Western States 100. Then three weeks later I’ll be doing a foot care study at the Tahoe Rim Trail 100-Mile Run. I’d love to see a few runners wearing a more substantial gaiter.

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

Foot Problems at Western States

June 25, 2013 by · Leave a Comment
Filed under: blister care, Foot Care, Health, Sports 

This weekend close to 400 runners will start at Squaw Valley and make the trek over the Sierras towards Auburn – 100 miles away. It’s the Western States 100 Mile Endurance Race. I love the race, having completed it three times in the late 80’s. It’s tough and throws a lot at the runners. Cold, heat, extreme heat, streams running down the trail, rocks, dust and grit, water crossings, long ups and long down through numerous canyons – and for many runners, a second sunrise with renewed heat.

Toe Blister

Toe Blister

I will again be working at the Michigan Bluff aid station doing foot care. Later, I will be at the finish line taking care of feet as people finish. Having worked this race for years, I have a good idea of what foot problems to expect. Here’s what I commonly see and a few tips.

First, here are common problems:

  • Toe blisters. Under the toenail, on the tips of toes, between toes, and under toes.
  • Heel blisters. Either at the rear of the heel or at the sides.
  • Ball of the foot blisters. Either in a certain area or across the whole foot.
  • Side of the foot blisters.
  • Stubbed toes. From hitting rocks or roots.
  • Sprained ankles.
  • Sore feet.

Here are some tips:

  • Cut toenails short and them file them smooth. No rough edges to catch on socks or hit the toebox of your shoes.
  • Reduce your calluses as much as possible. This close to the race, don’t file too much off. Aim to get reduce the thickest rough patches.
  • Use Engo Blister Prevention Patches in problem areas – sides of the heels and ball of the foot. They will greatly reduce friction and shear.
  • Pretape any problem areas.
  • Check your insoles for thick edges at the sides of the heel – always a problem area. Thin these down or change insoles. Most side of the heel blisters are caused by these edges.
  • Don’t use Vaseline as a lubricant. Stick to SportSlick, BodyGlide, or a similar lube.
  • Change socks frequently and clean your feet. Today’s trails shoes often have mesh uppers, which allow sand, dirt, and trail dust inside the shoe, on and into your socks, and on your feet.
  • Know how to manage your feet and patch blisters on your own – or your crew should have these skills. You can’t count on aid station people knowing what you need or want or doing it on your time schedule. There may be other runners in front of you or they may be out of supplies.
  • If you feel something inside your shoe, stop and clean it out. Even a small rock can cause problems.
  • Wear gaiters to keep rocks and trail grit and dust out of the top of your shoes.
  • Build your own quality foot care kit. Stock it with what you need and learn to use everything.

Maybe I’ll see you at Michigan Bluff. I hope it’s just to say Hi as you run through.

Have a great race.

Blister Treatment or Prevention?

June 3, 2013 by · 6 Comments
Filed under: blister care, Foot Care, Footwear, Health, Sports, toenails 

Which is more important, blister prevention or blister treatment?

For more than 17 years, I’ve taught foot care techniques to anyone who will listen. I have taught classes at running stores, REI stores, events, and more. In addition, I have worked medical at many races, helping provide foot care to participants. These races have been in Death Valley, Chile, Costa Rica, BC Canada, Colorado and Washington, and many in California. This year I will be at Western States 100, Badwater, the Gold Rush Adventure Race, the Jungle Marathon in the Amazon, and hopefully at races in Colorado and Namibia.

I have never counted the feet I have worked on but I would put the number well over 3000. I remember one race in Colorado in 2010 when I saw the same lady 10 times. It was a six-day stage race and she’d come in every evening and morning! I’d patch her feet in the evening and she’d take it off when she went to bed in her tent. She had foot wear issues that gave her blisters on top of blisters. She was never into prevention mode – only treatments.

In this picture, taken from the cover of the 5th edition of Fixing Your Feet, we see treatment taking place. I love the picture. I even know whose foot it is. What I can’t tell you is what he did for prevention. I wish I knew.

FYF Cover Image

FYF Cover Image

My question in this blog post is what should we spend more time on, blister prevention or blister treatment?

Prevention can take many forms: good choices in footwear, the right socks, lubricants and powders, toenail care, skin care, taping, Engo patches, correct lacing, the right insoles, and training and conditioning.

Treatments likewise offers many options: blister draining, many different types of patches, taping, ointments and salves, a multitude of tapes, wraps and straps, silicone pads, Engo patches, toe caps, and lubricants and powders.

So here are a few questions:

  • Does prevention last only until the race starts?
  • What are your best prevention options?
  • How much do you count on aid station personnel to manage treatments?
  • Do you know how to treat your feet?
  • Do you carry materials to treat your feet?
  • What are your best treatment options?
  • How well do you understand blister formation and prevention?

For 17 years, athletes have had Fixing Your Feet as a resource to learn important information about foot care. As I patch feet at races, I try to educate the athletes about what I am doing and why, and what could have helped in their feet. If crews come to me for advice, I try to help them too. I have watched athletes and crews work on feet with materials and using techniques I have long preached.

In general, foot care has advanced over the years. Shoes, socks and insoles have become light years better. Lubricants, powders, blister patches, and our tools are better. People interested in foot care are trying new blister patching techniques.

All this is good because every day there are new athletes coming into running, adventure racing, hiking and thru-hiking, walking, and other feet stressing sports. Let’s make sure they understand the importance of prevention before treatment.

Foot Care at Western States

June 27, 2010 by · 1 Comment
Filed under: Foot Care 

Yesterday I work medical at the mid-point Michigan Bluff aid station at the Western States 100 Mile Endurance Run. We had a team of about 12 people: doctors, RNs, LVNs, a chiropractor, a physical therapist, and paramedic. What happens when I work medical is that I spend my whole time working on feet. Of course, that’s what is expected of me. If there was a major medical that stretched the “pure’ medical folks, I would step over to that side of the aid station. So, what happened?

Runners kept us busy the whole day – from about 3:00 pm until we closed at 9:00 pm. We did not keep count. I had a good time because of Tonya, a physical therapist, who wanted to learn foot care. She was a quick learner.

In short, the day can be summed up with three words: maceration and toes. The snow in the high country had created a wet day for runner’s feet. Snowmelt ran down the trail and made for slushy conditions. Runners’ footwear ranged from regular trail shoes to lightweight minimalist shoes like the New Balance MT100s and Inov-8 models. I didn’t see anyone running in Five Fingers. Virtually everyone had wet shoes. And that, of course, led to macerated feet.

Michigan Bluff medical aid station

Michigan Bluff medical aid station

I set up with a pop-up and tarp and two reclining chaise lounge chairs. Tonya and I often worked side by side. She watched me for the first batch of runners and then, after a while, she took on feet alone. Her skills were good. Importantly, she asked questions.

How should blisters be lanced and when and why? What’s the best way to tape toes? How about heels? How about between toes? Wow, what’s that? What can we do for those toenails? How can you drain fluid from under a toenail? How can we modify footwear? What are the best supplies? What tools do you use?

Over the coming weeks I will address these questions.

About

January 15, 2009 by · Leave a Comment
Filed under:  

John Vonhof brings a varied background and extensive experience to FixingYourFeet.com. This website and blogt is the synthesis of over 18 years of experience as a runner and hiker.

Over the years he has provided volunteer medical aid at numerous running events and has patched thousands of feet at events like the Western States 100 Mile Endurance Run, the Badwater Ultramarathon in Death Valley, the Raid the North Extreme Adventure Race in northern BC Canada, Primal Quest Expedition Adventure Races, the TransRockies, the Gold Rush Adventure Races, the 4 Deserts Atacama race in Chile, the Coastal Challenge in Costa Rica, the Avon Walk, and more.

This background has provided a wealth of learning opportunities for what can go wrong with feet and ways to fix them.

Having run since 1982, John discovered the challenging world of trail running and ultras in 1984. Over the years, he has completed more than 20 ultras: 50KMs, 50-milers, 100-milers, 24-hour runs, and a 72-hour run. John has completed the difficult Western States 100  Mile Endurance Run three times and the Santa Rosa 24-Hour Track Run ten times.

In 1987 John, with fellow runner Will Uher, fastpacked the 211-mile John Muir Trail in the California High Sierra’s in 8.5 days with 30 pound packs.

As the former race director of the Ohlone Wilderness 50 KM Trail Run (15 years), John worked at providing a quality event for runners of all skill levels. This run is known as one of the most difficult 50 KM trail ultras in Northern California.

An opportunity to change careers in 1992 led him into the medical field where he has worked as an emergency room technician with certifications as a paramedic and orthopaedic technician. He currently works for the Alameda County Emergency Medical Services Agency in the San Francisco Bay Area in Central California.

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