Feet at Western States

July 2, 2017 by · 1 Comment
Filed under: blister care, Foot Care, Footcare, General, Health 

On June 12 I wrote a blog post Running a Wet 100 Mile Trail Run.

On June 24, I found out many runners ignored my advice, to their detriment. Maybe they didn’t read it, or didn’t see it, or simply read it and ignored it.

A typical year at WS has our foot care team at Michigan Bluff lancing and patching a goodly number of blisters. On toes, heels, ball of the foot, arches, and more. Maybe 50 to 75 blisters. Maybe more. We really don’t count.

This year I lanced and patched one blister. Yes, that’s right – ONE.

But this was not a typical year at WS. Instead of dry conditions, there were miles of snow, and mud, combined with heat so runners soaked themselves in streams and poured water over their hears and down into their shoes.

Maceration WS100I predicted the outcome. Maceration.

Runners came in to see us complaining of blisters and were surprised when we told them there were none. Just macerated feet.

So we powdered their feet, asked them if they had dry socks. And hopefully, dry shoes. We fixed and changed what we could and sent them on their way – wishing them well.

Were this year’s conditions not known in advance? I don’t think so. Runners and crews knew of the record snowpack. They should have expected water and wet conditions. For whatever reason, many ignored the warnings.

It’s unfortunate that so many runners jeopardized their opportunity for a buckle and a successful race on something that was manageable.

I’d love to hear from runners about what they thought. Send me an email.

In the meantime, click the link and read Running a Wet 100 Mile Trail Run.

Running a Wet 100 Mile Trail Run

In less than two weeks is the running of the Western States 100-Mile Endurance Run. I will be at the 55.7-mile Michigan Bluff aid station, along with Tonya Olson and others on the medical team. Our aim is to make sure you are healthy to continue on towards Placer High School and a good finish.

For the past six years, the mountains have been dry and the trails dusty. Feet get caked with dirt. Blisters are caused by the dust and dirt as an irritant inside shoes and socks.

2011 was the last snow year. I have looked a bit online and am unclear on snow conditions this year. But this much I am certain, there will be snow and feet will be wet. How much snow remains to be seen.

I am 100% certain that runners will have long sections of wet trail, either from the snow, snow run off, water on the trail, and stream crossings. That equals miles of running with wet feet. I’m also 100% certain that we’ll have lots of wet feet, blisters, and maceration. In fact maceration could easily be a bigger problem than blisters. Don’t forget to avoid pouring water over your head where it will run down your legs into your shoes, contributing to maceration. Lean forward rather then standing straight up.

A blister can be lanced and taped, and runners can continue without to many issues. Maceration is a different story. Once your feet are macerated – the skin shriveled like a prune, there is no quick fix.

With prolonged exposure, the skin on your feet goes through four stages as the maceration progresses to severe cracks and tears in the skin—that can be race ending. As the skin on your feet moves through the four stages, the skin folds over on itself and can crack or tear. This can be painful. Many runners come into aid stations complaining of bad blisters only to be told they don’t have any – it’s severe maceration.

I expanded the section on maceration in the 6th edition of Fixing Your Feet. Starting on page 188, are 12 pages with sections about Cold and Wet, Maceration, Trench Foot and Chilblains, Frostbite, and Snow and Ice. Included are tips and products to help with those conditions. If you have a copy, read the sections – and have you crew read them also. On page 101 is a section on High-Technology Oversocks like SealSkinz and Hanz, Serius, and eZeefit waterproof type socks. Another sock worth mentioning is ArmaSkin socks, which is used as a sock liner and fits tightly against your feet. They would be my choice for a wet race. I’d also wear gaiters to keep snow, dirt, and grit out of my shoes.

As far as skin preparation, here’s what I would do – expecting wet feet. My drop bags would have clean socks, small containers or baggies with powder to help dry wet skin, and container or tubes of any of the following: RunGoo, Trail Toes, Desitin Maximum Strength Original Paste, Boudreaux’s Butt Paste, or a strong zinc oxide paste. I’d also carry some in my hydration pack. I would apply a liberal coating of one of these from toes to up the heels and then roll my socks on. Rolling socks on will help prevent smearing and thinning the paste on areas of the feet.

Since proactive care is better than reactive, I’d check my feet at most aid stations, adding paste as necessary. If my feet were feeling bad at an aid station, I’d apply some powder to help dry the skin, and have some food while letting the powder do its job. Then apply more paste and clean socks. If your feet are badly macerated, it will take drying them, coating them with powder, and rubbing it in and letting it sit for a while, then stripping off the powder and adding more of your choice of paste. That may easily mean 15 minutes or more. If you don’t take care of macerated feet, they’ll get worse over time, requiring more care and longer time – and there may come a point when it’s irreversible in the time you have.

The time you take in aid stations does add up and it can quickly erase any time cushion you may have to finish within an allotted time. But skip quality care, rush too fast, ship hydration or eating, and you’ll pay the cost.

Remember your first line of defense should be your crew. They should know what you want for foot care and how to do it correctly. There aren’t enough medical people to take care of everyone’s feet and we may be busy with others, adding more time to your aid station visit.

Yes, as I said earlier, I will be at Michigan Bluff and Tonya and I will do our best to help you. But heed my warning. We cannot work miracles when you have failed to take care of your feet from the start. In the same way we cannot take away the pain and problems with black toenails and toe blisters caused by your not trimming your toenails, we cannot repair badly macerated feet when you have not tried steps to control the maceration.

I ran Western States in the late 80s and one thing I learned is the outcome of the race in your hands. Whether is your training, conditioning, choice of footwear, choices of food, what’s in your head, your choice of crew – lots of things affect your race. I encourage you to take the time necessary to care for your feet.

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.

Foot Care Expectations

June 17, 2012 by · Leave a Comment
Filed under: blister care, Foot Care, Sports 

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.

Foot Care Challenges at the 2011 Western States

July 3, 2011 by · Leave a Comment
Filed under: blister care, Foot Care 

Last weekend I worked the Michigan Bluff aid station at the Western States 100 Mile Run. The 2011 running of this amazing footrace over California’s High Sierras was different for several reasons.

This was a huge snow pack year, resulting in many runners with wet feet and footwear for long periods of time. The temperatures were particularly mild, resulting in the highest finisher rate since 1993.

As I worked the medical aid station, feet were my first responsibility. Somehow that’s the assignment I draw, and the rest of the medical staff are quite happy to let me do my thing. I don’t mind, it’s what I do. Push come to shove, many of them could do an acceptable job of patching a blister – but they are not knowledgeable with the best techniques.

So I set up my canopy, two chairs, stool, a card table with all my gear, my foot care kit, and several containers of extra supplies. I was ready. Over the course of the front-runner to the last runner, there was about an eight hour spread.

I didn’t count runners that I helped. I never do. I just move from one to the next as they come in for help. Strangely, this year I might have had one time when I had two runners in at the same time. Most years, there are runners waiting. And the runners I treated had less serious problems. So what did I see?

Two runners come to mind. I was amazed at how these two runners treated their feet. The first runner had come in for some minor blister repair. After I checked his feet and made a few minor repairs, I asked him whether he had clean socks. He pulled a pair out of his drop bag and handed them to me. One was fine. The other had a hole over the tip of the big toe. He laughed and told me they were his lucky socks, and asked whether I could put a Band-Aid over the hole. Really!

The second runner came and complained of heel problems. One heel had a quarter-size blister directly on the bottom and I cleaned and drained it, and then applied tape side to side under the heel. The other foot had no identifiable fluid or blister.  I asked about clean socks and he said he didn’t have any. So I powdered his damp socks and put them back on his feet. When I picked up his shoes, I was amazed to see that both insoles were worn through in the heels – exactly where he was having problems. The insoles had essentially fallen apart in the heel, creating a hole into which went the flesh from his heel. No wonder he had heel problems. I added an Engo Blister Patch on top of the indentation on each insole. After I had him set to go, he remembered he had extra socks in his drop bag, which he had forgotten about.

I saw several other things that could lead to problems.

For one thing, a majority of runners were not wearing gaiters. Those who know me have heard me preach the benefits of gaiters to keep junk out of shoes. Don’t use them and you take chances with small rocks and debris getting kicked up into the shoes, which can lead to hot spots and blisters.

Another huge issue was runners with wet socks. Failing to change socks for 65 miles leads to softened and macerated skin. More than one runner saw their day end because of this problem. When your feet hurt because of maceration, you slow down – and that leads to longer times between sia stations, and ultimately leads to missing a time cutoff. Some of these had gone through aid stations and not changing socks. Taking five minutes at an aid station to change socks can save you from slower and slower times when feet turn painful. Knowing ahead of time that snow would be an issue, failing to plan with additional socks, and even shoes, is puzzling.

Working at Western States is always an experience. I always come away having learned something new. This year I learned that no matter how many people I think I have reached and influenced with good foot care tips, there are still many who need to hear the message.

Feet, Socks, Shoes, and Other Foot Care Issues

June 29, 2009 by · 3 Comments
Filed under: Foot Care 

Feet, socks, shoes, skin, toenails, gaiters, foot care – all things that are a huge part of my life. Saturday and Sunday I worked at two aid stations and the finish line at the Western States 100 Mile Endurance Run. Nine hours at Michigan Bluff, a brief stop at Foresthill, and then five hours at the finish line. In this post, I will touch on a few things I saw and learned from the runners I saw and helped. Then in the weeks ahead, I will elaborate on each of the things.

  • Compression socks – quite a few runners wore compression socks
  • Gaiters – the majority of runners did not wear gaiters
  • Shoes – I realized many trail shoes have a huge flaw
  • Socks – I saw the good, the bad, and the ugly socks
  • Skin – lots of skin issues
  • Maceration – a huge, huge issue for many runners
  • Toes – lots of toenail issues
  • Patching – there are many ways to patch feet and they are not all equal
  • Expectations – many runners expect a lot from the podiatrity staff – sometimes, they want a miracle
  • Aftercare – a lot of different perspectives here
John and Catra at the Michigan Bluff aid station

John and Catra at the Michigan Bluff aid station

More than one of the above feet related items contributed, in my opinion, to runners being unable to complete the race. I did not count the number of runners we saw – but the numbers are always high.

Helping with podiatry care at an event of the caliber and size of Western States is always challenging. No matter what I know, I realize I can always learn something new.

In the coming weeks, I will write about each of the above items. Then too, I will be helping with foot care at Badwater in mid-July, and there will be more of the same. The one thing that amazes me is the energy and attitude of the runners, their crews and the volunteers. They are all great people. Congratulations to all the Western States finishers.

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