Foot Care Tips That Can Save Your Race

September 14, 2014 by · 1 Comment
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.

Maceration in a Dry Race

August 10, 2014 by · 2 Comments
Filed under: blister care, Foot Care, Footcare, Health, Sports 

Maceration in a Dry Race

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

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

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

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

Wet and macerated feet

Wet and macerated feet

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

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

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

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

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

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

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

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

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

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

Feet, Sand and Water

October 15, 2013 by · 1 Comment
Filed under: blister care, Foot Care, Sports 
Jungle Marathon

Jungle Marathon

I am writing this as I am flying home from the seven day Jungle Marathon Amazon stage race. Since 2002, I have helped at races like Death Valley’s Badwater, BC Canada’s Raid the North Extreme, Chile’s Racing the Planet Atacama, California high Sierra’s Western States 100 Mile Endurance Race, Costa Rica’s Coastal Challenge, and the Primal Quest and Gold Rush Adventure Races – and each is unique and difficult in their own way. The Jungle Marathon topped most of them in difficulty.

We had a medical team of 15 doctors and paramedics for the 78 runners. The team manned checkpoints along each day’s stage. Each medic team had a full medical kit, which included provisions for foot care. Depending on the stages, the medic team went out the afternoon before to get to the checkpoint to set up their hammocks and eat before jungle darkness came. For example, Todd and I hiked three miles through the jungle to get to the first checkpoint of stage one. We were accompanied by Rod and Lee to set up the ropes over a water crossing, four locals to clear the camp and manage the fire and water, and an interpreter. Our job was to make sure the runners were in good shape, and provide any medical care if needed.

This checkpoint came only three miles into the first of seven stages. But it set the stage for the whole race. The runners had come through three tough miles of jungle trail with rocks, roots, loose vines to trip feet, low hanging branches – all on terrain that was rarely flat. Toss in the stifling humidity and heat, and you get the picture.

Now comes the heart of the race – water. Our little camp was about 30 feet long and 20 feet wide, on the bank of a stream, carved out of your typical jungle fauna. Once they reached us, the runners had a mandatory 15 wait before continuing. When their time came, they jumped into the chest high stream and used the rope to pull themselves to the other side. Of course, there were no dry trails on the other side. The route was through a swamp. Three miles and 100 feet into the race their feet would be wet most of the time.

But as if water was not enough, there was sand. The trails through were on sandy jungle soil and on sandy beaches.

Combine water and sand and you have a mixture of two elements that are problematic to runner’s feet. We saw it every day. I have written about maceration many times, and generally tell people to avoid getting their feet whenever possible to avoid this painful condition. But in the Jungle Marathon Amazon, water is present everyday – along with sand. Even without the water crossings, the humidity would keep your feet wet. By the time we hiked the three miles to our camp with our overnight packs, my pants and shirt were soaked. And nothing dries overnight.

Without a doubt, I think the Jungle Marathon Amazon has been the toughest event when it comes to the participants’ feet.

The sand gets everywhere. And it sticks. While I did not see the skin abraded from the sand inside socks and shoes, especially at the heels, it’s damaging effects were more visible in the runners’ shoes, socks and insoles. One runner had holes in the toes and heels of one of his socks after day one. Another runner had holes through both heels of his insoles.

You might be asking yourself why people do this race. Good question. It has a great reputation in a very beautiful setting. The jungle is fantastic. This section of the Amazon River has white sand beaches. The race offers three events, the seven days race, a four-day race, and a marathon day. Runners carry all their gear including clothes, hammock, mandatory gear kit, and food for seven days.

Helping at this race was a fantastic opportunity, which I will never forget. Over the next few months, I will be writing about what I observed and learned. My posts will talk about shoes, socks, insoles, skin treatment, “hot shots”, tapes and taping, blister patching, and several products. As you might expect, a common thread through these post will be water and sand.

Even though you may never do the Jungle Marathon Amazon, there is a lot that can be learned from what these runners experienced. I hope you will stay tuned.

Moisture on Your Feet – Moist, Very Wet or Very Dry

September 22, 2013 by · 1 Comment
Filed under: blister care, Foot Care, Health, Sports, Travel 

Back in May I posted an article about Training With Wet Feet. My being invited to work on the medical team at the Jungle Marathons in Vietnam and the Amazon prompted the article. While the Vietnam race had to be cancelled, the Amazon race is happening – in a bit over two weeks.

As I wrote in that article, it was long felt the best way to manage your feet was to keep them as dry as possible. This was more and more evident as Denise Jones and I worked the Badwater Ultramarathon in the heat of Death Valley each July. Runners who kept their feet dry typically finished better than those who had wet feet. This was also based on our experiences at Western States and other events.

Then came the invite to help at the Jungle Marathons.

The Jungle Marathons are run by Race Director Shirley Thompson and the Medical Team Manager is Vicky Kypta. They found their runners had a better race when they trained with wet feet. As part of their instructions to their race participants, they stress the importance of training with wet feet.

The reason for this is the Jungle Marathons are wet. Very wet is typical in the jungle. Whether through rivers or streams, the Amazon is full of water.

When I am helping runners at the race in early October, I will be closely monitoring the condition of their feet. I expect runners will use lubricants and other products to control the moisture, or powder, socks, well-draining shoes, and maybe a few home-grown tricks.

Over the past few months, I have shared some of the findings by Rebecca Rushton, a podiatrist from Australia. In her Blister Prevention Report, she talks about managing moisture control. She supports her report with studies from medical and other professional journals. What she found through the studies is that you could reduce the incidence of blisters by keeping the skin either very dry or very wet.

Rebecca writes that, “… the very high or very low skin moisture strategies aim to reduce the coefficient of friction value between the sock and the skin to below blister-causing levels.”

The Coefficient of Friction

The coefficient of friction (COF) is the number that represents the slipperiness or stickiness between two surfaces. According to studies, this number is generally below 1.0. Inside the shoe, the COF between the foot’s skin, and the sock and insole can range from 0.5 and 0.9. Compare this to the COF between a sock and a polished floor – about 0.2.

In Rushton’s report, she illustrates this with an example of a runner whose feet sweat a lot. His socks become damp, creating a moist condition. The COF in this case might be 0.7. By moving away from a moist condition to either very dry or very wet, the runner might reduce the COF to 0.5. If the runner’s blister-causing threshold is 0.6, getting to 0.5 will reduce his chances of blistering. Reducing the COF between your skin and socks/insole combination is important to having healthy feet.

Moist Skin

Moist skin produces higher friction than very dry or very wet skin. Whether skin is dry and becomes moist through sweat or through a water moisture source, or is very wet and becomes moist through heat or simply drying out, when it hits this middle stage, it becomes more susceptible to blistering.

Very Dry Skin

Drying the skin can be done with powders, antiperspirants or other drying agents, used by themselves or in conjunction with moisture control socks. Keeping the skin very dry is tough because our feet sweat naturally. Humid or hot conditions can also make it hard to keep the skin dry. Dumping water over your head to cool yourself can result in water running down your legs into your shoes – defeating your efforts to keep your feet dry. Airing your feet with shoes and socks off can help. If you use powders, make sure it is high quality and does not cake, which can be an irritant. When counting on any of these methods to keep your skin dry, you mush also have shoes that allow moisture to escape. That may include shoes with mesh uppers and drain holes in the arches and heels.

Very Wet Skin

Increasing skin moisture leads to very wet, lubricated skin that reduces the skin’s coefficient of friction. This can be through the use of a lubricant and or by simply having wet feet. The thing to remember is that over time, 1-3 hours, friction will increase as the lubricant is absorbed into the socks – so ongoing application is required.

Amazon Wet Foot

Amazon Wet Foot

Remember too what happens to your skin when you spend too much time in the water. It becomes weaker and less able to resist trauma on wrinkly skin. In extreme cases, the skin can fold over on itself and split. Severe maceration can be painful and athletes say it feel like a giant blister on the bottom of their feet.

In the Amazon Jungle Marathon, the trick will be to dry the feet at the end of each day’s stage. Because the feet will be wet during much of each day’s stage, the runners will have to find the balance between very dry and very wet, avoiding moist as much as possible.

Here’s some advice from my previous post about training with wet feet.

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.

Rest assured that I will write about how everyone’s feet held up in the wet Amazon jungle.

Credit is due to Rebecca Rushton for her Blister Prevention Report. Her website is Blister Prevention. Check out her website and sign up for her newsletter and free reports.

Here is the link to the Jungle Marathon Amazon.

If you want to read more, check out this article I did in November 2012 about Stuart Crispin who completed the race in Vibram FiveFingers.

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

Training With Wet Feet

May 5, 2013 by · Leave a Comment
Filed under: blister care, Foot Care, Health 

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.

Training for Blisters in Wet Conditions

September 15, 2012 by · 2 Comments
Filed under: blister care, Foot Care, Health, Travel 

I have worked a lot of events. Every one has its one set of conditions that stresses the participants’ feet. Sometimes, it’s the dry heat of Death Valley or the rainy British Columbia coast, or the ups and downs on the trails of the many trail hundreds.

For years, the norm has been to avoid getting your feet wet. Wet feet often mean skin that is soft and can become 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.

And then there’s the Jungle Marathon.

The Jungle Marathon is held in the Amazon Rain Forest of Brazil. This year’s race is held over October 4 to 13.The race is in the stunning State of Para – often referred to as the Caribbean of the Amazon. Competitors have the choice of two distances: 240km or 100km, which will be completed in stages throughout the week. The longer distance will include six stages and the shorter will include four. Imagine running through the jungle with stream crossings, wet foliage, wet trails, mud, and extremely humid conditions. Your feet are always wet.

At the Jungle Marathon runners have to be self-sufficient, carrying their food and provisions during the race. They are provided bottled water at designated checkpoints. Nights are spent sleeping in hammocks at campsites along the shores of the river.

Shirley Thompson is the race director and she stresses, “Our medical team has many years experience in remote locations. Your safety and well-being is our prime concern and we employ only the most experienced personnel to assist us.”

Shirley 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. We also tell them to buy your book and try to find a strategy that works for them. As far as footwear is concerned, we always emphasize trail shoes with good grip, and that comfort is the main factor.

I personally spend quite a bit of time in the jungle preparing the trail and doing a trial run of the course, and I always use the same strategy, which I found years ago in your book. I spray on two coats of New Skin Liquid Bandage, then wear SealSkinz hi-tops, with a thin lining sock. I have never had a blister.”

Vicky Kypta instructs new medics who join the team on foot care and she gives clinics for competitors in the United Kingdom on foot care and preparation for the race. I emailed her and asked about their strategy for managing runner’s feet. Here is her response.

River crossing

River crossing

“Feet are soaked from the start of each stage, so in the end it made more sense to get people used to their feet being always wet. We found runners had less problems during the race when they had trained with wet feet. There was a lot of hideous feet in the first couple of years of the event before we adopted this strategy.

As far as blister prevention is concerned, we encourage all runners to find a shoe/sock combination that works for them and to train in them including getting them wet. During the race, the runners are told to stop and deal with any hot spots as soon as they start which includes not waiting to get to a checkpoint. It is amazing how just stopping for 20 minutes to deal with feet saves so much time and pain later in the race.

Some runners have their own preferences on how to treat blisters and if they do then we follow their instructions otherwise we tend to drain non-blood filled blisters. On those hardy enough we the inject compound tincture of benzoin to help seal the space created by the blister, to serve as a local antiseptic, and to prevent further abrasion or loss of skin. However, due to the intense burning sensation experienced for a few moments after injection not all runners want this method used – so for all others we drain the blister and then use the benzoin over the top to provide a tacky surface to help the tape stick. Over the top of the blister we then apply a layer of fleecy web and tape over that using zinc oxide tape.

Over toes we just use tape without the fleecy web as otherwise it becomes too bulky resulting in the runner being unable to put their shoe on.

Some runners like to use Compeed on their blisters and whilst they are very good at protecting the blister we have found through experience that with an ultra event such as the Jungle Marathon, they are very difficult to remove should there be any further problems with the blister later on during the race and more damage is often caused in attempting to remove them so we therefore don’t encourage their use.

Jungle Marathon foot care

Jungle Marathon foot care

Over the years we have been very fortunate and have had very few macerated feet as at the end of each stage we get the runners to remove all the tape and to thoroughly dry out their feet. Blisters and problem feet are then freshly taped later that evening or the next morning ready for the next stage.

Despite the incredible punishment the runners feet endure during the Jungle Marathon, year after year we have very few cases of macerated or infected feet which I believe stems from early and effective treatment of problems as they arise.”

Vicky holds foot care clinics including medical care prior to the races to help provide the runners with increased knowledge to enable them to treat themselves more effectively which will hopefully reduce the amount of foot problems even further.

The Jungle Marathon helps their runners successfully complete the race because of their unique approach to foot care. Here are my observations:

  1. They encourage participants to train with wet feet
  2. They even suggest soaking your shoes and socks before heading out for a training run
  3. They give specific advice that runners find the best shoe and sock combination for their feet when wet
  4. After each day’s stage, they have runners remove their tape, which allows the skin to dry out – re-taping afterwards

This combination of advice and attention of the runners keeping their feet healthy for the multiple stages of the race works well. I commend Shirley and Vicky and the Jungle Marathon for their success with foot care.

I encourage you to check out their website and Facebook page. If you are looking for a stage race with adventure, this is a well-organized event.

Here’s the link to the Jungle Marathon’s website.

Here’s the link to the Jungle Marathon Facebook page.

 

Foot Care Advice from Denise

July 8, 2011 by · Leave a Comment
Filed under: blister care, Foot Care, Health 

One of the runners doing next week’s Badwater 135 Mile Ultramarathon recently emailed Denise Jones with questions about managing his feet at this grueling race. Denise cc’d me with her response. I liked what she wrote and decided to use part of it here because it is important information.

[Denise talking about feet getting wet]. How you avoid getting your feet wet is that you avoid getting water sprayed on your legs. It’s your core that needs the cooling anyway. If you are sprayed on the legs, i.e., quads, you have to have it wiped off, then you wipe sunscreen off too. You can survive quite well without getting sprayed on the legs (honest). And, very importantly, you make mental notes about how your feet are “feeling” and address any hot spots BEFORE they grow!

As well, you make sure your crew knows by giving them strict instructions NOT to get you wet below your waist, and if anyone does (they DIE…just kidding). Really. The water that hits your legs runs down the legs into shoes. Depending on how hot it is, which is not looking very hot this year, the water that is sprayed often evaporates. However, if you get those feet wet, then one of the factors that come into play is blisters, i.e., heat, moisture and friction. You can’t avoid heat and friction, so you try to avoid moisture. The tape, as you know, acts as another layer of skin. But honestly, if you do get wet feet, and they blister, then it the athlete either is sucking it up and running anyway with those blisters, which has been done, or drops, which I doubt is on your agenda. Since you are fast, I imagine you are going to be pushing hard and those front-runners can definitely suck it up. When I see their feet afterward, I remark how much better they would have done if they had not allowed their feet to get wet or if they had figured out what works. Certainly socks, sometimes two layers, if you have trained with them and lube, and or powder can work well. Injinji’s often work with a sock over them, with lube and powder under that. The leg sleeves that have become popular now, which I really like, are a culprit I think because they allow water to drizzle into the shoes and socks. While they prevent sunburn, they do act as a catalyst to carry water that is in excess seeping down the legs onto the feet and shoes. That is DEADLY!

What I find is most important is that you have a Plan A – and then Plan B which comes into play if Plan A doesn’t work. Everyone is an experiment of “one”. About the time I think I have the magic combo figured out, someone proves me wrong. Case in point: KNOW YOUR FEET and what causes you problems and address that with a plan and then a backup plan if that fails. Then maybe you won’t need to use it once you are underway. All bets are off if you are pre-taped and those feet get wet because wet tape is not a good barrier. Duct tape is too hot and does not dissipate heat, though it can withstand moisture, often the feet macerate underneath.

Hopefully you do not have deep callus. That is also a “no-no” in my book in Death Valley because we cannot drain deep blood blisters because the callus can’t be penetrated.

Good advice from Denise – a pro about foot care in the heat. I’ll be back next week with a report from Badwater.

Maceration

June 23, 2011 by · 1 Comment
Filed under: blister care, Foot Care, Health 
A BAD case of maceration

A BAD case of maceration

This weekend is the running of the Western States Endurance Run, a 100-mile race from Squaw Valley to Auburn, over the California Sierras. While around 375 will start the race, the finisher’s numbers will probably fall between 200 and 250.

The main reasons for not finishing will include being under trained, stomach issues, simply missing cutoffs, and injuries.

Injuries are big. There will be sprained ankles, cuts and scrapes from falls, possible wrist injuries from falls, tons of blisters, and this year – a lot of problems from maceration. With higher than normal snow levels, and this week’s hot temperatures, runners will be in the snow more than normal. Plus runoff from the snow will affect trails and stream crossings. These wet conditions will affect many of the runners – leading to maceration.

The picture above shows a severe case of maceration. With maceration this bad, the runner usually cannot continue because of the pain.

Maceration at Western States

Maceration at Western States

So, what is maceration and what can you do about it?

Dermatology.about.com give the following definition: Maceration of the skin occurs when it is consistently wet. The skin softens, turns white, and can easily get infected with bacteria or fungi. The photo, taken at the Western States finish line years ago, shows a good case of maceration. The runner’s son asked me to look at his dad’s feet because he had huge painful blisters on the bottom of his feet. There were no blisters – only the skin as shown.

Wet conditions can have a negative effect on our feet. Blisters may go from being minor inconveniences to major problems. Maceration can happen. In severe cases, trench foot can become a real medical issue. When these conditions set in, you will be at the mercy of your hurting feet.

So what happens when your feet are wet and cold and how can that affect your racing? As your skin becomes wet, it softens and becomes more susceptible to blisters. If a blister forms, it is more likely to rupture. The skin then separates further. Maceration happens when skin becomes soft and wet for long periods of time. When you take off your socks and find your feet look like prunes, this is what has happened. The skin is tender and can fold over on itself, separating and creating problems. As layers of skin separate, blisters spread, the skin becomes whitish in color, and it can split open and bleed. It is very hard to patch feet when this has happened. Feet become so tender that every step is painful. The first photo shows such a case.

Many athletes with macerated feet feel as if the whole bottom of their foot is blistered, as I mentioned above. In fact, there are often no blisters. The skin is so soft and tender that every step is painful. Many times the skin had folded over on itself or has lifted to form deep creases. These feet need to be dried as much as possible by removing them from the moisture source, applying drying powders, and exposing them to air. There is no quick fix for macerated feet.

Tips for maceration

Maceration of the skin can cause a great deal of pain and interfere with walking and running. These steps should be taken prior to exposure for the best effect:

  • Apply a beeswax and lanolin preparation such as Pro-Tech-Skin from Atsko or Kiwi’s Camp Dry, or Hydropel Sports Ointment, which is used by many adventure racers because of its moisture-repelling capabilities.
  • Coat your feet with Desitin Maximum Strength Orginal Paste.
  • Reapply the skin protectant at frequent intervals or when changing socks.
  • Warm your feet when stopping, resting, or sleeping.
  • When resting or sleeping, remove footwear, dry your feet, and allow them to air.

Tips for moisture

  • For high-intensity, fast-paced sports, lightweight and fast-drying shoes are the best bet.
  • If you wear shoes with a Gore-Tex fabric, remember your feet will sweat and create moisture inside the shoe-therefore moisture-wicking socks should always be worn. Note: Once a Gore-Tex fabric shoe has water inside from a stream crossing or other water source, it will stay wet inside for a long time.
  • Treat your shoes with a waterproof spray to protect the shoes from the elements and, in turn, keep your feet warmer.
  • If your shoes have a breathable upper, layers of duct tape over the upper can keep the wind and moisture out.
  • Wearing shoes that do not have adequate draining capabilities will subject your feet to extended periods of moisture. Use a heated nail or a drill to make a few small holes where your upper attaches to the lower part of your shoe or boot. Make one on each side of the heel and one on each side of the forefoot. Some athletes prefer holes in the sole of the shoe for faster draining.
  • Wear socks that are have moisture-wicking capabilities. Whatever socks you wear, change them frequently and dry the old socks.
  • Consider wearing waterproof socks. The best choice is SealSkinz socks.

Wet and cold feet can lead to long-term and even permanent disability. Even at temperatures above freezing, the combination of cold and moisture can lead to serious injury. Trench foot can occur even in mid 60-degree temperatures. The care of your feet in wet and cold weather is crucial.

Socks that Work for You

July 29, 2008 by · 1 Comment
Filed under: Footcare, Footwear, Health, Sports, Travel 

Two weeks ago, I was in Death Valley to help as part of the medical team for the Badwater Ultramarathon, a 135-mile run from Badwater, the lowest point in the continental U.S. to the Mt. Whitney Portal, at about 8600 feet. This race is always held in July to challenge the runners with extreme heat. The route is entirely on roads, however the runners often favor the rocky sides rather then the hot asphalt. As you might guess, this usually takes a toll on the runner’s feet.




In addition to the foot work done by the runners’ crews, three of us patched a lot of tired and hurting feet. Denise Jones, called the “Blister Queen of Badwater,” Gillian Robinson of Zombierunner.com, and I were all busy up and down the course.  By the way, I am running an interview with Denise in the next issue of my Fixing Your Feet Ezine.

 


I was wearing socks from Drymax and had two extra pair. I like these socks because they do a superb job of elimination moisture against your feet. While other socks have Sock_trail_running_quarter_crew_black_gray wicking capabilities, Drymax socks are made with an inner thread that hates water, making it pass through to the outer surface of the sock. With wicking socks, water adheres to the fiber’s surface. Once wicking fibers get wet, they stay wet. The fibers hold the moisture next to the skin ensuring the skin stays wet. Conversely, with Drymax socks, water drops actually bend around the Drymax fiber, rather than sticking to its surface. This happens because Drymax fibers do not carry surface charges, so the negative & positive charges of water are not attracted to Drymax fibers. Because sweat clings to wicking fibers, the foot remains wet when wearing socks made of wicking fibers. Also the process of wicking must rely on evaporation for the fibers to dry out. Evaporation is a relatively slow process, especially in humid environments such as inside a shoe, where evaporation takes place at a much slower rate than sweating.


 


When sweat droplets move through the Drymax water-hating fibers they stay together and move instantly through the fibers. Drymax stays dry and therefore needs no drying time to keep the skin dry. I have noticed this when I wear the socks. Others have too.


 


So, back to the Badwater story. Jon, the runner from a year ago whose horrible feet I patched (click here to read his story in the August 2007 Fixing Your Feet Ezine), came into Panamint Springs needing some minor foot patching. Once I finished, I looked at his socks and offered him a pair of my Drymax socks.  Denise Jones gave away two pair of Drymax socks. The runners were appreciative and finished the race successfully. Jon told me he loved the socks.


 


Trust me, these socks work for you. I wrote a lengthy review of the socks in the June Fixing Your Feet newsletter. If you are in the market for new socks, or if you want to see how they will reduce your likelihood of blisters, check them out. The website is DrymaxSocks.com and they can also be found at Zombierunner.com. Just click on Store and then Socks.


 


After all, we need to keep our feet happy.

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