Tonya Olson and I met at Western States this summer. She worked with the medical team and was really interested in learning foot care. A few weeks ago she asked for advice on how to manage foot care and supplies at the new Pine to Palm 100 last weekend. Here is her report.
The inaugural Pine to Palm 100 mile endurance race in Ashland, OR this weekend exhibited some rather atypical weather for the runners. It rained for 30 hours straight. Not so many blisters to address but plenty of macerated trench feet. Here are a couple of photos.
The first was the result of 30 hours of running in the rain with blisters starting at mile 27. He didn’t get help from me at 65 and his wife put moleskin across the bottom of his foot, which adhered to the macerated skin and blood blister, you can see a little dark patch of the remaining moleskin that I was able to remove using a scalpel. I didn’t see this runner until after the race so, I removed the moleskin and counseled his wife who is a nurse practitioner on how to care for the feet when he got home and showered.
The other photo is after the race as well and is a nice heel blister.
Let’s evaluate the photos.
The first photo shoes a badly macerated foot. No surprise there. Skin folds on the bottom of the foot can lead to huge problems. These folds are painful. The one her in the center of the arch developed into a blood blister, which then split open. A blister this low in the mid-foot is probably caused by the insole and shape of its arch. It could also have grown worse because of the maceration and folds, leading to a split, where under normal condition, it would have been fine. The photo shows what appears to be dirt inside the blister. This could easily lead to infection.
Prevention and treatment of maceration can be difficult. In this case, with as much rain as the race had, it is hard to keep feet dry. Probably the best bet is to use a drying agent to keep moisture under control. Once the skin is macerated, drying can be accomplished through powder, exposure to air, and dry socks and shoes. The skin folds will return to normal – over time. There is no fast cure. Here are a few more tips:
- Apply a beeswax and lanolin preparation such as Pro-Tech-Skin from Atsko or Kiwi’s Camp Dry.
- Coat your feet with Desitin Maximum Strength Original Paste.
- Reapply the skin protectant at frequent intervals or when changing socks, making sure to clean the feet first.
- Make sure your footwear drains moisture out of the inside of the shoe.
- Warm your feet when stopping, resting, or sleeping.
- When resting, remove footwear, dry your feet, and allow them to air.
- Consider wearing waterproof socks. You have two choices. SealSkinz socks are designed to keep water out. Seirus StormSocks are made from neoprene and are designed to hold warmth in, but some water can get inside.
The second photo shows skin peeled back from a back-of-the-heel blister. The maceration softened the skin and rubbing in the shoe’s heel counter caused the blister.
An ENGO patch in the heel counter would have helped prevent the rubbing. Taping before the race could have helped.
Something to try before an event where rain is expected is to pre-tape the bottom of the feet. A carefully done tape job, with Compound Tincture of Benzoin to make the tape adhere better, could help reduce the occurrence of skin folds.
Thanks Tonya for sharing these photos.