This post is an editorial about foot care at races – and more importantly, the lack of it.
Over the years I have worked many multi-day multi-sport adventure races and multi-day running races. Most of these are six or seven-day events. Adventure races are races where the clock doesn’t stop until the team gets to the finish. Running races are typically stage races where each day is a specific mileage and camp changes every day.
Please continue reading – even if you don’t do multi-day races – because this blog post applies to those doing 24-hour races, 100-mile races, and athletes in general.
These types of races always have a list of mandatory gear. The list is composed of mostly safety items with a mix of medications and first aid stuff. Some of the first aid items can also be used for foot care.
Here’s the rub though. Most athletes want to minimize, as much as possible, the amount and the weight of the stuff they have to carry. If the list calls for tape, they’ll carry a ½ inch wide very small roll, as few as possible blister patches, 2 or 3 alcohol wipes, 2 Band-Aids – you get the picture. They don’t have the right stuff because the lists are very general and don’t specify exact brands or types of supplies. They don’t have enough because they are not the average athlete and will need more. They only carry what they are required to carry and miss what they need for their feet. And many of these athletes don’t know how to use what they carry.
I have worked many multi-day races and have seen athletes finish a day’s stage and come to medical for every little thing. The medical staff at any race should not have to manage all your foot care. You can manage the small pea-size blister on your toe. If you have hot spots, you can tape over them and check for shoes for seams. There is typically not enough medical staff to care for 100% of each runner’s needs. In addition, the supply of medical equipment is limited and can easily be overtaxed by runners wanting everything done for them.
One runner in the Jungle Marathon came to see the medical team every day, telling us what he wanted down to the color of the tape and showing us all the spots on his feet he wanted fixing. We would have had to spend an hour just on him, with a lot of supplies, when he had a medical kit but wanted us to do it for him.
I am becoming more and more convinced that mandatory gear lists should be material specific. The width, length, and type of tape should be listed. The number and type of blister patches. Scissors rather than a needle. Specific powder and amount. A specific number and type of tape adherent. And so on. The mandatory gear list needs to be reviewed with the medical director. This applies to runners in any race 50 miles or longer too. While the majority of runners don’t typically carry foot care supplies in a 100-mile run, their crews need to have the supplies. If you wear a hydration pack, a small zip-lock baggie will easily carry what you need.
I also am convinced that runners need to know how to patch their feet. Running a 100-mile race with no knowledge of how to care for one’s feet if and when problems develop is asking for trouble and putting undue burdens on the medical teams. You cannot assume that all medical personnel know how to patch feet—and have the best supplies for doing so.
Several years ago I worked a multi-day event that had only basic medical supplies at the aid stations. There was virtually nothing that could effectively be used for foot care. The participants were not promised foot care, only first aid, and medical personnel. In fact, the pre-race materials did not mention foot care. Many aid stations did not allow crew access. The result was runners who were generally not carrying a foot care kit, had no crew access at many aid stations to help with their feet, and no medical personnel trained in or equipped to do foot care—a disaster waiting to happen. I had my complete foot care kit and worked on many runners’ feet. I know several other aid stations happened to have medical people who knew how to do basic foot care. But we each used our own supplies and skill levels vary. I can honestly say that without the few of us on the course, the finishing rate would have been less than 30% because the race organizers did not think through the possible problems and build in solutions.
In my opinion, putting on a race of any length requires race organizers to put runner safety as their first concern. Runners pay their money and expect a certain amount of good organization and common sense in return.
But, in what has become a catch-22 situation, many runners genuinely expect there to be medical personnel able to manage emergencies as well as manage their feet. They think “first aid” and “medical personnel” means foot care. In reality, many races make no provision for foot care and take an “Oh well – that’s life” attitude.
In fairness to medical personnel, I know anyone doing medical at an aid station will try and help any runner needing it. However, they may not have the supplies and / or the training.
The Jungle Marathon had multiple doctors and paramedics, a fully stocked medical cache of basic and emergency supplies including medicines and narcotics, bandages and foot care supplies galore, and a complete set of medical protocols. Each checkpoint was manned by at least two medical personnel with a complete medical kit. Western States has great medical care at the major aid stations. So does Badwater.
In the end, every race lives and dies based on runner perceptions and what they share with their friends. Give them a bad experience; bad or non-existent medical care, and the word will spread.