Susan Alcorn’s Backpacking & Hiking Tales & Tips is a monthly email newsletter from her website at Backpack45.com. Susan and her husband Ralph have done hikes on the Pacific Crest Trail, the John Muir Trail, the Camino de Santiago, and more. Every month I review her newsletter for tips and information that I can share with my readers. I encourage you to check out her website and subscribe to her newsletter.
Only once before in the 15 plus years of publishing an email newsletter and this blog have I shared information that has the potential to save a life. Please read on and take this information to heart.
In the December newsletter, Susan shared a story they experienced while hiking the John Muir Trail. They met a hiker with a sobering tale he shared with them. He and his wife had reached Palisades Lake when she was suddenly hit with nausea, fever, and weakness. Initially he thought it was exhaustion, but the next morning his wife was worse so they did a layover day. She was even worse the following day so they decided to exit at Bishop.
His wife became so weak that she could no longer walk – even without her pack and with help. She collapsed on the attempt to descend the Golden Staircase. Her vitals were a temperature of 105, blood pressure of 90/50, a resting pulse 135 – and she was unaware of her surroundings. He and two others tried to carry her out, but found it impossible because of the narrow trail. A helicopter was brought in and she was airlifted out in a basket to Deer Meadow, where she was put inside the helicopter and taken to the hospital.
The Alcorn’s met the husband as they were leaving the John Muir Trail over Bishop Pass. He was going out on the east side and then going to find a way over to the hospital in Fresno. We wondered for days how this had played out and were happy when they heard a subsequent report. After four days in the hospital on antibiotics, the lady was ready to be flown home – not entirely well, but no longer in danger. The hospital did not do tests to determine the cause, but only treated symptoms, so the cause of the problem was up for speculation. Her husband thought that an infection had probably entered her blood through blisters in her feet – most likely the source was open blisters and their soak in hot springs.
Susan says, This is a reminder of the importance of avoiding infection in any open sore – especially under trail conditions.
I agree. In 2007 I wrote an article about another hiker on the Pacific Crest Trail who had to be evacuated out and spend a long time recuperating from a serious infection. Her infection was also caused by an infection through an open blister. This first photo shows her infected foot after she reached the hospital.
Bacteria causing the infection can come from your skin, from the environment, or from anything that gets inside the blister. The web spaces between the toes have more skin bacteria and open blisters here present an increased risk of infection. The second photo shows the redness common to an infection.
The take-away here is that we need to understand how to properly clean and care for blisters, have the right materials to patch them, and know the signs of infection.
All open blisters should be watched for redness, streaks up the leg, pus, heat to the touch, pain and/or swelling around the area, and fever. When any of these are present, prompt medical care should be obtained.
In my 2007 Fixing Your Feet newsletter I wrote, I think this is the most serious and important issue yet. It has in-depth focus on infections as a result of blisters. First read my editorial, Blisters Can Lead to Serious Infection, and then the feature article, My Infected Blister – Almost My Life! where Cari Tucker “Sandals” tells her story. I think you’ll agree with Denise Jones, the Badwater Blister Queen, who told me, ‘This is indeed sobering and shocking (literally). I think people need to see this because I do not think they take blisters very seriously!’ I urge you to fully digest the articles, then read the articles on Blood Blisters and Infections, Staph Facts and Cellulitis Facts.
Here’s the link to the July 2007 Fixing Your Feet newsletter with the articles.
Filed under: blister care, Foot Care, Foot Care Products, Sports
Last month I provided foot care at the Jungle Marathon Amazon. In preparation for the trip, I searched for new tapes. One of my searches turned up Theratape.com, a web-based store that specializes in kinesiology tapes and supplies. The website is a wealth of information on kinesiology tapes and kinesiology in general.
I emailed the owner, and received answers to all my questions regarding different brands of kinesiology tape. They carry many to choose from: Kinesio Tape, Nasara, PerformTex, RockTape, SpiderTech, and StrengthTape. Another brand is KT Tape. That’s seven brands to choose from.
Because I was going to the Amazon, where I knew feet would be wet, tape adherence was a major factor. The Theratape staff told me that the two best adhering tapes for wet condition were RockTape H20 and StrengthTape.
Three weeks before the Amazon, I tried a roll of each tape. On one foot I used a strip of StrengthTape, and another of Kinesio Tex Tape (my old standard). On the other foot I used a strip of RockTape H20 and another of LevoTape (a brand from the U.K.). I had one strip on the mid-foot, side-to-side, and another strip on the forefoot behind the toes. I did not use Compound Tincture of Benzoin as a tape adherent. The LevoTape came off on day four and the Kinesio Tex on day five. Finally on day six I removed the Rocktape H20 and the StrengthTape. Of the final two, the StrengthTape still had some stickiness left. It became my first choice of the kinesiology tapes. I promptly ordered one of the bulk rolls. Service from Theratape.com was great.
Here is the StrengthTape description from the theratape website: StrengthTape by LifeStrength begins with all the features of a high quality kinesiology tape, but is then “supercharged” with the addition of advanced ionic technology. Seven different minerals and gemstones are crushed into microscopic particles and infused into the tape. The natural properties of these substances create a negatively charged material that emits anions or negative ions. When applied to the skin, these negatively charged particles are readily absorbed into the body, enhancing the pain relieving and healing properties of the tape. Its 10% greater elasticity provides additional support for injuries and snap-back for performance enhancement. The proprietary AllSport extra-strong adhesive provides superior sticking power in all conditions, including water when properly applied, most applications will provide pain relief, comfort and support for 3-7 days. Uncut rolls are16’ in length and two inches in width, while each 16′ pre-cut roll contains twenty 10″ strips.
For those familiar with RockTape, I did try the RockTape H20. On the website, RockTape H2O is described as, the ultimate kinesiology tape for water sports. With an adhesive twice as strong as regular RockTape, H2O has undergone rigorous testing in the wild waters of the Pacific. H2O is a great tape for swimmers, triathletes, and other water sports participants. RockTape H20′s other features include a tighter weave and greater elasticity than other kinesiology tapes. It stays on longer and provides enhanced support, even under the toughest conditions.
In the Amazon, I used Leukotape, RockTape H20, StrengthTape, and Hypafix for between the toes. To start with, I used the StrengthTape and Rocktape equally, sometimes both on one runner. I wanted the feedback.
We had the advantage of applying the tapes in the late afternoon and evening, which allows the tape’s adhesive time to bond with the skin. After applying the tape a short 20-30 second rub was done to warm the adhesive and activate the adhesive.
Several things are important when using kinesiology tapes. Lay the tape on the skin and if you have to stretch the tape around a heel or toe, only apply a slight stretch. The more stretch you apply, the more likely the tape is to come loose, especially in wet conditions. Secondly, whenever possible, apply the tape the night before it is needed. At Badwater we try and tape the night before the race to give it good bonding time. At a minimum, try to apply it an hour before activity for the tape to set.
StrengthTape was the winner. Several days in to the Jungle Marathon, runners were asking for the “blue” tape (my blue StrengthTape). On some runners, the tape did not hold – but in fact no tape held up well when the runners walked around on the sand and dirt in bare feet or skimpy homemade flip-flops. The combination of the wet conditions when they finished the day’s stage followed by dirt and sand constantly worked away at the edges of the tape. That’s why we re-taped most afternoons and evenings.
We taped a lot of toes with StrengthTape, as you can see from these pictures. The runners would come into camp after finishing their stage and tell me how the tape had held up – or not. Sometimes the sand was simply too abrasive and it rubbed against the tape, working it’s way under the edges. I’d apply a light strip of Benzoin along the edge of the tape and the skin to help the edges hold better. This helped a lot.
In wet conditions, the race medical team from past years found that Injinji socks were better than other socks for blister control. Many runners wore Injinji socks. For these runners, the little toe socks of the Injinji’s was perfect to help hold the StrengthTape in place. One runner completed the race in Vibram FiveFinger Lontras, which also help hold the tape in place. To read my blog post about the survey and what worked, click on the link: A Survey About Feet From The 2012 Amazon Jungle Marathon.
In my tests, I found the RockTape H20 had good adherence, but frayed around the edges. Applying a strip of Benzoin on the edge of the tape and skin can help control the fraying.
I will be using StrengthTape at the races where I provide foot care. My stash of other brands of kinesiology tapes will be used as I learn about using the tape for its intended purpose of kinesiology.
If you are interested in ordering StrengthTape or RockTape H20, I recommend checking Theratape.com. They have generously offered a 15% discount on anyone’s first order of StrengthTape or RockTape – just use the code “fixyourfeet” in the discount code box on the order page. The discount code is good for any of the two tapes, tape size and quantity. The tapes come in a variety of colors. I welcome your feedback when you use the tape.
Disclaimer: Kinesiology is the study of human movement. The benefits of kinesiology tape include relief of pain and swelling, relaxation of overused or tight muscles, activation of weak or poorly-toned muscles, and enhancement of athletic performance. Made from cotton with a hypoallergenic acrylic adhesive, kinesiology tape is designed to be worn for 3-5 days, providing therapeutic benefits 24/7, the entire time it is worn. I apply kinesiology tape to feet because of its ability to stretch and shape to the curves of the foot, in addition to its smooth surface, adhesive, breathability and lack of leaving tape residue on the skin. If you watch the Olympics, you have probably seen kinesiology tape on athletes’ shoulders, arms and legs, and more.
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.
Filed under: blister care, Foot Care, Foot Care Products, Footcare, Footwear, Footwear Products
Vicky Kypta is the Medical Team Manager for the Jungle Marathon, which starts October 6 in the Amazon in Brazil. Last year she did an informal survey of the participants and the results are interesting. The race lasts seven days and goes through the jungle on pre-existing paths, trails, and tracks with natural obstacles to pass including streams and shallow rivers. This leads to feet that are constantly wet.
This is the race that I will be at in a few days.
Vicky shared the results of the questionnaire and commented it was quite interesting, although the sample group was quite small. There were about 30 participants.
Here are some of the findings:
- 77% of the respondents wore Injinji socks
- 100% of those NOT wearing Injinji sock got blisters
- 46% of those wearing Injinji sock got blisters: out of those 50% were on the balls of the foot and 50% were on the toes. Those who had blisters on their toes all wore shoes in their normal size.
Out of those with no blisters:
- 100% wore Injinji socks
- 100% wore shoes one size larger
- 75% applied some form of anti-friction compound to their feet; i.e. Body Glide, 2nd Skin or Zinc Oxide cream
- 75% pre-taped problem areas or hotspots
I find this interesting and wonder what we will find with the 78 participants next week. The Jungle Marathons are well run and the staff tells runners to train with wet feet. They have found this results in less foot problems.
The results are striking in several areas (remember this is a seven day stage race):
- All the runners who did not get blisters wore Injinji socks and shoes a full size larger than their normal shoes
- All the runners who did not wear Injinji socks got blisters
- Runners wearing their normal size shoes all got toe blisters
- The majority of blisters were on the forefoot and toes
Over the past 17 years, I have worked a lot of ultramarathons and multi-day stage races. I can honestly say that overall, feet have improved. More runners are prepared and know how to manage their feet.
When I return, I will share what we found at this year’s Amazon Jungle Marathon.
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 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.
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.
Filed under: blister care, Foot Care, Foot Care Products, Footwear, Sports
In my last post, I talked about four ways to reduce shear and the likelihood of blisters. To recap, they were fit, cushioning, moisture management, and socks. Today’s post will cover a fifth way by using ENGO Blister Prevention Patches.
Tamarack Habilitation Technologies is well known for providing healthcare professionals and clients with innovative, value-added orthotic-prosthetic componentry and materials. Their ShearBan product is similar to the ENGO Blister Prevention Patches reviewed in this article. ShearBan is used in the orthopaedic and prosthetic industry on prostheses at amputation stump sites to reduce the incidence of skin breakdown.
Introduced in 2004, ENGO Blister Prevention Patches have radically redefined the way hot spots, blisters and calluses are treated. As a preventative measure, ENGO patches provide peace-of-mind that blisters won’t become a painful, debilitating problem. If a blister has already formed, applying patches to footwear, corresponding to the blistered area eliminates painful irritation and further skin damage, allowing continued activity. Friction forces are reduced by more than 50% when you apply an ENGO Patch to your footwear.
The patches are made from an ultra-thin Polytetrafluoroethylene (PTFE) film and are 0.015 inches total thickness – a very slippery surface. They are very durable, lasting four to six weeks in most applications. The aggressively sticky patch peels away from the backing and is applied to dry shoes or boots. The PTFE ENGO Patch reduces the ‘stickiness’ between the shoe and sock so they can glide over one another. The foot, inside the sock, glides over the patch shear distortion and friction are reduced, and blisters can be averted, in spite of pressure.
Avid runners, hikers and sports players rely on their feet to reach performance goals; from day hikes to ultra marathons. But quality footwear and socks alone don’t eliminate the skin trauma your feet can experience from repetitive rubbing — building friction forces to levels that cause hot spots, blisters and calluses. While I use these patches in runners’ footwear at races, they can also be used in ordinary every day shoes to reduce calluses.
Similar to Tamarack’s ShearBan material, ENGO patches are applied directly to footwear and equipment, not to the skin. Outcomes of this unique application include ease of use, long-lasting and guaranteed friction relief.
ENGO Patches are made in several sizes and types:
- A large oval – 2 ¾ x 1 ¾
- A small oval – 2 x 1 ½
- A rectangle – 3 ¾ x 2 ¾
- Back of the heel patch – 3 ¾ x 1 ¾
- A cushion heel wrap – 3 ¾ x 1 ½
When I work a race I always have a bag with different sizes of ENGO patches. I have applied the ovals and rectangles and the back of the heel patches. The patches are applied to the shoes and insoles – not to your skin. This means wherever you are going to apply a patch has to be dry. My advice is to apply patches before your race when your shoes are dry. I have used them inside the shoes in the sides, in the heels, and on the insoles.
Typical problem areas in footwear are under the heel and forefoot, and at the side of the heel. An oval patch can be applied to overlap the side of the heel counter and the insole as seen is the photo. I often use a rectangle or large oval under the ball of the foot or an oval under the heel – applied directly to the insole. The patches are useful over stitching or seams in footwear that are rubbing the wearer. If necessary, a patch can be cut to shape for where it will be applied.
The patches will reduce shear and friction; provide relief from hot spot and blister pain, and can be used in any type of insole or orthotic and footwear, from sandals to running shoes, and any type of hiking or ski boot.
I like ENGO patches because they work. The patch is thin and does not alter the fit of the shoe. When properly applied to dry footwear, they stick.
Rebecca Rushton, a podiatrist in Australia, strongly recommends ENGO Patches. She discovered the patches after getting blisters herself and now represents ENGO in Australia. She has written several free reports on blister prevention available on her website, Blister Prevention.
If you are unclear about shear and blister formation, here’s a link to my article An Introduction to Shear and Blister Formation.
The Technical Stuff
JM Carlson, in a 2009 report wrote, “The measurement of friction is the ‘coefficient of friction’. The coefficient of friction (COF) is a number that represents this slipperiness or stickiness between two surfaces and is generally below 1.0. Within the shoe, the COF between the foot, socks and insole can range from 0.5 – 0.9. In contrast the COF between a sock and a polished floor is around 0.2.” Tests have shown PTFE patches to reduce the coefficient of friction (COF) in the shoe by up to 80%. The COF is in approximately 0.16, which is significantly lower than all other in-shoe materials. Importantly, the low COF is maintained even in most and wet conditions inside the shoe.
Check out GoEngo.com for more information about ENGO Blister Prevention Patches. They also offer a money-back guarantee.
Disclaimers: I support ENGO Patches and am supplied with whatever I need for the events I work. I am an affiliate of Zombierunner and make a bit of any sale made through the link above.
Back on June 17 I introduced the concept of shear with a post by podiatrist Rebecca Rushton from Australia who has studied blisters and identified shear as a major factor in blisters.
It’s best to start by refreshing our memories about what was shared on the previous article. Here’s the link in case you want to see the full post: An Introduction to Shear and Blister Formation. Otherwise, here’s a short piece from that post:
Poor blister prevention outcomes are due in no small part to the misunderstanding of the cause of this obstinate injury. The force that causes ‘friction’ blisters is not friction. And it’s not rubbing. It’s shear. But if you ask 100 people the question “what causes blisters”, nobody would answer “shear”. Shear is the sliding of layers across one another – internal layers that are structurally connected. Those connections can break and when fluid fills that cavity, you have a blister! What Does Shear Look Like? Try this … Step 1: Place the tip of your right index finger on the back of your left hand. Step 2: Wobble it back and forth but keep it stuck to the same bit of skin. Notice how your skin stretches? This is shear and this is what causes blisters. Shear might look like rubbing but it’s not. Notice how your finger tip has not moved relative to the skin of the back of your hand? But your hand skin has moved relative to the underlying bone. This is shear. Your skin doesn’t need anything to rub over it for blisters to form. It just needs shear (this stretching of the internal tissue layers) to be excessive and repetitive.
Managing shear is key to managing blisters. Let’s look at several ways to reduce shear.
The first way is to make sure your footwear fits. Many people buy shoes that seem comfortable in the store but don’t make sure they feel ok by wearing them around the house for a few days. Make sure they have enough room in the toe box both in height and length. Make sure there is not undue pressure on soft tissues over any bony spots (sides of the forefoot, ball of the foot, sides and back of the heel, over the instep, etc.). Make sure they are not too loose, allowing too much movement leading to skin abrasions, hot spots, and then blisters.
Using a cushioning product is a second way to reduce shear. This might be a gel pad under the ball of the foot or under the heel bone, or a replacement insole meant to pad and cushion.
A third method is to manage skin moisture. This can include skin-drying strategies and skin lubrication. Studies have shown that you can reduce the incidence of blisters by keeping the skin either very dry or very wet. Drying the skin can be done with powder, benzoin, alcohol wipes, and antiperspirants. Lubricants can include SportSlick, BodyGlide, BlisterShield, and other popular products. Zinc oxide is also effective at controlling moisture. The method of having runners train with wet feet has been successfully used by Shirley Thompson and Vicky Kypta of the Jungle Marathon Amazon. They have found that the feet of their race participants have been better with this suggestion given to runners before the race.
The fourth method of controlling shear is with socks. This may include double layer socks or wearing two pairs of socks – a thin liner and usually, a thicker second sock. This allows movement between the two sock layers. Injinji toe socks are great for those with toe blister problems.
Next time, we’ll talk about a fifth way to reduce shear – Engo Blister Prevention Patches.
In the mean time, check out ZombieRunner for many products that can help with cushioning, skin-drying and lubricants, and socks.
I have a large file of feet pictures on my computer. Pictures of toes, heels, balls of the feet, and arches. Pictures of blisters of all shapes and sizes. In addition, I see all kinds of feet when I work events. Over the years, I have worked races ranging from short distances to ultramarathons, to multi-day stage races.
I am probably one of a limited number of people in the world who gets excited at photos of bad feet. I like them because they tell stories.
The first full multi-day event I worked was Racing the Planet’s Atacama Desert six-day stage in the high desert of Chile in 2004. The stressors of being on your feet for long distances day-after-day for six to seven days often bring out the worst in feet.
A lady in that race wanted us to remove her toenails at the end of day two. Another runner had the worst case of trench foot I have ever seen. That was nine years ago and my techniques have changed for the better, but the feet remain the same – bad!
I believe that feet tell a story.
The photo here is from the Racing the Planet Iceland. I don’t know the owner of the feet. I don’t know the level of training and experience the person had prior to this race. I also don’t know what experience this person had with foot care planning before a race and during the race.
Here are my observations about the story behind these feet.
- Almost every toe has something going on.
- The photo was posted online for stage five, meaning the runner had to tolerate these toes for four plus days.
- These blisters don’t typically happen in one day. My guess is they started on day one, progressed to blisters on day two and then got worse.
- My bet is the shoes’ toebox was too short in length and/or too low in height.
- The runner may have worn two pairs of socks, which could have made the fit too tight.
- The toenails don’t look too long but it’s hard to see if they have any rough edges or are thick, both of which can lead to toe blisters.
- These toes scream pain – especially if they are encased inside shoes.
- It’s possible the toes received some degree of care, but it is hard to tell from their condition.
- Four of the toes have major trauma.
- We cannot see what is going on under the toes, but from the outside edges of the big toes, you can see blistered skin of the left one and maceration on the right one.
- The left big toe has blood showing in the blister on the outside edge.
That’s a lot of information pulled from a photo. I wish I knew the toes’ owner. It would be nice to learn more about his/her race. What shoes and socks they wore. How the trauma to the toes progressed day-to-day. What care they received. Whether they finished the race.
My guess is that with proper care, much of this could have been prevented. That care could have included lubricants, moisture control skin protect, tape, modified shoes, and nail care.
What story do your feet tell?
Here’s the link to the Racing the Planet’s Iceland race. Racing the Planet does four desert races every year called The 4 Deserts: the Gobi in China, the Atacama in Chile, the Sahara in Egypt, and Antarctic. Every year they add a new location for that year. Past sites have included Australia, Nepal, Namibia, Vietnam, and 2014 will be in Madagascar. You can check them out at Racing the Planet.
Filed under: blister care, Foot Care, Foot Care Products, Footcare
Over my years of taping feet, I have seen techniques improve to where pre-taping is more helpful then ever before.
Often times, in the middle of a race, one cannot take the time necessary to do a high-quality tape job. Things may be rushed. The runner may be in a huge hurry to make a cut-off. The feet and skin may be wet. Conditions may be less than ideal – lightening, set-up, workable access/angle to the feet, supplies, etc.
However, before a race, a hike, or run, there is more time to do a high quality pre-tape job. It’s also the time to practice your skills and learn how to do a really good tape job. The first photo here shows a pretty poor tape job on toes. In this photo, the tape will probably peel off from sock changes and general wear. If any one of the pieces comes off, the now untapped toe will be subject to the roughness of the tape on the neighboring toe. It looks like Leukotape, which sticks well, but does not conform to the curves of toes and other places on the foot. It is possible to do a great tape job on toes with Leukotape – but it take time and practice. I must admit I like Leukotape for certain conditions and tape jobs.
A good, high-quality pre-tape job should hold up well, for several days if necessary, and cared for. In this next photo, you can see the right foot of Bogie Dumitrescu after finishing a solo, self-supported crossing of Death Valley followed by up and down to Mt Whitney. You can see how the tape has held for 157 miles in the extremes of Death Valley. It’s hot on the valley floor, but there are two long uphill’s climbs followed by long downhill’s over two passes. An 11-mile trail hike follows that up to and another 11 back down Whitney. The tape job held for 157 miles! In fact it looks perfect.
The tape is Kenesio-Tex on the heels, balls of the feet and big toes. Hypafix tape is used in a figure eight cut to anchor the tape at the forward edge of the ball of the foot, between the toes, and anchored again on top of the foot. This prevents the forward edge of the tape from rolling.
The next photo shows Bogie’s two feet after the tape was removed. No blisters. One of the reasons the tape held is that Bogie managed his feet well. He kept them as dry as possible. This is important in Death Valley where often Badwater runners get their feet wet when they are sprayed or doused with water in an effort to cool them.
Bogie was fortunate to have his feet taped by Denise Jones, the Badwater Blister Queen. Denise is a master at taping feet and does a precision tape job. This is not a 30-minute tape job. It takes as long as it takes to do it right. Denise and I tape almost identically. If we apply a piece of tape and it looks or feels wrong, we remove it and retape. Our aim is to get the runners on the course and able to finish with good feet.
The point of this blog post is to show a good tape job that can hold up over multiple days. The final photo shows Danny Westergaard’s feet that Denise taped for Badwater three weeks ago. Danny’s feet are taped perfectly. You can see the small strip of Hypafix that Denise wrapped around Danny’s big toes to further secure the tape edges.
I commend Bogie and Danny for their runs. Bogie completed his solo self-supported Badwater crossing the week before the official Badwater ultramarathon. Danny completed his 7th Badwater, went to the summit of Whitney and then reversed direction and went back to the start for his 7th Badwater Double.
And I commend Denise Jones for her care of runner’s feet. She’s a class act. Thanks Denise.
Kinesio, Leukotape and Hypafix tapes, as well as Compound Tincture of Benzoin and other foot care supplies are available at Zombierunner.com.
Disclosure: When you purchase through this link, I make an affiliate small amount of each sale.
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.
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