Several years ago I met Gregg at Badwater in Death Valley. We were in line to check in at Furnace Creek and I heard the last name. It was the same as an aunt of mine. Turns out we are related.
At Badwater he ran well and finished near the top. Later that year, he and his wife moved to Asia and I had not heard from him – until the other day. He sent an email about running the Spartathlon in Greece. It’s a 246-kilometer (153 mile) race between Athens and Sparta. The Spartathlon aims to trace the footsteps of Pheidippides, an Athenian messenger sent to Sparta in 490 BC to seek help against the Persians in the Battle of Marathon. Here’s his email:
I just finished running Spartathlon. It was nearly as hot as Badwater (100.4), ok maybe not as hot as Badwater, but it was far to hot for this race, considering it is normally 86. The race by the way is fantastic; I would highly recommend that you make a trip out there if you get the chance.
So, I took a photo of my feet after the race and thought you might like the photo, being that you are the foot guy. Might make for a good example. The blister appeared to start from underneath the pad of my foot by my big toe. The pressure built up so much that it formed the blister on top of my foot as well – as you can see from the photo. Pretty cool if you ask me. I probably ran with it for 50 miles, since I didn’t change my shoes and didn’t feel like taking them off. They lanced it when I finished… as I was receiving two bags of IV fluid. Haven’t had any problems with it since, although it has taken a few days for the pressure under my foot to slowly recede.
As you can see in the photo, there is blood in the blister. Here’s where you have to be careful and take precautions to prevent infection. I don’t encourage people to lance these on their own, but in aid stations with the right equipment and knowledge, it can be done. When I do it, I always give the athlete the warning signs of infection: redness, warm to the touch, pain, fever, pus, and swelling. If you have a blood blister, be careful.
Really though, Gregg’s feet look pretty good for just having run 153 miles. Don’t you agree?
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.
“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.
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:
- They encourage participants to train with wet feet
- They even suggest soaking your shoes and socks before heading out for a training run
- They give specific advice that runners find the best shoe and sock combination for their feet when wet
- 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.
In reality, most blisters don’t have blood in them. Repeated heavy pressure (friction) or simply long periods of pressure can turn an ordinary blister into a blood blister.
The fluid will go from clear to light pink, and with continued pressure, to blood red.
The general rule of thumb is not to lance and drain any blood blister. You may have to pad the area to take the pressure off the blood-filled skin. You need to now how to manage a ruptured blood blister.
Here’s why. The problem with blood blisters is that by draining them, the athlete’s circulatory system is opened to possible infection. In a sterile environment or at your home, this may not be an issue. However out on a trail, or somewhere where the athlete may be unable to keep his feet clean, it’s a different story. Where the blister is on the foot can present more problems. A blood blister on the side of the heel is not as problematic as one on the bottom of the foot. The opened blister is exposed to dirt, grime and any bacteria on whatever is touching the skin. Blood blister must be treated as wounds.
Another issue is whether the athlete has he right supplies in his foot care kit to patch the blister. Opening it up and not applying antibiotic ointment and a covering it is a huge mistake.
I tell athletes that normally blood blisters are not lanced because that is the wise thing to say. If everyone thinks they can simply lance them, without fully understanding how to care for them, we’ll have a lot of people with infected feet.
At Badwater last year we had a runner with a very large heel blood blister. She was from Brazil and would be flying home – but she was also a diabetic. Because of her diabetic status, we declined to lance the blister. It would not have been safe.
The photo here is from last week’s Badwater Ultramarathon in Death Valley. The runner had completed the 135-mile race. I talked to him at the finish line and told him the pitfalls of lancing a blood blister. I told him to shower and be careful of popping it and to come see us in the medical room if it did pop. It popped when he was in the shower, the best of all places.
I cleaned the area with alcohol wipes and lanced the blister with a #11 scalpel. I made three cuts so any more fluid would be forced out as he walked. I expelled the blood and applied a generous layer of antibiotic ointment. A gauze 4×4 was placed over the top and then the foot was wrapped with Coban, a wrap material that sticks only to itself. I gave the runner a Zip-Lock bag with a small tube of ointment, several more 4x4s, a Popsicle stick to apply the ointment. I told him he could unwrap the Coban and reuse it multiple times. Then I asked him if his Tetanus was up to date after which I gave him the usual infection speech.
Recheck the blister three times a day for signs of the infection. Each time you check, apply a new coating of antibiotic ointment and change the dressing. Early treatment can keep the infection from becoming more serious.
An infected blister may be both seen and felt. An infection will be indicated by any of the following: redness, swelling, red streaks up the limb, pain, fever, and pus. Treat the blister as a wound. Clean it frequently and apply an antibiotic ointment. Frequent warm water or Epsom salt soaks can also help the healing process. Stay off the foot as much as possible and elevate it above the level of your heart. If the infection does not seem to subside over 24 to 48 hours, see a doctor.
It’s wise to keep a tube of antibiotic ointment in your foot care kit. You may never get a blood blister, but then again, you might. And if you get one, it may not rupture, but then again, it might.
It’s better to be prepared by knowing how to care for blood blisters.
Next week is Badwater. I’ll be there along with Denise Jones, patching feet. I’ve captured the press released from Chris because if utilizes the best of social media and the web to keep followers in touch with the race. After the race, I’ll post pictures. Promise. Here’s the story and links.
AdventureCORPS, Inc., an event production firm specializing in ultra-endurance and extreme sports events, will host the 35th Anniversary Badwater Ultramarathon on July 16-18, 2012. Recognized globally as “the world’s toughest foot race,” this legendary event pits approximately 95 of the world’s toughest athletes – runners, triathletes, adventure racers, and mountaineers – against one another and the elements. Covering 135 miles (217km) non-stop from Death Valley to Mt. Whitney, CA in temperatures up to 130F (55c), it is the most demanding and extreme running race offered anywhere on the planet.
The start line is at Badwater, Death Valley, which marks the lowest elevation in North America at 280′ (85m) below sea level. The race finishes at Mt. Whitney Portal at 8360′ (2533m). The Badwater course covers three mountain ranges for a total of 13,000′ (3962m) of cumulative vertical ascent and 4,700′ (1433m) of cumulative descent. Whitney Portal is the trailhead to the Mt. Whitney summit, the highest point in the contiguous United States. Competitors travel through places and landmarks including Mushroom Rock, Furnace Creek, Salt Creek, Devil’s Cornfield, Devil’s Golf Course, Stovepipe Wells, Keeler, and Lone Pine.
A true “challenge of the champions,” the 2012 AdventureCORPS Badwater Ultramarathon features 49 Badwater veterans and 49 rookies: die hard “ultra-runners” of every speed and ability, as well a athletes who have the necessary running credentials, but are primarily known for their exploits as adventure racers, mountaineers, triathletes, or in other extreme pursuits. They represent twenty countries by citizenship or residence: Argentina, Australia, Brazil, China, Costa Rica, Czech Republic, Canada, France, Germany, Iran, Italy, Japan, Mexico, Poland, Serbia, Spain, Sweden, United Kingdom, United Arab Emirates, and United States of America (and nineteen America states).
There are 18 women and 80 men. The youngest runner is 23 (rookie entrant Claire Heid of Tacoma, WA) while the oldest is 70 (Arthur Webb of Santa Rosa, CA, a thirteen-time finisher), with an average age of 45. Full details are available on the race roster.
The men’s course record is held by Valmir Nunez of Brazil with a time of 22:51:29 set in 2007, while the women’s course record of 26:16:12 was set in 2010 by Jamie Donaldson of Littleton, CO. It is expected that the winner of the 2012 AdventureCORPS Badwater Ultramarathon will finish in 22 to 26 hours. The average finishing time is approximately 40 hours, while the overall time limit is 48 hours, as compared to the 60 hour limited used in the races held through 2010. For those who finish in less than forty-eight hours, their reward is the coveted Badwater belt buckle. There is no prize money.
The 2012 race field is particularly competitive. Veteran contenders include 2011 men’s champion Oswaldo Lopez, 40, of Madera, CA (also place 2nd in both 2009 and 2010; Mexico citizenship), 2010 men’s champion Zack Gingerich, 32, of Tigard, OR, 2009 men’s champion Marcos Farinazzo, 44, of Brazil and 2004 men’s champion Dean Karnazes, 49, or Ross, California. Also competing is Marshall Ulrich, 61, of Idaho Springs, CO, the 17-time finisher who placed first in 1991, 1992, 1993, and 1996.
The women’s field, with 18 entrants, includes 11 rookies and 7 veterans. Veteran contenders include the 2011 women’s champion, Sumie Inagaki, 46, of Aichi, Japan and Pam Reed, 51, of Jackson, WY, the 2002 and 2003 overall champion who also won the women’s field in 2005. Every year is a new year at the Badwater Ultramarathon, with rookies and “previously unknown” athletes surprising the contenders with top performances. New stars will shine as the race unfolds in July.
RACE MAGAZINE Download the 2012 edition (44 pages; 3.4MB).
RACE WEBCAST Follow the race live via the webcast.
BADWATER ON TWITTER
Follow the 2012 Badwater Ultramarathon via Twitter. We will post race updates and observations, photo links, and important news and announcements. NOTE: Please use hashtag #bw135 to join the Twitter conversation! Here’s the current conversation stream.
BADWATER ON FLICKR
Official race photos by the Badwater Race Staff will post to Flickr July 15-18. Race Director Chris Kostman’s race photos will post to Flickr July 15-18 in his photostream.
BADWATER ON INSTAGRAM
Badwater Race Director Chris Kostman will be posting photos “live” (whenever a cellular connection is available, which is in Furnace Creek and then the latter 1/3 of the course and the finish line) via his Instagram account. Follow his photo stream on your iPhone or Android with the Instagram app and his stream at “chriskostman.” Photos also automatically post to Chris’ Instagram stream for viewing online.
BADWATER ON YOUTUBE
We will be posting videos from the race on the AdventureCORPS YouTube channel. Most videos will appear on Tuesday and Wednesday, where the internet connection is far superior to that in Death Valley.
Feet are a big part of my life. For the past 15 years, Fixing Your Feet has introduced me to great people. I have enjoyed helping runners at events like Western States; Badwater in Death Valley; Primal Quest in Colorado, California and Washington; Raid the North Extreme in BC Canada; the TransRockies in Colorado; Racing the Planet Atacama in Chile; the Coastal Challenge in Costa Rica; the Avon Walk; the Susan G. Komen 3-Day Breast Cancer Walk; and others. In all these events, I have worked on thousands of feet. In addition, I have responded to an uncounted number of emails from folks asking for foot care advice.
The best part has been the people I have met. Runners, hikers, adventure racers, walkers, and their crews. Athletes walking a fine line between making a cutoff in a race, front runners, back of the pack runners, short and long distance hikers, solo and in groups – all ages. Athletes with a simple blister and others with blisters all over. Athletes in pain, and those wanting to quit.
I can recall many of these people. I remember their stories. Some of you are in my stories. I have learned a lot from each person whose feet I have patched. I don’t pretend to know everything about feet. Together we have learned a lot. I thank each of you for what you have contributed to the Fixing Your Feet story.
I wish all my readers a fun, bright, delicious, warm and cozy, and loving Merry Christmas. I hope you can spend time with family and friends.
Some of you may have followed the recent saga of Lisa Bliss’ solo, self-supported Badwater Solo crossing of Death Valley on the Badwater Ultramarathon course. Lisa is one of the strongest women runners I have met. – and this solo adventure proves it.
Lisa started at Badwater, the lowest point in the United States at -282 feet, and covered the 135 miles to the Mt. Whitney portal in just over 75 hours. Then she made the climb up to the summit of Mt. Whitney at 14,494 feet, the highest point in the lower 48 states, about another 11 miles. All without any support from another person – no extra food or water, no help of any sort.
Lisa has two great, well-conditioned feet. This picture shows the tape job done by Denise Jones before her start. That’s it. A single strip of Kinesio Tex tape across the ball of the foot, with a piece of Hypafix tape cut in a figure 8, holding the leading edge down. Denise is fantastic at taping, being very careful to avoid creases or folds in the tape, and making sure all edges are secure.
The second picture is of Lisa pushing her 240 pound cart through Death Valley. The cart carries all her water, food, clothes, and other essentials.
The third picture is of Lisa on the way of the Portal Road. This is probably around mile 132.
The fourth picture is taken very near the “official” finish line of the Badwater race, the Whitney Portal at 8371 feet. At this point, the road part is done. This is where most of the Badwater runners stop. But the official solo rules include summiting Mt. Whitney. So the cart is stowed and the hike to the summit starts.
Lisa reached the summit and became only the second person to have completed a solo, self-supported run on the Badwater course. Lest you think Death Valley is flat, you might be surprised to find out there is a long 15-mile uphill from Stovepipe Wells at 0 feet to the top of Townes Pass at 4956 feet. Then you descend to Panamint Springs at 1980 feet, before starting the climb to Father Crowley Point at 4000 feet and then over Panamint Pass at 5300 feet, and then the rolling road into Lone Pine. That takes you to about mile 122 at the 3700 foot Lone Point. Then as said earlier, the Portal is mile 135 at 8371 feet. Mt Whitney’s summit is another 11 miles to it 14,494 summit. Remember that after completing the solo, and reaching the hut at the summit on Mt. Whitney, she had to turn around and go down the mountain back to the Whitney Portal. They came down the mountain in a storm.
Lisa wrote me a note after she returned home and shared how her feet held up. Here’s what she said:
“I had NO trouble with blisters even with all that toe-off on the uphills. I had just a tiny blister on the end of my second toe, noticed in Lone Pine when I was changing socks for the first time. I snipped it and filled with it with benzoin. No more trouble even with soaked shoes for 7 hours coming back down the mountain in the rain. My feet were pruny, but no blisters. They recovered just fine.
I’d say I was lucky, but I really think it was more due to the pre-run foot care with me filing callouses and toenails, Denise’s pre-tape for balls of feet, the Engo pads, and the very, very thin layer of Hydropel I always use between my toes.”
I commend Lisa for a fantastic accomplishment. It was fun for us, watching from the comfort of our homes and offices, to hear updates on Facebook the the ultra forum. Lisa is a good friend and a great runner.
The first and only other solo, self-supported Badwater Solo crossing was done by Marshall Ulrich in 1999. Here’s a link to Marshall’s webpage to read his account. Marshall and Lisa are special people.
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.
Sunday I leave to help at the 135 mile Badwater Ultramarathon that takes runners from Death Valley to the Mt. Whitney Portal. Many of the runners continue on to the summit of Mt. Whitney, another 10 miles—making it a run from the lowest point in the Western Hemisphere (280’ below sea level) U.S. to the highest in the contiguous U.S. Run on the road, the race exposes runners to extreme heat, up to 130F, and possible sandstorms.
My role will be to provide foot care as part of the medical team. Don and Gillian, the owners of ZombieRunner.com will be there too helping with foot care. With the recent heat wave, it is expected to be hot—with predictions of 122F. The pavement can be even hotter!
So how will extreme heat affect the runner’s feet? For some, their shoes may come apart. Some will pour water over themselves in an effort to cool off, and the water will run down into their shoes—in many cases causing blisters to form. Some will blister from the distance, from wearing shoes that become too tight when their feet swell, from the rubbing of the socks or the shoes on their feet, from friction, and from heat.
We will tape feet, apply blister patches, lubricant or powder, file toenails, file calluses, modify shoes to eliminate hot spots and friction, and more. Our arsenal of gear includes Micropore tape, Kinesio tape, self-adhering wrap, tincture of benzoin, alcohol wipes, Body Glide, Hydropel, Gurney Goo, Zeasorb powder, lots of Spenco products (2nd Skin, Blister Pads, QuikStik Pads), 2×2 gauze, scalpels and needles, gloves, nail drills, nail files, callus files, several types of scissors, tweezers, Engo Patches, antimicrobial wipes, and a few other items.
When I get back next weekend, I will give a report on the challenges we faced, and what worked and what didn’t work. These are extreme conditions for feet and it will take a lot to keep them happy. We’ll do our best.