Training With Wet Feet
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
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
“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
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.
Foot Care Advice from Denise
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
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
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
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 
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.
Tips to Control Moisture and Cold
As your skin becomes wet it softens and is 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. This is what has happened when you take off your socks and find your feet look like prunes. The skin is tender, and can fold over on itself, separating, and creating problems. As layers of skin separate, blisters spread and the skin can split open and bleed, and the skin becomes whitish in color It is very hard to patch feet when this happened. Feet become so tender that every step is painful.
Consider the following pointers when planning any event where moisture and cold can be an issue.
• Wear socks that are have moisture-wicking capabilities. Socks made of 100% cotton should be avoided. Choose synthetic fabrics like Coolmax or Olefin or a blend of materials. Smartwool socks, make from wool, are good in wet conditions. Whatever socks you wear, change them frequently and dry the old socks.
• Foot powders that absorb moisture can help keep your feet dry. Put small containers of powder into your drop bags and in your pack. Reapply powder when you change your socks. Zeasorb or Odor-Eaters both make a good moisture-absorbing powder that does not cake up into clumps. Wipe off the old powder and grit before applying new.
• Wearing shoes that do not have adequate draining capabilities will subject your feet to extended periods of moisture. Use a heated nail 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.
• Consider wearing waterproof socks. SealSkinz Waterproof MVT socks from Dupont are made without irritating seams and have a vapor-permeable membrane sandwiched between an outer layer of nylon and an inner layer of Coolmax. Their weak point is their Lycra cuff that can let in water. Another option is the Seirus Neo-Sock or Stormsock made from four-way stretch neoprene with breathable macro-porous technology to prevent moisture buildup while sealing in body heat.
• When resting or sleeping, take off your wet shoes and socks to allow your feet to breathe.
Keep Your Feet Dry
Summer is officially here—and many involved in walking, running, hiking, adventure racing, doing a triathlon, or any other sport where shoes and socks are worn, will have damp or wet feet.
I am urging you to go to your sock drawer and throw out any socks that are not moisture wicking—or at least put them aside for the summer. Usually these are cotton. Visit your friendly 
outdoor store, running store, or camping store, and get a few pairs of synthetic blend or wool socks which will take the moisture away from your skin and move it to the outside of your socks. Wet feet, from perspiration or water (from any source), will make your feet more prone to blisters. Dry feet, on the other hand, have less friction, and therefore, are less prone to blisters.
If you find your feet are getting hot spots or blisters, this is the first thing I would check. Of course, humidity can also contribute to dampness. Socks will only help so much. Your feet will be somewhat clammy, but, you want to avoid overly damp and wet feet. Damp and wet socks that hold moisture against the skin will lead to skin problems and blisters – so do yourself a favor and wear moisture wicking socks. Almost every quality store carries several brands of these socks now days. You should have no trouble finding them.
Circulation