Introduction

If you intend to treat foot problems as they arise at any multi-day race you may well have already chosen the wrong strategy!  If you haven’t started, then start your foot-care preparation now. After all, feet are the most important part of your kit.

This article was first published via the Cape Wrath Ultra

Experience from the 2015 Berghaus Dragon’s Back Race™ has shown us that 38% of the competitors had medical treatment for blisters, and that blisters were the reason many participants failed to complete the full course or had to retire from the event altogether. This statistic is also reflected in many other multi-day races such as Marathon des Sables, The Coastal Challenge or the Everest Trail Race for example. If you haven’t already read the 2015 Berghaus Dragon’s Back Race™ Medical Report (HERE), then we strongly suggest you do, and pay particular attention to the Race Director’s comments at the end.

These are:

After some consideration and discussion with the medical team we are going to introduce a triage system…, much like you would see at an Accident and Emergency hospital and insist that competitors take primary responsibility for their own foot care. This will mean:

1. Patients will be assessed in a triage system prior to treatment with the most needy being treated first, regardless of the how long others may have already queued.
2. We will not assess anyone’s feet unless they have been washed and are presented in a clean, mud free condition.
3. We will expect minor blisters to be treated by competitors themselves.
4. At triage assessment advice will be given as to whether a blister is ‘minor’ and how to treat it if required.
5. Competitors must have their own blister treatment kit and this is part of the mandatory kit list for the event.

Of course, many races offer varied systems of foot care while racing. Marathon des Sables has very much lead the way with the innovative ‘Doc Trotters’ foot team. However, listen to any experienced racer and they always say:

‘I like to look after my own feet. Autonomy is best. I can treat my feet as I require and I don’t need to wait in a long line for my turn when I cn be resting, eating, drinking or sleeping!’

 The Cape Wrath Ultra™ have been very clear ahead of the 2016 race in providing a FAQ which can be read HERE

Scroll down to the ‘Support and Services’ section:

9) What medical facilities will be available?
There will be a medical support team for participants at the Overnight Camp and a medic can be summoned to Checkpoints. However, the Cape Wrath Ultra™ has a strong self-reliance theme and participants will be expected to look after themselves and must bring a personal first aid kit for self-treating blisters, minor injuries and ailments, for cleaning wounds and for addressing most kinesiology issues. The Medical Team will prioritise and work on more serious incidents and ailments, but advise on minor issues. Our experience from the Berghaus Dragon’s Back Race™ (HERE) is that the Medical team can get swamped with minor issues if not managed. Having said this, participants are encouraged to talk to the Staff & Medical Team if they have a concern about their personal well-being. The event will generally be a long way from any Hospital. 

It’s sound advice – be autonomous!

The Cape Wrath Ultra are expecting you to help them during the event by looking after yourself first and foremost but you are not on your own. There will be approximately 150 participants and you’ll be sharing tents with a number of others and the races encourages a buddy system to look after each other, not only on the hill, but in the camp too. So don’t be afraid to get down and dirty, and help each other look after your feet!

This theme is reflected at other events that I have worked on, Marathon des Sables for example creates networks of people as 8 runners share a bivouac. It can often be all for one and one for all.

Ourea Events have unashamedly based this summary advice on three sources. These people are experts at foot care for multi-day events:

• John Vonhof’s “Fixing your Feet” and buy it Here
• Anna Beetham’s “Oxfam Trailwalker”
• Rebecca Rushton’s “Blister Prevention”

There are references (with links) at the end of this section, and we thoroughly recommend that you read John Vonhof’s book. Then practice – a lot.

Everyone is unique and the advice here is for information purposes

Blister Prevention

Foot care is easily divided into several phases. We are sure you all know the 6Ps: ‘Proper Preparation Prevents Piss-Poor Performance’. Well, you should be thinking of this too!

• Proper Preparation = foot care in the months before the race
• Prevents = prevention of blisters before and during the race
• Piss Poor Performance = treatment during and afterwards

Blister Prevention – Before the Race

Proper Preparation (months before the event)

• Get rid of calluses, keep nails short*. Get rid of rough patches. Visit a chiropodist for proper advice and pedicure.
• Keep the skin soft and supple with massages and skin-care creams. Some people recommend creams with shea butter.
• Practice prevention.  Learn preventative taping: you know your own problem areas. Try alternative socks, shoes, strategies such as foot lubricants, powder and blister plasters. Consider friction reduction of the shoe.
• We do not recommend vaseline, gels or similar products on your feet. Vaseline in particular is sticky, attracts grit and hardens in your socks.
• We do not recommend waterproof shoes: They will fill with water and keep your feet wet. You will be running for eight days in wet terrain! Shoes should drain rapidly to help dry your feet.

* At all the Ourea Events expedition races a participant has had to withdraw because poorly maintained toe nails have caused blistering to adjacent toes. Don’t be a statistic… nails should be neatly trimmed about 5 days before the event.

Blister Prevention – During the Race

Prevents (pre-race and during race)

• Use your practiced taping method. Use a skin adherent.
• Use lubricants with caution on your feet. Do only what you know has worked in your training. If lubricants are used, Ourea reccommend Body Glide – Here.
• Use good moisture-wicking socks and shoes that you are familiar with.
• During the race change socks, clean and dry feet, reapply tapes, powder or gels as necessary. You should always do this immediately after finishing to give your feet the longest possible time to recover overnight.
• Stop and treat hot-spots immediately.
• At the end of each day pamper your feet: wash and dry them, massage them, keep them warm, keep your feet up whenever you can.
• Remember there is no single method to be recommended. What works for you is the correct method.

Blister Assessment

Piss-Poor Performance
This is what happens if you don’t follow the other Ps! We insist that participants take primary responsibility for thier own footcare but Ourea medics are available to offer advice or treatment as required. A similar scenario exists at Marathon des Sables with Doc Trotters, The Coastal Challenge with Duggie Duggan and many other multi-day races will adopt a similar strategy of foot care. If you do develop a blister, the first questions to consider are:

1. How bad is it?
2. Can I treat it myself?
3. Do I need medical advice or treatment?

A and B © Berghaus Dragon’s Back Race™ Competitor. C © Jim Mann (not his feet though!)

• A: This foot has a blood blister and two small (intact) blisters. Whilst these will make running uncomfortable, these are not ‘bad’ blisters and particpants would be expected to treat these themselves at Ourea events.
• B: This is certainly a painful blister but good quality self care (cleaning, padding, taping) allowed this participant to continue. Don’t worry about asking for treatment advice from the medics.
• C: These blisters show signs of infection and required hospital treatment (they were sufficiently painful that the participant needed crutches to walk). Infected blisters are dangerous, look out for signs of infection – these include:
  • worsening pain
  • feels hot in the area
  • swelling and redness around the blister,
  • pus coming from the wound (yellow/green discharge not the normal clear yellow fluid)
• D: Macerated feet (see picture below) are extremely sore and prone to infection. Macerated feet occur when the skin is saturated for long periods of time and this leads to the overhydrated skin becoming soft and easily damaged. Unlikely at Marathon des Sables, possible at The Coastal Challenge and a distinct possibility at any UK race… This condition in particular is a signifigant hazard at the Cape Wrath Ultra™ due to the wet nature of the Scottish Highland terrain.

© Berghaus Dragon’s Back Race™ Competitor

Blistered and macerated feet are treatable but only by withdrawal from the event. REMEMBER: Prevention is better than cure.

Blister Treatment

DIY blister care is simple with a general aim of reducing pressure friction at the blister site.

Blister Treament when the skin remains intact AND the blister does NOT require lancing:
This treatment protocol would be the same for a ‘hot spot’.

1. Ensure your hands and feet are clean.
2. Apply an non adhesive island dressing. Ensure that the blister is covered by the non adhesive part of the dressing.
3. Tape to secure the dressing in place.
4. Monitor for signs of infection and reapply dressing if it becomes soaked with fuild from the blister.

Blister Treament when the skin remains intact AND the blister requires lancing:
A blister only requires lancing once it has become swollen with fluid.

1. Ensure your hands and feet are clean.
2. Lance the blister using a sterile scapel blade. Lance in multiple sites to aid fluid removal.
3. Gently massage the excess fluid under the blister out through the holes.
4. Apply antiseptic such as Betadine.
5. Apply an non adhesive island dressing. Ensure that the blister is covered by the non adhesive part of the dressing.
6. Tape to secure the dressing in place.
7. Monitor for signs of infection and reapply dressing once it has become soaked with fluid from the blister.

Blister Treament when the skin is broken:
When the ‘roof’ of skin over the blister site has partially torn.

1. Ensure your hands and feet are clean.
2. Apply antiseptic such as Betadine
3. Apply an non adhesive island dressing. Ensure that the blister is covered by the non adhesive part of the dressing.
4. Tape to secure the dressing in place.
5. Monitor for signs of infection and reapply dressing once it has become soaked with fluid from the blister.

We do not recommend using Compeed or other ‘sticky blister plasters’ on blisters when the skin remains intact or whilst some skin remains on the blister site, this is because of the multi-day nature of the event. These types of plasters tend to stick to the blistering skin surface (the ‘roof’ of the blister) and tear it away when the blisters are assessed and/or re-dressed causing further damage.

Blister Treament when the skin has been removed :
This type of blister is known as ‘de-roofed’.

1. Ensure your hands and feet are clean.
2. Apply antiseptic such as Betadine
3. Apply a hydrocolloid dressing (such as Compeed)
4. Tape to secure the dressing in place.
5. Monitor for signs of infection and reapply only once the dressing has naturally become soaked and peeled away (usually a few days).

Blister Treatment Kit

A Blister Treatment Kit is mandatory equipment for the Cape Wrath Ultra™. This MUST contain the following items that can be used by the participant or the medical team when treating a participant’s blister. The Blister Treatment Kit must include the following:

• Sterile Medical Scalpel Blade (size #11) x5
• Antiseptic Ointment (such as Betadine) 30ml
• Sterile Non Adhesive Island Dressings (7cm x 6cm) x5
• Sterile Cotton Swabs x10
• Hydrocolloid Dressings (such as Compeed) x5
• Profoot Moleskin Roll (7cm x 45cm) x1

Participants are welcome to source these supplies themselves or alternatively they can purchase a premade kit direct from us for £20 + p&p HERE

Mandatory kit at Ourea events also includes:

• Kinesiology Tape (5cm x 5m) x1
• Small Scissors x1

We strongly recommend that kinesiology tape is cut to length before the event as this is time-consuming and frustrating when tired.

Please note that a foot care medical kit is personal, find out what you need and what works for you!

All the above content is ©capewraithultra/ ©oureaevents

It is reproduced with permission.

Why not take part in our 2017 Multi-Day Training Camp which takes place in January each year? Details are available HERE

Foot care treatment is very personal and Elisabet Barnes, 2015 Marathon des Sables champion has some excellent ‘on-hand’ experience of how to look after feet from experience.

Many essential foot care items can be sourced HERE

Ourea Events HERE

Cape Wrath Ultra HERE

Disclaimer: We are all individuals and the information provided in this article is designed to provide information so that you can go away and ascertain what is the best foot care method for you and your own individual needs.