Ultra Marathons: Foot Care (Attack of the Blisters!)

Something that I did not mention in our recent article, Lessons from 2013 Gobi March: Preparing for a Multi-Stage Ultra Marathon, but is something that Rich and I feel deserves a fair amount of attention is foot care. When doing any type of running race, your feet are your most important asset. Cracked, swollen, and blistered feet can make your life difficult and very painful. Knowing how to take care of them, though, can significantly reduce the likelihood that you’ll need to pull out of a race, or spend the next few weeks watching your toenails rot and fall out.

I was wonderfully naïve going into the Gobi March as how to properly take care of my feet, and suffered for it. In fact there was one stage in particular when I got back to camp and found 9 blisters forming on my left foot. (I was wondering why it hurt so much too!) Lucky for me though, the race was full of individuals who piled the tips on me as to how to prevent blisters and swelling for future attempts.

Now that I am in training, and have just discovered a blister on my left big toe (Owww!), it is definitely time for me to start implementing these tips. Since different methods work for different people, I will share the bits of wisdom I picked up from my Gobi friends here.

1. Well Fitting Shoes

An obvious one, but people do go wrong here. The problem with wearing your favorite pair of trainers is that when you’re doing a multi-stage Ultra Marathon, your feet will swell. The swelling generally doesn’t occur until about the 2nd or 3rd day, but when you get to that point, your shoes may no longer fit comfortably. With your feet pressed up against the front and sides of your shoes, you can bet that the friction between foot and shoe will increase dramatically, and the blisters will start rising.

Ideally, you would make sure that whatever pair of trainers you race with will have ample room for your toes. What I’ve been told to do here, and something that I happily knew prior to leaving for Gobi, was to buy shoes that are about 2 European sizes larger than what you’d normally wear. This gives you plenty of room to swell into.

Trust me, you’ll want the extra room. I saw more than a few people during Gobi cutting open the sides or the front of their shoes and then duct taping them back together, so as to give their feet more room to breathe. There was also a pretty nasty urban legend going around camp about a Japanese woman who competed in the Atacama Crossing a few years ago. She apparently, not wanting to break her shoes open for fear of allowing more rock and sand to get in, cut off one of her pinky toes.

As a bonus, getting slightly larger shoes will help prevent the loss of toenails! The most common cause of toenail loss is having the nails constantly pressing up against the front or top of your shoe. So, by getting something slightly larger than you’d normally wear, it is much less likely that your toenails will be rubbing against your shoes all too much.

2. Hydrate Responsibly

As another line of defense against swelling, please remain properly hydrated throughout your race. Though you may be guzzling water, by not taking in the correct amount of electrolytes with your water, you significantly up your swollen feet.

Additionally, it is possible to overhydrate. Although I’d rather over hydrate than dehydrate, overhydration or hyponatremia, which occurs when you’ve taken in too much water and not enough salt/electrolytes, can cause muscle weakness and cramps, lethargy, nausea, and vomiting, among other symptoms. Vomiting water is far from as nice as it sounds.

Generally, during a race, individuals will have 2 x 750 mL bottles easily accessible. Many will have one of those bottles as pure water, and the other will contain electrolytes. I tend to prefer to have electrolytes in both bottles. It is up to you to figure out what works for you. Take the time out before the race to find the right water/electrolyte balance for you.

3. Conditioning

This should be an obvious one, but it can’t be overlooked. The idea here is to train and toughen up our feet as much as possible prior to a race. Put as many miles as you can on your feet. It doesn’t matter if you’re running or walking, just as long as you are out there and getting your feet used to the motions.

4. Get Rid of Calluses

This is an iffy one. There are some that believe that having calluses is a sign of your feet’s toughness, and having them would reduce the likelihood of developing blisters. I have heard suggestions such as toughening up your skin by doing daily, 15-minute soaks of your feet in either lemon juice, rubbing alcohol, or surgical spirits.

However, there are plenty of people who would get rid of calluses all together. I would fit into this school of thought. Having seen people who’ve suffered from deep forming blood blisters that the race medics are unwilling to pop, I am pretty wary of calluses. It is very possible to develop blisters under calluses. At that point, what do you do? You might not be able to reach the blister through traditional methods if it’s formed underneath a callus, and at that point, you’ll likely just have to continue on with the race as is, careful not to tread to hard on your blister.

If you’re with me, and want to get rid of your calluses before a race, I’d recommend using salves, creams, lotions, and files to smooth and thin calluses.

5. Toe Socks 

More than once have toe socks been described to me as a godsend. Toe socks help reduce the friction and rubbing of your toes against one another, decreasing the likelihood of getting blisters between toes. Injinji is the brand most often recommended by runners, though they do tend to spread the toes apart, which some people may not enjoy. If you use a different type of toe sock, make sure to choose a pair of moisture-wicking socks and change them when they get full of grit and dirt. If they’re a compression sock as well (to reduce swelling), then all-the-better!

6. Lube Up!

Another way to reduce friction is to rub Vaseline or Diaper Rash Ointment on your feet before putting on your socks during an event. Lubricants help to repel moisture, and damp feet tend to create more friction than dry feet. Additionally, the use of Vaseline makes your feet slicker, also helping to significantly reduce friction. It also won’t wipe or wash off easily, in case you have to do a stream crossing.

If you prefer not to lube up, you can also wrap your feet and/or toes in athletic tape in order to help reduce friction.

7. Use Gaiters

Gaiters are a necessity if you’re going to be running in a location where there is a high chance of getting dirt, rocks, or sand in your trainers. Used primarily as protective equipment, gaiters are worn over the shoe, ankle, and sometimes over the lower leg. As gaiters wrap around the shoe and ankle, they prevent unwanted trail remnants from getting into your shoe, increasing friction and, in turn, blisters.

The difference in blister acquisition, for me, between the stages prior to my accidentally tearing up one of my gaiters during the Gobi March was huge. Prior to the tear, I would get maybe one or two blisters a day. Afterwards, I’d get at least 6 a day.

That said, make sure you’re getting a sturdy pair of gaiters. I had been using a pair of Raidlight gaiters (I believe the pair I was using has since been discontinued), but after having rocked up to the starting line, to my dismay I found that several others had found mine to be quite flimsy… I did manage to acquire some Solomon gaiters thanks to another competitor who had had to drop out of the race at a later stage though, and they were great!

8. Dry Your Feet

Something you can do at the end of a race or a stage to help with blisters that have already formed is to take the time to dry them out. The easiest thing to do when you’re in a Stage race with limited resources is to wash and dry your feet out under the sun, but if you have the ability, soaking your feet in Epson Salts can significantly dry them out.

9. Bring a Foot Care Kit

As is mandatory for 4 Deserts racers, you need to bring a blister kit if you plan on doing multi-stage races.

The items recommended by Racing the Planet, who run the 4 Deserts race series include:

10 x alcohol wipes

 2 x hypodermic needles or safety pins

 1 x roll of paper tape

 1 x roll of elastic tape

 5 x Spenco 2nd Skin or Compeed pads

For a 6-stage race, like the 4 Deserts, in my opinion, this is a minimum supply. About 2-stages into the Gobi March, medics were announcing that they were running out of supplies, thanks in part to the masses of blisters that people were coming in with. If, like me, you’re prone to getting blisters, you’re going to need quite a bit of the above. Things like safety pins, which are used to pop blisters, can be reused, but it’s hard to keep them sanitary if you only have a few alcohol wipes to sterilize them with.

10. Remove Blisters

Although ideally you wouldn’t get any blisters, we need to be realistic. Even if you do everything right, there is still a chance that over the course of a multi-stage race one is going to form.

Blister removal is never a pleasant experience, and though you might not need to know how to do it if you have medics who can do it for you, it is not a bad skill to have in your back pocket. So, here is my little guide to blister management and popping:

If you feel a blister coming on when you’re running a multi-stage race, it’s best to get rid of it sooner rather than later. Plenty of people will tell you that it is best to leave the blister alone, and if you’re going to recover on your couch at home, that’s probably the right idea. However, when you have another run to do the next day, running with a blister is only going to prolong the pain.

So, when you feel a “hot spot” coming on, take a moment, adjust your shoes and/or your socks, depending on where you feel the friction, and keep going. Slight adjustments can be the difference between the hot spot swelling into a blister or it’s cooling down. If you missed the hot spot, and have arrived at camp to find a cluster of blisters, now is the time to pop.

Take out an alcohol wipe, and wipe your hypodermic needle/safety pin, as well as the blister and the skin around it. Use your finger to press against the side of the blister to raise it, and go in sideways at the very edge, opposite of where you’re applying pressure. You’re only after the blister, so to make sure you don’t go too deep with your needle and puncture something else, make sure to direct the needle parallel to your skin. Then, squeeze the blister from the side to get all the fluid out. If there is still fluid left over after squeezing, it is possible that the fluid is trapped between several layers of skin. In this case you’ll have to go in with your needle again. Try to use the original puncture if possible. By only using one hole, you reduce the likelihood that you’re going to rip the blister open. Cover it with a bandage, and you’re done!

Hopefully this is a helpful little guide for you and your feet. I won’t guarantee that it is all going to work for you, as everyone is different. Now, I need to go out for another training run, so it’s time to pop this little bugger on my foot, and figure out what is going on with my trainers.

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