Kalahari Augrabies Extreme Marathon
Footcare for Adventure Racing by Lisa de Speville
You've put in weeks of training and preparation ensuring that your legs will hold up to hour after hour on the bike and trekking up hills. You've worked your upper body, ensuring that you'll have the strength for climbing, rope ascents and paddling. But now, 3hrs into the race, you've developed a niggling blister on your little toe and heel. By the end of the day you've got blisters on both feet and the one on your heel has popped and is raw. By the middle of the second day your feet are so blistered and so sore that you can hardly walk... you're really not enjoying this race. Familiar?
The adage holds true - adventure races are won on foot. As Gerard Fusil, the father of adventure racing says, "Fast cars need good tires".
Finding what works for your feet is a trial and error process. People will give you suggestions, but what works for them may not work for you.

Blisters form when the 'glue' (basement membrane) connecting your outer skin layer (epidermis) and the underlying layer (dermis) becomes unstuck and the space between these layers becomes filled with fluid. The following are four 'glue-dissolving' elements we regularly encounter:

  • Heat causes a thermal reaction which breaks down the 'glue'. Heat buildup is caused by ineffective sock materials, hot ground surfaces, non-vented shoes and friction.
  • Cold temperatures initiate a physiological response that reduces blood flow to the extremities (yes, your feet), making the skin more fragile.
  • Moisture is absorbed by the skin making it soft and tender. The skin will be more likely to stick to your socks, rubbing inside your shoes. Sweat can build up as a result of non-wicking socks and non-vented shoes and obviously walking through streams, snow and dew-covered grass will wet your socks and shoes.
  • Friction is caused when two surfaces rub against each other - between feet and socks or socks and shoes. It is also caused when your shoes are too tight, your socks bunch up or when dirt gets into your shoes.
A precursor to a blister is a hot spot, an area that has become red and sore as a result of rubbing. With continued rubbing, the glue connecting the outer (epidermis) and inner (dermis) layers of skin is broken down and the sac inbetween fills with lymph fluid. And, as the outer layer is cut off from oxygen and nutrients it becomes dead skin. If the blister bursts, the sensitive dermal layer will be exposed.

BASIC FOOT CARE KIT (carried in your backpack)

  • Small container of foot powder
  • Alcohol swabs
  • 2.5ml syringe and a few needles
  • Tube or sachet of lubricant
  • Friar's Balsam & gauze
  • Tape, plasters and blister patches
Treating and protecting a hot spot is your first line of defence and if caught early it will not develop into a blister. As lubricants will only provide only temporary relief the hot spot must be covered with tape to protect it against further rubbing. It is important to determine the cause of the rubbing and eliminate it. Then clean your feet, change your socks, powder your feet and continue racing.
But, if you do develop a blister, treat it as soon as possible, draining the fluid-filled sac. The easiest method is to use a small syringe and needle. If you can't do it yourself, ask a team mate to do it for you - it really doesn't hurt. If you've only got a needle, prick a few holes in the blister-roof and use finger pressure to drain the fluid. Even if you've only got a small developing blister, drain it as soon as possible and keep up the maintenance throughout the race.
When you've drained it, patch it. There are a number of tapes and plasters available. Green Cross and Scholl make special blister patches - even those donut-shaped corn plasters will work well. If you apply a little Friar's Balsam to the skin around the blister the plaster will adhere better. Avoid getting it into the blister, or any open cuts, as it will sting like hell. Don't get the sticky part of the plaster on the blister as it will create friction and will rip the roof off your blister when removed later.

In extreme cases Friar's Balsam or methyolate can be injected into the blister. This is INCREDIBLY painful. Forget about a red-hot poker, it's like having a white-hot poker held against your foot. The method is to use a syringe (without needle or you'll end up with the needle in your heel) to inject the chosen solution into a drained blister, immediately applying pressure to make the blister's roof adhere to the base skin. Ask one team mate to do the injecting while another holds your leg still. A brave few are able to do this themselves.

I tried this once, on day 2 at the Augrabies Extreme last year - and howled in pain. I only put up with it for one blister and retreated to drain the others myself. This proved to be the best and most successful treatment. I kept my feet clean, FB'd and powdered my feet and drained the troublesome blisters regularly. By te end of the 3rd day there was a vast improvement and by day 5 my feet were in better condition that anyone else's and the blisters had healed giving me no trouble.

Super glue and many other creative methods have been used by racers to get them through races... But, by this stage if your pre-race preparations and during-race maintenance have failed you, then go for it.
You and your team have to understand the benefit of taking a few minutes early on to deal with hot spots and minor blisters before they develop into a serious problem. If you push on not wanting to hold up your team, remember that within a few hours you, or a team mate, will be in pain, will travel even slower and ultimately may not be able to complete the race.
OLD WIVES TALE?
Apply a mixture of tea tree oil and vitamin-e oil (3/4 tea tree + 1/4 Vitamin E) every time before you run, to the places where you are prone to getting blisters...

Handy Foot Care Tips...
  • SOCKS, socks, socks... you can never have enough. Try different types of socks of various thicknesses and fabrics (remember that thicker socks = hotter feet = sweaty feet = moist skin = blisters). Choose moisture-wicking fabrics with seamless toes over an all-cotton sock. Try a two-layer system - a thin sock under a thicker sock will offer an inner layer that moves against the outer layer, reducing the rubbing against your skin. Some people swear by pantyhose socks under their regular socks as the pantyhose almost acts as an outer layer of skin over which the sock can easily slide without friction.  While racing, change your socks regularly always keeping an extra pair in your pack.
  • Spending TIME on your feet will condition them to the stresses and distances of adventure racing. Another way to toughen the skin is to walk around barefoot as much as possible on rough surfaces.
  • My favourite, GAITERS. They go over your socks and the top of you shoe preventing grass seeds, sand, stones, sticks and grit from getting into your socks and shoes. These irritants cause friction, which causes blisters - so the cleaner you can keep your socks and the inside of your shoes the better. Make sure that they fit correctly i.e. not too tight on your skin and that they stay around the top of your shoe. Make your own adjustments if necessary (Velcro, safety pins). I always remove the strap that is meant to go under the shoe arch. They're available as anklets or knee length gaiters. The knee lengths are handy when bashing through scratchy vegetation that is likely to shred your shins.
  • Like a well-oiled machine, LUBRICATE your feet. Reapply lubricants (look for silicone based lubes; nappy cream, Sports lube, KY Jelly) frequently making certain that you clean off the old layer before applying. And, make certain that your feet are clean and dry. Dirt will irritate the skin, making a hot spot and later a painful blister. Remember that lubricants have a softening effect and could make your skin tender and more prone to blistering.
  • If lubricants don't work for you, then POWDERS may be the answer. They help to reduce friction between your feet and socks by absorbing moisture. Dry skin is more resistant to blister formation than soft, moist skin. Powers can cake in the presence of moisture (this includes sweat), causing blisters so dust your feet in the powder and don't go overboard. (Johnson's Baby Powder or even corn flour)
  • SKIN TOUGHENERS work by coating the feet for protection and drying the skin. The most commonly used is a tincture of benzoin, known as FRIAR'S BALSAM in South Africa. METHOLATED SPIRITS also works well by really drying out your skin.
  • TAPING your feet is also an option. But, your skin could react to the tape/ plaster, blistering within hours. Even before the race starts, place small pieces of moleskin over 'hot-spot' zones where you would normally blister. It's thin and smooth, providing a little cushioning and more importantly it will not irritate neighbouring skin.
  • The GOLDEN RULE when taping your toes is that if you tape one, you must tape them all. The plaster/tape is certain to irritate and create friction on the neighbouring digits creating blisters on all your little piggies.
  • Trim your TOE NAILS to avoid toe blisters. Cut them straight across and file them so the front edges are smooth and will not catch on your socks.
  • Keep well HYDRATED to reduce swelling of the feet. When you are fluid and electrolyte deficient your skin will more easily rub and fold over itself causing blisters.
  • Take off your shoes and socks to AIR your feet whenever you rest so that they dry out and ELEVATE them above the level of your heart to reduce swelling.
  • TRAIN with the socks and shoes you are going to use on race day and run with your pack at an approximate weight to what you will be carrying in an event so that you are not subjecting your feet to new stresses at the race.
LISA'S SKIN TOUGHENING RECIPE

Friar's Balsam (FB) is my favourite and over the past year I've perfected my foot preparation with great success. FB is readily available from pharmacies. Make yourself a 'Foot Care' box. In it you will need:

·  A bottle of FB

·  Decent piece of gauze for application

·  Baby powder

·  Pumice stone

Bath before you go to bed, giving your feet a good scrub. Tend to your feet with the pumice stone rubbing down callouses and hard skin layers. Using your piece of gauze, apply the FB, focusing on hot-spot areas where you commonly blister i.e. heel, inside of the big toe and the soft skin between your little toes. Then lie on your bed for 10 minutes while the FB dries. Don't walk around 'cos you'll stick to the floor. When the 10mins are up, dust your feet with baby power and go to sleep. I prefer to do this at night because if I treat my feet in the morning, even though I powder my feet, they will end up sticking to my shoes during the day.

I find that it works to start preparing your feet about 3 weeks before a big event, treating them 3 - 4 times a week. You don't want to start too early because you'll build up a layer of dry skin which could flake off by the time the race comes around - particularly on your heels and main pad. FB does turn your feet brown. This can be remedied by soaking your feet for 10mins in metholated spirits, which is also a good skin toughener. Do this once or twice a week.

FB stings if it gets into blisters, helps plasters and tape to adhere to your skin and provides an antiseptic coating that prevents cuts and blisters from becoming infected.