Feet, keeping your wheels turning

“Your feet are your wheels!” – most GORUCK Cadre

Everyone at some point has walked, hiked or ran and ended up with painful, perhaps blistered feet.

Like almost everyone that does ‘endurance’, I started out my event/race ‘career’ blind, worrying more about nutrition and hydration and not enough about my “wheels” (or rather my feet). This is rarely out of arrogance for people, and almost always out of ignorance. Its only when you still have many miles to go and a blister that won’t give up, when you realize how your feet matter more than almost anything else. Over time I have myself developed a bunch of experience and quick fixes that work for me.

Note that some of the stuff I will mention is generic enough, and some might be more specific to me. A great place to get a good understanding of foot care during endurance events is the book Fixing Your Feet. Nothing beats experience but this book will certainly ramp up the learning curve.

My own feet are a weird shape. I have a protruding heel and wide toes. My little toe is too short but too fat, and curls under the toe next to it. Therefore I have had issues with toes being squashed together and rubbing against each other, as well as severe heel blisters on a regular basis.

The three main issues I have found most common with feet and long distance, abnormal racing (wet, muddy, etc) are blisters, maceration, and sprains/fractures.

Blisters

Blisters are caused by a combination of 3 factors: heat, moisture and friction. Even in cold conditions, the movement of your feet along with blood flow can generate enough heat to be an issue. Moisture can come from sweat, or an external source (puddles, rain, or in a GORUCK event doing PT in a lake or ocean). Friction is the biggest factor, though, in my experience. Movement of the skin against a loose fitting shoe, the rubbing of toes together, etc, can all invoke blister producing friction.

Blisters manifest as a bubble of clear serum underneath the surface of the skin and as we all know can be exceedingly painful.

Maceration

Maceration is the softening of skin with prolonged exposure to moisture. If your blister prevention is on point you might still get unavoidable maceration, and personally I find this the most painful problem to deal with. As the skin softens with moisture, it can swell. As you move over terrain (especially ascents and descents) the swelled and softened skin can fold over itself causing pressure points that can be very painful.

If you’ve ever been in bath water too long to the point that your skin has “pruned”, imagine then putting your feet under the stress of a hill climb on that soft skin and you can imagine the effect as that skin distorts.

Sprains/Fractures

These obviously can occur when impacts over time (especially when undertrained) cause stresses on your foots bone structure that can cause significant damage.

Towards the end of this post I will talk a little about my current approaches to preventing and temporarily fixing these issues. Note that where I provide links, it means I recommend the product. In principle of full disclosure some of these are affiliate links but again only to products I’d highly recommend anyway.

My Evolution of Foot Prep

1. Winging it.
   Problem : At first I did what everyone does when they start road or OCR races. I put on whatever pair of socks I owned, the running shoes I thought worked best for me and ran the race. Even for 5k races, I blistered a little bit, but never worried about it much. Its easy to suck it up for a couple of miles. Once the distances went up, so did the chance and severity of blisters. This was exacerbated by shoes that didn’t quite fit. The extra friction from them rubbing up and down my heel almost always have me a heel blister.Solution: get better socks – cotton or poly blends do not cut it. Get better fitting shoes
2. Better Gear
   Problem : Better socks delayed the chance of problems, but they still happened. Better fitting shoes reduced the amount of friction but didn’t eradicate it completely. At this point most of my blister issues came on my toes and the base of my heel.Solution : A layered sock strategy. Thin toe socks underneath good wool socks. The principal here is that movement of the foot and shoe would mostly cause the socks to rub together first removing the amount of friction on the foot.
3. The next level
   Problem : The layered sock problem actually worked really well for me for OCR races, and had I stuck to those I’d probably still be using that strategy. They mostly eradicated the friction problem.
   However, for me the events changed. The switch to GORUCK for example changed the playing field and while friction was reduced the act of moving under weight, as well as having soaking wet feet for a considerable portion of the events totally changed the dynamic. The friction forces changed, and the “moisture” and “heat” parts of blister generation started kicking in.  Even with layered socks, I was starting to get blisters on the ball of my feet and between the toes. Additionally constant wet feet meant I was experiencing maceration for the first time. Ouch.Solution : Tape.
4. Getting serious
   Problem : It was around this time that I was recommended the book I highlighted above. And reading it was a revelation. Here as a tome that told more about feet issues I could even imagine existed. One of the techniques I used was taping the base of my feet and my toes (with Leukotape) and this worked phenomenally well. Ideally you will want to apply a little benzoin to help the tape stick, and then ensure the tape is placed flat on the skin with no overlap or gaps a good few hours before the start of the event. The extra time helps it adhere. The problem is even with something as amazingly adhesive as Leukotape,  longer wet-feet events (GORUCK Heavy, Death Race) mean that eventually this becomes unstuck and then you are back to square one.
   At the end of the day for me the panacea is more around conditioning, prevention, quick remedies and last resort fixes.Solution : Preparation and priorities of work. This leads to my current routine which has worked consistently well for me for the all sorts of events lately.

My Current Routine

“An ounce of prevention is worth a pound of cure” – Ben Franklin

My foot care routine is much more relaxed than it ever used to be and revolves around a few key principles. These revolve more around preventing issues than anything else.

• Conditioning
• Correct equipment
• Preparation
• Constant evaluation and priorities of work
• Fixing problems

Conditioning

The key issue here is that you cannot expect to go into a long arduous wet feet event and have no issues without building up tolerances. Advice that has worked well for me are to head out on ruck marches or runs with already wet feet. Start at short distances, and if you have issues allow your feet to heal before going again. Rinse, lather and repeat increasing distance over time. The more I ruck, race and suffer, the less issues I have over time. Conditioning works – but takes time. Invest that time wisely.

One thing I started doing a couple of years ago that helped tremendously is switching to minimal shoes for everyday wear. I wear Inov-8 F-Lite’s almost daily and their minimal design as done wonders for strengthening my feet.

There are some recommendations out there for a product called Tuf Foot. This was originally designed to toughen up the paws of animals, such as pet dogs, but also has the same application for human feet. The general idea is that this product is applied to feet which, over time, will eventually add a toughened layer of skin. It’s main ingredient is benzoin which has already had applications in foot care (see the Fixing Your Feet book) and has been touted by a number of badass GORUCK Selection finishers. Personally I find that with my own feet the toughened layer that develops has a tendency to soften more quickly when moist, but others have seen more favorable results. For that reason, I still recommend it as something to try.

Equipment

As mentioned blisters are caused and exacerbated by moisture, heat and friction, and maceration by moisture and torsion of the skin. Your choice of equipment should work to reduce these factors as much as possible.

Shoes/boots

Whether you select boots or shoes depends on many factors. For a OCR I will typically go with lightweight trail shoes that fit well. Salomon, Inov-8 and Rebook make great trail shoes. Try on lots of pairs, and find ones that fit and move with your feet without rubbing at all.

For almost anything else that involves less running I will go with military style boots. These have many advantages. The ankle support is useful, but more than that it holds the boot to your foot in a way that allows it to move with your feet rather than against them – vastly reducing friction. Additionally most good military boots vent air in and water out remarkably well. This can allow your feet to dry more quickly over time even compared with traditional trail or OCR shoes. Now my feet tend to hold heat so boots for me retain much of the heat, but the reduction of friction more than compensates. The ability to both vent water, and also the reduction of movement against the foot keeps maceration down.

Another advantage for me is that with wide toes, most boots I have tried have a larger toe box so keep my toes healthy as well.

This is why for GORUCK and Death Race events you will likely see my in a pair of Rocky S2V or C4T boots. Other great boots are Nike SFB and Oakley Assault boots.

Insoles

The insole that comes with most shoes or boots are quite frankly crap. I always replace these in my boots and running shoes. For boots, my favorite is Super Feet. Expensive but worth it. Not only do this add a lot of comfort to the boot, but Super Feet are not absorbent and so help expel water much ore quickly than most standard insoles I have seen (that are almost always highly absorbent)

Socks

I like to have multiple styles of sock with me during a longer event. The biggest reason is that different equipment and clothing will rub and have impact differently and in different locations. I have tried almost every style of sock and my main piece of advice is to spend some money. Its worth it.

Here is a quick review of socks I have tried.

• Injinji. The principle here is that protecting each toe prevents blistering from them rubbing together. That said I find they hold moisture too much and the weave can be abrasive. Additionally if the toes in the sock do not fit perfectly they can fold over and cause more issues than they resolve. For me injinji socks make the blistering on my little toe worst than by simply applying lube to my toes.
• Wright Sock. The principle here is that the double layering reduces friction and therefore blisters. This works for regular running, but again I have found they retain moisture more than better socks and for events like GORUCK and Death Races they absorb and hold onto silt. During GORUCK Selection, I removed my Wrightsock to find they had captured a LOT of sand and dirt that could not be expelled, making friction a problem again.
• Smart Wool/Darn Tough. The principle with these socks is that natural wool fibers keep you well insulated and comfortable. They aren’t designed especially to reduce friction, expel water and therefore don’t protect particularly well against maceration. That said, I tend to blister a little less with these – probably due to the reduced friction of the wool fibers compared with synthetics
  These are amazing socks for a hike or winter wear, but not for an event.
• DryMax. DryMax are weaved in such a way that the layer against the skin is hydrophobic (repels water) and the layer on the outer part of the sock attract water. This pulls sweat and moisture away from the foot, and having worn these socks for over a year can attest to how well they work. They also offer the warmest winter socks I have used, by virtue of their fibers having such low thermal conductivity. These are one of my two favorite brands of sock.
• Prosok. Prosok are joint favorite for me with DryMax but offer some significant advantages that are turning them into my favorites. While they don’t expel moisture as well, they do keep it away from the skin. The weave and fibers additionally cause less friction by far than any other sock I have tried, reducing hotspots significantly.

After the original writing of this article, I performed a stress test comparison of DryMax and Prosok socks.

Preparation

Prior to an event, proper preparation is paramount. For some people this would involve taping clean and dry feet but as mentioned before taping doesn’t help me much these days. So my prep starts with constant exfoliation to keep the hard and callused skin to a minimum. This reduces the chances of maceration considerably. Live skin is affected by moisture much less than dead skin.

With clean, dry skin, I take a small amount of the product Trail Toes product and rub thoroughly into all the skin on the base of my foot taking particular care to get it between my toes and onto my heel (common hotspot areas for me). A thick layer is not needed – just a thin coating. Then I will put on my socks (DryMax or Prosok) and boots and am good to go.

The main idea behind Trail Toes is that it applies a thin lubricating layer that vastly reduces the effect of friction on the foot as well as reducing moisture permeation. There are lots of home remedies with the same intent, but Trail Toes product works more reliably than anything else I have tried.

One note. DryMax recommend their product is used without lube because it affects the transport of moisture through the weave. However for events like GORUCK or Death Race I find it has a more positive than negative effect to use TT.  Prosok have no such restriction as far as I know.

Some events won’t have you fully submersed. Regular hiking or a Death Race for example might have you ankle deep in a stream but not submerged. Sometimes in these circumstances I will wear a waterproof sock over my regular sock. This will likely be my strategy during bloodroot at the Death Race in June. Beware that sweat can develop and give you a puddle of water inside the waterproof sock over time.

Constant Evaluation

During a GORUCK event or other race there will be opportunities to stop and rest. This is where your priorities of work kick in. Your priority should be feet, hydration, food, other stuff.

As feet are the top priority, you need to first take care of any issues you have been feeling along the way. Take off one boot/shoe, and sock. If you have hot spots developing, apply moleskin, duct tape or lubrication. If your feet are excessively wet or starting to become embedded with moisture you will want to apply a thin coating of powder before wiping away excess (because powder will clump and aggravate your foot later). You might want to put on dry socks, but my preference is to thoroughly wring out the sock you are wearing – it will completely dry once you start moving – before replacing and putting on your boot/shoe. At this point you can move to your other foot. The reason to do one foot at a time is in case you suddenly need to get going. If you feel hotspots, maceration, blisters or pain in one specific foot deal with that one first.

Fixing Issues

• Hotspots
  These are the start of a blister and are caused mostly by friction on your foot as you move. You will want at this point to remove the cause of the friction. This will most likely be solvable by using a piece of moleskin or a layer of duct tape (duct tape is great because it sticks well to skin but has low friction on the non-sticky side – reducing the friction effect on your hotspot).
  If you ignore your hotspot it will almost certain blister at some point
• Blister
  You have two choices. Ignore it or drain it. Almost always for me a blister is a constant source of nagging pain and I will almost certainly drain it. For this reason I carry a kit that contains sterile lancing needles. I will pierce the blister in multiple locations (so as not to have it seal back up and remain a problem). If the blister is really bad or it has burst on its own I will often apply some New Skin (amazing product) onto the open wound or inside the blister. Like benzoin this reseals the skin and protects it going forwards.
  Also remember that blister pain is not indicative of damage. If you can suck up the pain you will be unlikely to be permanently injured. So last resort, grab a straw and suck it up 🙂
• Maceration
  This is much harder to deal with. The first thing you need to do is try and get rid of excess moisture on your foot. For this apply plenty of foot powder and then remove all excess to avoid clumping when you continue. If the maceration is mild I might leave it at that, but if its more severe I will probably pull back the folded over skin, apply New Skin underneath and (continuing to pull the skin taut) blow on the New Skin until its dried.  This will seal the developing wound at the fold and reduce the chance of moisture getting in and making the problem worse.
  If the maceration is severe I would probably also use duct tape over it to hold the skin where I want it to reduce the chance of it getting worse.
• Other pain – stress in the skeletal structure
  This could be anything and your options are to quit the event or tape it up and hope it doesn’t get worse. Using duct tape or athletic tape can help keep some of the integrity of your foot and modify the impact on the bones to reduce the chance of making things worse.

My Foot Care Kit

My foot care kit has evolved over time, and is pretty lightweight and thorough. I helped Scott of Trauma1 Kits develop the runners care kit for what I saw as typical needs. Therefore this kit is a staple for any event I do and only costs around $20.

• GORUCK Foot Care Kit ($12.50)
• New Skin ($6)
• Foot Powder ($2-3)
• Duct Tape ($2-3)
• Spare Socks

Summary

Prevention is key. Putting in lots of miles, making your feet stronger and more durable, are the biggest factor to staving off problems during longer races and events. Experimentation is also key. I have developed the fixes above over time for the worst case scenario – when the conditions have put my feet in a position of discomfort or pain.

And again, the preparation and kit I have above works for me and has been developed over time to take into account how my feet react to the events I do. Yours might work better with different techniques so go ahead an experiment.

Please direct all questions, comments and additional advice to the comment section.