Guidance on foot care

A selection of expert advice from the race medics, blister specialists and the race organisers.

INTRODUCTION

If you intend to treat foot problems as they arise at Cape Wrath Ultra®, you have already chosen the wrong strategy! After all, feet are the most important part of your kit.

We know from the 2016 and 2018 editions of Cape Wrath Ultra® that 31% and 22% of participants respectively 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.

On both occasions, 38% of participants sought repeat treatment on at least one occasion, some many more times! This is likely a large underestimation of the true ‘blister effect’, as many people were offered advice on appropriate blister self care and therefore this was not recorded. Blisters account for a large burden of work for the race medical team.

The triage system

Much like you would see at an Accident and Emergency hospital, there will be a triage system if you visit the medical tent for assistance AND we 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 how long the others may have already queued for.

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 (this is part of the mandatory kit list for the event) and the consumables from each competitor’s personal blister treatment kit will be used to treat them with.

So, we are expecting you to help us during the event by looking after yourselves first and foremost, but you are not on your own.

There will be approximately 300 participants, and you’ll be sharing tents with a number of others. We encourage 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!

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

• John Vonhof’s “Fixing your Feet” (buy it here)

• Anna Beetham’s “Oxfam Trailwalker”

• Rebecca Rushton’s “Blister Prevention”

• BMC article by Dr Suzy Stokes “Friction Blisters: Prevention and Treatment”

We thoroughly recommend that you read John Vonhof’s book and watch the videos (below). Then practice – a lot.

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 (you are responsible for this)

• Prevents = prevention of blisters before and during the race (you are responsible for this)

• Piss Poor Performance = treatment during and afterwards (we will help with this)

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. A urea-based footcream will help to soften hard skin.

• 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 (Engo patches, double socks etc).

• 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 potentially wet terrain! Shoes should drain rapidly to help dry your feet. If you wish to use waterproof 'footwear', then we recommend waterproof socks rather than shoes, but it is important to remember that these can also fill with water and cause the same problem as waterproof shoes.

Tip

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

Prevents (pre-race and during race)

• Use your practiced taping method. Use a skin adherent. Save time by bringing enough pre-cut tape for the week.

• Use lubricants with caution on your feet. Do only what you know has worked in your training. If lubricants are used, we recommend PJur Active 2Skin. We also recommend Trench.

• 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.

Piss-Poor Performance

This is what happens if you don’t follow the other Ps! We insist that competitors take primary responsibility for their own foot care but our medics are available to offer advice or treatment as required. If you do develop a blister, the first questions to consider are: How bad is it? Can I treat it myself? Do I need medical advice or treatment?

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 treatment 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 a non-adhesive island dressing (NOT a ‘Compeed’ type dressings). 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 fluid from the blister.

Blister treatment 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 scalpel 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 a non-adhesive island dressing (NOT a ‘Compeed’ type 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 treatment 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 a non-adhesive island dressing (NOT a Compeed type 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.

Tip

Why do we 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 a multi-day event and 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 treatment 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 or Inodine dressing

3. Apply an island dressing

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 competitor or the medical team when treating a runner’s blister. A blister treatment kit must include the following:

• Sterile scalpel blade (size #11) x5

• Steropore sterile island dressings (6x7cm) x5

• Sterile cotton swabs (5x5cm) x10

• Inadine dressings (9.5x9.5cm) x2

• Clinell 2% chlorhexidine disinfection wipes x5

Participants are welcome to source these supplies themselves or alternatively they can purchase a pre-made kit through our shop.

The mandatory kit also includes:

• Kinesiology tape (5cm x 5m) x1

• Small scissors x1

These items are not included in our blister treatment kit. We strongly recommend that kinesiology tape is cut to length before the event as this is time-consuming and frustrating when tired.

SHARPS

Scalpels are extremely sharp! Participants should take great care when using them not to damage themselves, other competitors or the tent. Scalpels can be carefully re-packed into their protective foil wrappers once used. We are able to safely dispose of medical waste including 'sharps'.

FINAL WORD

The medics are not just foot care attendants. If you have any other medical problems, please ask and they will be happy to help you out.

Good luck. Practice lots.