Foot Care in the Extreme!

It’s been a great time here at Tweed Podiatry in sunny mid-April as we celebrate Foot Health Week 2021! And I cannot think of a better way to share good foot health tips than this superb and inspiring piece written by our very own Sports Podiatrist, Holly Lackenby. Here she shares the story of her incredible adventure in the Marathon des Sables, or “MdS”: a six-day, 251 km ultramarathon across the Sahara desert (you read all that correctly). For her debut blog post on the website she has really hit it out the park and I’m certain you’re going to enjoy reading (and no doubt learning a lot from) it as much as we all did. So without further ado, over to Holly:

And we’re off! The start of day 1

This was it. Two years of training and meticulous preparation had got me to this moment. The thrum of the helicopter overhead was drowned out as the first lines of ACDC’s Highway to Hell blared out of the massive speakers flanking the starting line. The 33rd Marathon Des Sables was underway. Everything I needed for the week ahead was in the pack on my back weighing in at 8.9kg. I had to trust that my training and preparation would get me so far and I would just have to take my chances against the searing 50 degree Saharan heat and the one thing every runner dreads...blisters.

Out here the merest of hot spots could quickly deteriorate into debilitating wounds that could easily spell the end of the race. 150 miles of running, walking, shuffling, hobbling over salt planes, sand dunes, navigating our way up and over jebels where the rocks were so sharp they could easily tear through your gaiters would take its toll on our bodies and more importantly our feet. The constant trudging in the heat would also cause our feet to swell, further increasing the chances of hot spots and those dreaded blisters. Again, I would just have to trust that hints and tips I had taken on board from previous competitors would see me through.

Fast forward, (OK more like shuffle forward), to seven days later and I crossed the finish line of one of the toughest races I have completed to date. My feet survived with only a few small blisters. The rest of my legs were a different story. An unforeseen heat reaction, not yet seen by the medics on hand to help, resulted in painful ‘bunches of grape like’ blisters breaking out over my ankles and lower leg. But my feet survived and they have continued to carry me through numerous blister free events since. I approach every event now with the same foot preparation as I did for the desert and, touch wood, I have remained blister free since.

A hockey coach once told me that ‘prior preparation prevents p*ss poor performance’ and nothing holds more true than when preparing and completing endurance events. Here are my desert foot preparation pointers and I hope it can provide some good advice to anyone active out there - whether you are preparing for your first marathon, or climbing your first Munro or tackling your first or tenth endurance event.

Pre-taping some hot spots

·        Pre event prep:

Two weeks leading up to the desert I rubbed Gurney Goo into my feet every night. This ensured my skin stayed nice and supple and allowed the anti-friction elements to build up in the skin. Many people think using surgical spirit to toughen the skin up works best but personally I find that supple skin allows it to move and adapt better to different environments under the feet, and also prevents any painful cracking! I then took a much smaller tube of Gurney Goo, (reduced weight means everything out there in the MdS so less is defiantly more!), into the desert and rubbed it into my feet every night during the race. Other anti-friction ointments are available but Gurney Goo also has the added benefits of containing some antiseptic elements such as tea tree. On that note body glide is an absolute gem of an anti-friction/anti-chafe ointment for other body parts prone to rubbing i.e., shoulders, armpits etc.

Around 15 miles into the long stage (55 miles)

·        Nail and skin care:

Nail and skin care in the month leading up to the race was also important. Nails cut too short could begin to dig in and cause in-grown toe nails as your feet inevitably swell throughout the week. Nails too long and they can become irritated in other ways as your feet swell and the nails hit off the end of shoes or dig into the adjacent toes. Hard skin can also be problematic for endurance participants. To be fair none of us are likely to ever have the prettiest of feet… and now is certainly not the time to try and make them so. Hard skin builds up over areas that require protection and believe me you are going to want every ounce of protection your feet have to offer. That being said, too much hard skin, likely accumulated throughout your hard training, can become pathological. I suggest getting any problematic hard skin removed by your podiatrist no later than one month prior to the event. This allows some degree of protection to build back up without becoming problematic.

Bivouac life

·        Footwear and socks:

Having the right shoes! This one seemed to be a biggie for a lot of MdS participants and it is so easy to get bogged down under the staggering amount of different brand and options available. So I utilise another old hockey coach acronym KISS – Keep It Simple Stupid. Wear whatever you have been training in and what you know works for you. Do not change it up as last minute nerves trick you into thinking you have to have the newest shoes or high tech socks on the block. That way of thinking will certainly spell disaster. That being said, make sure your footwear suits the event you are doing and will hold up during the event. Out in the desert we didn’t have the luxury of taking extra pairs of footwear with us and everyone’s trainers, whether they were road or trail, were all but shredded by the end. Some endurance events allow support crew and many a competitor like to swap between different models of trainer throughout. This allows small alterations in the pressure points and many find the change up keeps the feet feeling a bit more alive. If this is something you are considering, make sure you practice in training!

An extreme heat reaction

·        If a hot spot hits then stop:

Taking all the above into account unfortunately blisters can still occur. During any endurance event as soon as you feel any hot spot occur stop and sort it. Out in the desert even the smallest grain of sand could literally wear holes in your feet – some people have likened it to running repeatedly on sandpaper. We wore gaiters attached via stitched on Velcro to our trainers but it seemed the sand always found a way to get in! Before a blister occurs stop and tape your feet. Check out Rory Coleman’s YouTube video on how to tape your toes - It is brilliant. Spend a bit of time practicing the taping techniques before an event so you know what you’re doing when the time comes. If you know you are prone to blistering then pre-taping hot spots is recommended. Applying tincture of benzoin – more commonly called Friar’s Balsam – to the area of skin requiring taping beforehand helps keep it in place. I taped up my little toes on day two of the desert race and that taped stayed on until I pulled it off at the hotel 6 days later! A lot of our morning desert routine was spending some time prepping and checking our feet and it really did pay off! A lot of our evening routine was spent lying with our feet propped up as best we could to help prevent excessive swelling of the feet and ankles.

Mummified!

·        Stop, pop, drain, clean and tape:

If a blister does occur before you can stop it then it is worthwhile knowing a little first aid to help you sort them out on the go. Ideally speak to a medic of the event as they have sterile needles to cleanly pop and drain the blister. Then clean with antiseptic and tape as above.

Failing the help of a medic pop any big blisters, as cleanly as you possibly can, allow them to drain, clean and tape as above. Small blisters can just be taped over as long as the area is cleaned prior to taping. A first aid kit is usually a must for endurance events so make sure you have some blister prevention bits in your pack. Out in the desert this was a self sufficient race however they did have a medical tent set up at each camp fondly known as Doc Trotters. Here the medics took great pleasure in popping our blisters, with a sterile scalpel of course, and then squirting iodine straight into the blister. I can tell you it hurt like heck but only for a bit and then the blisters would dry up nicely for you to tape over. I vividly recall many a competitor hobbling around camp with bright orangey/red splodges over their feet trying to do anything they could to battle on for another day.

Ridge running on day 3

I hope the above hints and tips prove to be useful; whether you are embarking on your first endurance event or simply tackling a local hill or two so you can enjoy the wonderful outdoors in blister free bliss!

Me and my dad – finishers! What a week!

Holly runs several clinics a week at our Kelso practice treating patients for all manner of foot, ankle and lower limb issues with a special emphasis on running and sport-related injuries. Don’t put up with pain - Holly and the rest of the team are here to help!