Happy Feet, Happy Trails
Essential Ultramarathon Foot Care
Ali Upton, Nurse
“‘I was poorly prepared when I did the 100km Thames Path challenge in 2019. I hadn’t allowed for foot swelling and so ended up walking the last 18km wearing all the socks from my bag and no shoes!’”
I learnt the hard way, as a fair few participants do – I researched and changed my footwear, socks and learnt to pre tape. Some participants learn to research and change things, others just crack on and end up with the same results event after event.
As we all know, blisters on events are typically caused by friction, heat, and moisture. When walking long distances with ill-fitting shoes or socks, repeated rubbing of the foot against the shoe or sock can create the friction. Sweaty or moist feet will exacerbate the friction and increase the likelihood of blisters forming, creating pressure points within the shoe will also contribute to blister formation.
Education in looking after your feet is key; identifying and taping areas that are prone to blisters prior to events (including training and challenge day) is something that can be done whilst treating the blisters that have already formed. It may also be beneficial to pad areas prior to starting your ultra challenge and using the correct padding is key to preventing any unintended consequential injuries.
The use of kinesthetic tape (KT) tape is preferable as it is designed to mimic the elasticity of skin, this means that tape does not encourage further resistance or friction. KT tape is made of cotton and the acrylic adhesive is activated by body heat.
Approximately 95% of the participants that TrailMed interact with on ultra challenges are feet related and predominantly concern blisters. It is therefore important that if you want a happy trail experience that you try to prevent and treat blisters in a way that will not add to the formation of further blisters.
Steps for footcare
If there is existing wet KT tape in place this will need to be carefully removed if it hasn’t already found itself rucked up in a clump or fallen off - fresh KT tape will not adhere to wet tape!
Clean the surface to be treated - this can be achieved by two ways, either antiseptic wipes or filling a spray bottle with water and applying a small amount to a piece of gauze squares to wipe the surface of the skin, ensuring that you dry thoroughly afterwards with the paper towel.
If there are no visible blisters, but areas on the feet are painful, these are usually termed ‘hotspots’ and are often where blisters are likely to occur. Applying KT tape to these areas, ensuring that the ‘corners’ are cut to a curved shape (this is important as it can help prevent the tape rucking up) will help to create a barrier and reduce friction between the foot and the sock.
Dealing with blisters
Unless you have finished your event, these need to be drained with a sterile needle, this prevents them from rupturing in your sock and introducing sweat, fluff and other contamination which may increase the amount of time it takes your body to heal. When lancing a blister a minimum of two holes should be used to try and prevent the blister refilling - all TrailMed Medical Team stations have needles, sharps bins and staff who can assist participants with this on events.
If you hold the needle in the fluid part of the blister the blister fluid will drain down the hub of the needle onto the gauze
Gently ‘milk’ any remaining fluid from the blister
If you come across a blister where the roof is rucked up, it is important to try and ensure it is as flat as possible.
Covering
To provide padding, I recommend absorbent padding (5x5 pad squares are a good size to carry in a running vest or walking bag) and cutting the pad to the size that you need is key. Making sure that you round the corners of the pad and then applying them flat to the surface of the foot to be covered.
These can then be secured in place by KT tape.
Ensure the piece of KT tape is big enough to ensure there is an adhered border to cover the pad.
Why use 5x5 absorbent padding?
Medical-grade absorbent pads are designed for wound care. These pads are often made of materials that are more suitable for prolonged contact with the skin, and they are specifically engineered to absorb moisture while providing cushioning and protection. These pads are breathable, moisture-wicking, and have a low-profile design to minimize bulkiness and discomfort.
What not to use, and why!
Final thoughts…
Blisters are not inevitable in ultramarathon, they’re common, but they’re not inevitable
Remember that proper sock choice is also crucial for blister prevention. Opt for moisture-wicking socks that minimize friction and provide extra support. If possible avoid cotton socks, as they tend to retain moisture and increase the risk of blisters. Additionally, consider footwear with an open toe box to give your toes more room and reduce pressure on the front of your feet.
Finally the team at TrailMed are always available to support you on events to ensure that even if we can’t influence a happy trail then we can help you towards happier feet!
