The Adelaide 6 Day / 48 Hour Ultramarathon 2014
This event was the first 6-Day ultramarathon in Australia since 2006. Here are a few specifics of the event:
The surface was a 1.13km asphalt surface loop.
The track varied from flat to having a significant camber. Runners changed direction every 24hrs.
There were a small number of competitors: thirteen 6-Day competitors and seven 48-Hour competitors.
This was my first ultramarathon experience. I did not run! I provided foot care from 8am - 1pm each day. The following are my observations of the race.
Six Ultramarathon Observations In Six Days
1) There's a large variation in structural and functional characteristics
Many ultrarunners are far from biomechanically perfect (yet look at what they're capable of)! A few very obvious things that caught my eye were:
asymmetries in arm swing, leg length and foot size
significant spinal problems
tight calf muscles
marked (dare I say it) overpronation
"It’s a gait that is at a speed almost immediately above the walk/run transition and there is NO flight phase (which is part of the definition of typical “running”); it is more of a bouncy gait; it is a gait used by slower runners; it is possibly a more economical gait solution at the walk-run transition speed." Craig Payne (2014)
There was a broad range of running shoes in this race. Hokas were popular! But there were still plenty of ’standard’ running shoes in use. There was not a lot in the way of minimalist footwear (and there were no Vibrams 5 fingers in case anyone was wondering). Some runners brought 6 or more pairs of shoes while others wore the same pair all race. One runner was wearing a pair of shoes that were 10 years old!
And there were varying levels of preparedness and support. From two crew members who did shifts over the 6 days; to being totally self-supporting; to a spur of the moment decision and calling the wife 60kms into the race to tell her where he’ll be for the next 2 days!
2) Shin pain was common
The main structure seemed to be tibialis anterior (muscle belly and/or tendon). Runners blamed the hard running surface. So I posted the question on Podiatry Arena to find out the exact mechanism and this was confirmed - tibialis anterior has to work harder eccentrically when running on a hard surface. Differential diagnoses include: muscle trigger points, delayed onset muscle soreness (DOMS), anterior compartment syndrome, stress fracture, tendinosis and medial tibial stress syndrome.
Here’s a bit more information about the tibialis anterior trigger point.
This explains the reasoning behind the cold spray in the spray and stretch technique I used in Adelaide. Essentially, the cold spray is used to stimulate receptors in the skin which has an effect of distracting the trigger point activity allowing the muscle to relax more to stretch.
This is the paper on delayed onset muscle soreness referenced on Podiatry Arena - it's worth a read.
3) Toe blisters were common
There were quite a few blisters under the ball of the foot; but many more toe blisters! Strategies in use included taping (Fixomul, Rocktape, Compeed), toesocks, silicone gel toe covers and shoe modifications (see observation 4). Of their type, the two most common toe blisters were:
4) Cutting away the toebox was popular
I was surprised how common this practice was! There were varying degrees of mutilation: from cutting only the little toe area; to the top of the toebox; to the whole toebox entirely! The main reason was to relieve pressure on the toes - particularly the little toe. But also for the toes from the end of the shoe.
What was the cause of this pressure? Here are some possibilities:
Swelling made the shoes too small (in width and/or length)?
Other things made the shoes too small (in width and/or length) such as toesocks and toe taping?
The shoes were too small (in width and/or length) to start with?
The foot slid forward due to the hard surface, making the toes hit the end of the shoe?
The foot slid forward due to the laces being too loose?
Is cutting the shoe open a good solution for this pressure problem? The consensus was it worked perfectly. But what if this was a trail race? Or what if the asphalt surface had a bit more loose rubble on it? Surely it wouldn't have been an option.
Is there a better solution? Do ultrarunners need to have a pair of shoes 1-2 (or more) sizes larger than usual for the latter stages of multiday races? Are multiday ultrarunners not purchasing shoes adequately wide in the toebox? Are appropriately wide shoes not readily available (in Australia)?
5) Many ultrarunners like their laces loose
I would say too loose. To the point of being a contributing factor to blisters (toenail blisters, toe blisters and blisters under the ball of the foot). I need to find out more about the reason(s) behind this as it must be significant enough for runners to ignore common sense.
Is it a time-saving factor – leave them loose to save time loosening them later when the feet swell?
Is it because after a while, it's difficult to bend down far enough or stay there long enough to firm up the laces sufficiently?
Do particular lacing systems make it difficult to get the laces firm enough?
Is it to relieve pain at the top of the foot? Is this worse when the tongue of the shoe is thin or with skinny speed laces?
Is it to increase ventilation in the shoe when it was hot?
Is it to stop irritation at the back of the heel?
Or is it something else?
Have a look at lacing of the photos above. What do you think about how firm they are?
The next time you get toe blisters or black toenails, have a look at the firmness of your lacing; is it keeping your heel right to the very back of the shoe? If not, firm them up. Use the last eyelet (the holes your laces go through) - we almost always neglect this one and yet it can make a big difference. Or try this lacing technique. Then let me know if it helped or not ... please, I'm curious to know if this is as relevant to the ultrarunning community as it is for the general running community!
6) Friction reduction worked better for easing soreness under the ball of the foot compared to cushioning
Several ultrarunners complained of soreness under the ball of the foot. Clinical judgement generally saw me apply either 3mm Poron (cushioning) under the insole, or an ENGO rectangle patch (friction management) on top of the insole, or both. Two things surprised me:
The non-tolerance to the cushioning. Not only did it not help, it tended to make things worse. This could have been because many shoes had substantial cushioning build into their structure already (think Hokas). Or it could have made the shoe too tight due to the additional bulk.
The success of the ENGO patch.
There were occasions when I assumed cushioning would be the best intervention and yet friction management performed better. There was one runner who didn’t like the lack of traction with the ENGO, and this is understandable because it has the potential to reduce traction across the metatarsal heads too much. For this reason, I usually advise caution with full width friction management across the forefoot, preferring a smaller oval patch. But the amount of relief this provided, without consequence, surprised me. I’ll exercise a little less restraint in using this in the future.
Running around a track (rather than running from A to B) proved an excellent race format as my first ultramarathon foot care experience. It facilitated the preventative / early intervention approach I'm interested in. And by getting feedback every 1.13kms, it allowed me to experiment and have the opportunity to change unsuccessful interventions very quickly. It was a great format for learning.
I'm not sure what the runners thought of running around the same track for 6 days though!
I get the feeling that as long as they're running, they're happy.
Written by Rebecca Rushton
Rebecca is an Australian podiatrist with over 20 years experience. She has spent a lifetime dealing with her own blister prone feet in her sporting and everyday life. Rebecca specialises in helping athletes and sports medicine professionals figure out how to manage foot blisters with ease. And for kicks, she enjoys providing blister care at multiday ultramarathon events.
Rebecca is the founder of Blister Prevention and author of "The Blister Prone Athlete's Guide To Preventing Foot Blisters".
Resources for Ultrarunners (Blisters and the ANZAC Ultra)