Could these 8 tips make you a better ultrarunner?
The ANZAC Ultra 2015 was the brainchild of Australian ultra identity, race director Phil Essam. It consisted of a 75km part road / part trail loop. Runners completed either 1, 2, 4 or 6 laps over as many days. The first two days saw freezing temperatures, record rainfall and snow on nearby mountains. This made for a particularly challenging event for the 6-day runners with issues from foot maceration to hypothermia.
Naturally, this article focuses on feet and blisters. With a particular focus on what steps ultrarunners can take to maximise their performance (and enjoyment) of a mulitday ultramarathon.
1. There’s always a first time for blisters
First time on my big toe. First time on that foot. First time ever! This continues to come as a surprise to runners. It shouldn't.
2. Get yourself a blister kit
Get a blister kit together. One that not only gives you the power to treat blisters - but also the power to prevent them! Don’t have the time to source all the items you’ll need? Get one of mine (below). Prefer to DIY? No problem - take a look at what’s in these and source the individual items yourself.
Perfect for bushwalking, day trips and your sports bag. The Advanced Blister Kit provides medical-grade blister protection in the form of cushions, padding, patches, plasters, dressings, antiseptic and more. Take the pain out of your foot blisters immediately, help them heal faster, and prevent them from ever coming back with advanced blister prevention and treatment gear.
2 x sterile hydrocolloid dressings (6.9cm x 4.4cm)
1 x adhesive felt sheet (9cm x 11cm)
2 x sterile Scalpel blades (size 15)
2 x ENGO large oval patches
1 x Silicone gel toe sleeve (narrow)
1 x Silicone gel toe sleeve (wide)
2 x Povidone iodine (Betadine) swabs
2 x Gloves (medium)
½ metre Fixomull tape (5cm width)
2 x sterile Cutiplast dressings (7cm x 5cm)
2 x Skin Prep adhesive enhancer swabs
Easy-to-follow instructions included
The Complete Foot Blister Prevention & Treatment Kit
Perfect For Trekking, Multi-Day Hikes, Expeditions, Ultramarathon Running, Endurance Sport, Remote Locations & Extreme Climates.
IMMEDIATE PAIN RELIEF & FASTER HEALING – Blister pads, cushions, dressings, plasters, tapes, protection and more.
PROTECTION FOR EVERY BLISTER - 60+ medical grade components for every blister - heel to arch to toe.
EXTREME CLIMATES, REMOTE LOCATIONS - Top-rated gear an an emphasis on sterile for your protection.
EASY-TO-FOLLOW INSTRUCTIONS - Peace of mind you're providing the best level of foot blister care.
DIMENSIONS - 15cm x 20cm x 5cm and 248g. The soft cover bag is compressible to take up minimum space.
6 x Cutiplast island dressings 7cm x 5cm (sterile)
6 x Joint island dressings (sterile)
12 x "Finger" island dressings (sterile)
2 x Hydrocolloid dressing 6.9cm x 4.4cm (sterile)
2 x Hydrocolloid dressings 6.5cm x 2.5cm (sterile) *new*
2 x Hydrocolloid dressings 6.5cm x 2cm (sterile) *new*
2 x Small Oval Patches (3.8cm x 5.1cm)
4 x Large Oval Patches (4.4cm x 7cm)
1m Fixomull 5cm width
6 x Betadine swabs
2 x Skin Prep wipes
2 x 5 Cotton tip applicators (sterile)
2 x 5 Cotton wool balls or gauze (sterile)
2 x Scalpel blades size 15 (sterile)
2 x Hypodermic needles 23G (sterile)
2 x Gloves (medium/large)
1 x Emery board
1 x Orthopedic felt sheet 15cm x 11cm x 5mm thick
1 x Poron/PPT sheet 15cm x 13 cm x 2mm thick
1 x Gel toe sleeve - wide
1 x Gel toe sleeve - narrow
1 x Gel toe cap - narrow
1 x 2Toms BlisterShield powder *new*
For more details on how to use each item, see this article.
3. And don’t be afraid to use it
It’s no good having a blister kit if you don’t know how to use what's in it. Watch the videos below to see how I do things and what I do it with.
4. Don’t put Compeed on an intact blister – this is what can happen
In this painfully good example, a Compeed was put on an intact blister (that’s a no-no; only use on deroofed blisters). The Compeed peeled back a bit and stuck to the sock like glue. And as the runner took his socks off, it ripped the blister roof right back (I watched this happen, it was not pretty).
This provided us with a torn blister. But this blister roof was not worth saving - the flappy torn blister roof was glued to Compeed and I couldn’t separate the two! I cut the rest of the roof off and flushed the dirt out with saline (sterile salty water). We were left with a deroofed blister.
Ironically, this now-deroofed blister needs a hydrocolloid dressing on it. A raw weepy blister base like this is exactly the type of wound hydrocolloids are meant for [minus the dirt … you do not want to use hydrocolloids if your blister is infected, so we flushed the area with saline and applied antiseptic]. To learn more about which blister dressing suits which type of blister, watch the How To Treat Foot Blisters video above.
[Note: Compeed is a well-known blister product around most of the world. But it is not available in the USA. A comparable product is “Band Aid Advanced Healing Adhesive Bandages”. There are also other brands of hydrocolloid dressings. For example, I’ve used a lot of Comfeel and Duoderm as they are available in larger sizes. These products are usually sold as ulcer dressings and may be available from your pharmacy. I also have my own brand of hydrocolloid dressings: BlisterPod Hydrocolloid Blister Plasters].
An Alternative To Compeed
Promote Rapid Skin Healing With 10 Sterile Individually-Packaged Blister Plasters In 3 Convenient Shapes (Large: 6.9cm x 4.4cm, Medium: 6.5cm x 2.5cm, Small: 6.5cm x 2cm)
3 Pack Options:
LARGE: 10 x Large plasters
SMALL: 10 x Small plasters
MIXED: 4 x Large plasters, 4 x Small plasters, 2 x Medium plasters
HOW THEY WORK: Hydrocolloid blister plasters are an exudate-absorbent hydrophilic gel dressing. They have a rubbery texture and are slightly translucent. As your raw blister base weeps, the plaster absorbs this moisture and forms a gel, turning a white colour. This shows that your blister is healing. Contrary to popular belief, this moist environment is the perfect environment for rapid skin healing - strong resilient skin will form instead of a dry, irritating, brittle scab. They ensure your skin heals and returns to full strength faster so you can return to full pain-free activity sooner.
AVOID SCABS: Scabs are not healed skin. They are simply a dry lump of wound goo that hides a raw sore underneath. Scabs are easily dislodged and they delay skin healing. Your blister can take twice as long to heal if it scabs over, so don’t leave it “open to the air” to dry out.
ONE PLASTER CAN LAST ALL WEEK: Change your plaster when the white gel reaches an edge of the plaster. This may take up to a week. It’s absolutely fine to leave the same plaster on for a whole week. In fact, it’s advisable – as long as it’s not too weepy and the edges haven’t loosened.
MAXIMUM DURABILITY: BlisterPod Hydrocolloid Blister Plasters are designed for athletes. They exhibit bevelled edges, good adhesion, a moderate amount of stretch, are 100% waterproof and provide cushioning and protection from further rubbing for up to a week. However, what other hydrocolloid brands won’t tell you that the edges of any hydrocolloid blister plaster can catch on footwear and stick to socks, even after applying it as best you can. It is advisable to secure the edges of hydrocolloid plasters with a thin flexible tape like Fixomull Stretch, especially when used for foot blisters. This will ensure a long-lasting seal even in the most extreme endurance athletic situations and challenging environmental conditions.
DON’T MAKE YOUR BLISTER WORSE: Hydrocolloid blister dressings work their magic on raw weepy wounds only - like ulcers and deroofed blisters.
Do not use plasters on intact blisters or torn blisters. Not only is this a waste of a plaster, you can actually make your blister worse, because when you remove the plaster, it will be stuck to your blister roof and rip it off! Watch the video below.
Do not expect hydrocolloid blister plasters to prevent blisters either. In spite of what other hydrocolloid brands recommend, this often does not work. It’s a waste of a plaster and a misuse of the hydrocolloid material technology.
A WORD ABOUT COMPEED: BlisterPod Hydrocolloid Blister Plasters are sterile and individually packaged. Combined with being waterproof, they are exactly what you need to ensure your blister doesn’t get infected. Do not use unwrapped non-sterile plasters (like Compeed) on your raw weepy blisters. They are not sterile and infection through the broken skin barrier is possible. BlisterPod Hydrocolloid Blister Plasters bring you the convenience of Compeed’s 3 plaster shapes, with the assurance of being free from infection-causing germs.
STERILE, HYPOALLERGENIC & LATEX FREE 100%: BlisterPod Hydrocolloid Blister Plasters won’t irritate your skin, no matter how long it stays on for.
5. Beware of edge blisters at the heel
Edge blisters at the heel were common among ultra runners at this event. This is what they look like.
The irritation comes from the insole where it curves up and meets the side of the shoe. When there’s a lot of blister fluid, it gets squeezed upwards so it looks like the side of the heel is the problem area. The best way to prevent and treat these blisters is with Engo patches to reduce friction levels. These work even better than donut pads (donut pads are always uncomfortable on this part of the foot). Learn about edge blisters and how to apply Engo patches with this video. Below that is an Engo 4-Pack which contains 4 large oval patches. Using a special application technique for these edge blisters, the 4-Pack will cover you for 2 edge blisters (that’s one pair of shoes if you have one edge blister on each foot).
These oval-shaped ENGO Patches provide versatility for any blister situation. The shape makes them easy to apply to any area of the shoe and the size provides perfect coverage for most blisters. Most commonly used for blisters under the ball of the foot, top of the toes and edge blisters.
4 x Large Oval Patches (4.4cm x 7cm) in each pack
6. And keep your focus on prevention
Blisters are not inevitable in ultrarunning. They’re common, but they’re not inevitable.
Let me help you!
If you really think you’ve tried everything, email me. I’m serious. Tell me where you get your blisters. Send photos if you’ve got any. And tell me what you’ve tried.
7. One thing leads to another
I can give you two examples of this that I saw at this race.
A seemingly insignificant roll of the ankle, even if it doesn’t hurt much at the time, can cause you to change your running technique. Sometimes without you even realising. Rolling your ankle (inversion ankle [subtalar] sprain) can tweak the lateral ankle ligaments. This makes the peroneal muscles work harder to limit the motion that aggravates the injured ligaments. And things can go downhill from there.
Blisters can form in the days after the race. There were two runners that finished the event a day early but stayed at the venue. Both saw me the following day for post-race blister care. And both had formed new blisters at the styloid process (the bony lump half way along the outside of the foot) - an odd spot for a running blister. Neither blister was there at the end of their race 24 hours before. So this was unexpected. Although neither runner had spent much time on their feet in that 24 hours, there was a lot of side to side sway when they were walking - due to their aches, pains and stiffness (the post-ultra waddle). I assume this very stiff and guarded gait was the cause of these blisters.
8. Watch out for infected blisters
Pus indicates infection. Compared to normal blister fluid which is thin and clear, pus is yellow. This one was on the tip of the second toe under a callus. The runner didn’t feel it as being sore (mind you, everything’s sore after you’ve run 450kms in 6 days). I discovered it while treating a different blister that was bothering him. The toe was not red, there was no cellulitis or lymphangitis. To the untrained eye, it looked like a callus with a small blister underneath it. But to someone who deals with feet a lot, the look and feel of the callus indicated there was underlying infection.
Do you know what the signs of infection are and what to do?
It was an absolute pleasure to be involved in this race. And a big thank you to the runners who let me take photos (and videos) of their feet!
Got feedback? I welcome your comments.
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".