Happy feet

One thing I always notice when I start training for a Marathon is that my feet have to go through a phase of toughening up. Even if I have been running regularly, the relentless onslaught of longer, harder and more densely packed workouts means one thing... Blisters.

The first thing is, obviously, to make sure that you are running with shoes that don't normally lead to blisters and with a reasonably good running technique. As you know, I am a follower of the minimalist running movement and precisely because minimalist shoes are so unforgiving, you quickly learn to run with as little force in any other direction than that necessary to overcome gravity: this reduces blisters from the feet sliding around in the shoe. Or, said the other way round, as minimalist shoes are not designed to restrict your feet like a kind of "crutch", they tend to be much more spacious, like the Run Amoc shoes I run with.

Having said that, from a sudden increase in activity, blisters are bound to appear on the toes and directly under the ball of the foot from the skin stretching and rubbing against the sole of the shoe as your foot "dorsiflexes" (a fancy way of saying that the toes bend upwards). I find treating blisters is a bit of a fine art.

Any blisters that do not support your weight while you run can be just left to their own devices to heal. That milky liquid inside them (appropriately called "serum") is full of natural goodness to speed up healing and acts as a cushion in the meantime. If the blister is open, then being left to dry out is just as effective. If you have to put a plaster on an open blister then putting just any kind of plaster can interfere with the healing process, not allowing the blister to dry out and form a scab. This is where those magic plasters by Compeed come into play - they trap the serum and therefore speed up the healing acting like a second skin, as if the blister had not burst in the first place. The idea is to leave the plaster on as long as possible or until the blister has completely healed.

The art comes into play when you have to bear weight on the blisters - in other words, if you can't wait for them to heal naturally before returning to training or competition. If they are closed, then it can be very painful to put weight on them because the serum adds to the pressure on already tender skin. The other issue is that, left to their own devices, the old outer skin dries up and cracks exposing a virgin skin beneath which is not really yet up to the rigours of vigourous running, so the whole cycle is likely to repeat itself.

In my experience, the trick is to lance the blisters as soon as they emerge so that the outer layer of skin is largely conserved and becomes thicker. On the other hand you don't want too much dead skin to build up on your feet. Firstly, this makes your feet less sensitive and is a bit like wearing thicker soled shoes: if you'd wanted to wear thicker soled shoes you wouldn't be running in minimalist shoes... Secondly, I have found that the islands of dead skin can move around while you run, causing further blisters and irritation in the joins between dead skin and live skin. The question is: how much to remove? Sometimes you start picking at a bit and a massive chunk comes off - if you are lucky you manage not to take any live skin off into the bargain and the new skin you reveal below is sufficiently mature by now to withstand your running demands. If you are unlucky then you are in the situation described in the next paragraph. The ideal thing is to try to avoid to this by lancing blisters as soon as possible and by regularly filing off "waffer thin" layers of dead skin from the soles of your feet and toes. I use one of those Ped Egg gadgets for this purpose and I keep a penknife handy for emergency lancing of blisters immediately after running.

Doubles as a cheese grater

The worst case are open blisters on the soles of your feet or toes. This is where Compeed comes in to save the day, but there is little you can do to avoid the cycle repeating itself once the new skin has come through (except build up your training more slowly). You can only hope that you catch the blister in time before it bursts the next time...

I read in Haile Gebrselassie's biography that he once jeopardized a 10K race by lancing blisters the night before which then became infected. I must say (while touching wood), that this has never happened to me and i never bother to use a sterilized implement to puncture the blisters nor do I usually put any disinfectant. That is not to say that neither of those two things would be a good idea.