Seven days, 113 foot care episodes (95% blister-related), and the Australian 6-Day Ultramarathon Festival 2024 is done.
What an event! Records were broken, PBs achieved, a few DNFs, a little bit of gastro, kiwis complaining about a few flies, 2 ambulances, and to finish it off, some wild weather in the last hour keeping Medic Molly busy.
The winning male (Blaine Bourke, QLD) ran 855.615km while the winning female (Nikki Wynd, VIC) covered 646.185km. But this event is about so much more than who “wins”. It is a week-full of determination, personal goals, pain, mental ups and downs, silliness and giggles, feel-good vibes, comradery, fabulous volunteers, and a whole lot of food!
Below are some stats from my records of the race, for my own record keeping and analysis more than anything.
Number of Competitors
- 6-Day event: 19F / 20M (Total 39)
- 72-Hour event: 2F / 1M (Total 3)
- 48-Hour event: 1F / 2M (Total 3)
- 24-Hour event: 6F / 6M (Total 12)
- TOTAL ALL EVENTS: 28F / 29M (Total 57)
Number of Podiatry Treatment Episodes
- Day 1 (1pm – 5pm): 7
- Day 2 (9am – 5pm): 26
- Day 3 (9am – 5pm): 16
- Day 4 (9am – 5pm): 18
- Day 5 (9am – 5pm): 19
- Day 6 (9am – 5pm): 24
- Day 7 (8am - 9am): 3
- TOTAL: 113 treatment episodes
Reasons for Podiatry Consultation
- 95% blister-related
- 5% other injuries/symptoms included:
- Tibialis anterior muscle DOMS
- Tibialis anterior tendon tendinopathy including insertional
- Achilles tendinopathy
- Plantarfasciopathy
- General plantar forefoot soreness
Who Was Seen For Podiatry
- 6-Day event: 15 of 19F / 14 of 20M (Total 29 of 39)
- 72-Hour event: 1 of 2F / 1 of 1M (Total 2 of 3)
- 48-Hour event: 1 of 1F / 2 of 2M (Total 3 of 3)
- 24-Hour event: 2 of 6F / 0 of 6M (Total 2 of 12)
- TOTAL ALL EVENTS: 28F / 29M (Total 36 of 57 ie: 63%)
Treatment Episodes Per Competitor
- 8 visits: 2 competitors
- 7 visits: 1 competitor
- 6 visits: 3 competitors
- 5 visits: 5 competitors
- 4 visits: 2 competitors
- 3 visits: 3 competitors
- 2 visits: 10 competitors
- 1 visit: 10 competitors
- 0 visits: 19 competitors
Most Common Blister Locations
- Heel edge (medial, lateral and posterior)
- 5th toe blisters, including pinch blisters, lateral toe blisters and toenail blisters
Blister Stages
• Only one deroofed blister (interdigital)
• Approx 25% torn blisters
• Approx 75% intact blisters
Most Common Products Used
- ENGO Blister Patches
- Betadine
- Joint dressings
- Primapore island dressings
- Scalpel blades for lancing
- Gel toe protectors
Other
- 4 cases of inappropriate use of Compeed/hydrocolloids (as a prevention)
- 2 cases of blisters in spite of the Compeed (unsurprisingly)
- 1 case leading to tearing of blister roof upon removal (unsurprisingly)
If you are surprised at my comments above regarding the use of Compeed and hydrocolloids in general, watch the video on this page.
Discussion
Maceration
There were a couple of cases of moderate-severe maceration of blistered areas, more severe than expected for an almost dry (minimal rain – until the last hour) race. Essentially, island dressings became wet and remained soggy and in place for too long before being changed. Showers were available 24/7 at this event, where in previous years that I had attended, they were only available for one day. I could be wrong but it is possible showers were had and dressings not changed at that point, which of course, they should be. Or it could have come from water tipped over heads, or simply excessively sweaty feet on a hot day. To prevent infection, island dressings should be changed just before strike-through, which is likely to be at least 4 times per day. This would be considered absolutely impractical by competitors, but it clearly increases risk of maceration. Maceration just makes everything look ten times worse than it is. It can really look like new blistering when in fact it isn't, to an extent that continues to surprise me. I remember a really severe case of this at the Anzac Ultra about 8 or 9 years ago. I could have sworn there was a huge blister, but no matter how many times and how deep I lanced it, no fluid was expelled. It's just waterlogged tissue that swells to many times its original thickness to look like blistering.
Tibialis Anterior
Tibialis anterior delayed onset muscle soreness (DOMS) and tendinopathy (including insertional) continues to dominate the musculoskeletal symptoms suffered. The hard unrelenting surface underfoot creates a rapid ankle joint plantarflexion moment at heel strike, which is decelerated by tibialis anterior. To minimize this issue, runners and walkers, especially those who spend most of their training on trail or grassed surfaces, should train on hard surfaces. They could also consider seeing a podiatrist, physio or exercise physiologist for eccentric exercises to increase this muscle’s ability to handle these forces.
Creepers Toesocks
The numbers of competitors in Creepers toesocks, as opposed to Injinji toesocks, was startling. I had heard of the brand but didn’t realise it was so popular among ultrarunners. The main difference between the two brands is that Injinji uses synthetic moisture-wicking materials almost exclusively. Creepers on the other hand have a high merino wool content. Discussions with competitors revealed the Creepers are more comfortable and feel like they deal with moisture better.
Long Thick Toenails
Thick or long toenails were not uncommon. And a few factored in some subungual blisters (blisters under the toenail). While a trip to the podiatrist is a worthwhile investment before this event, if you want to skip the podiatrist, take a look at our toenail clippers (they are an exceptional clipper, which is something coming from a podiatrist who has been cutting toenails every day for the last 30 years) and the Kredioo nail drill (this will help you thin down your nails so they are less likely to be a cuasative factor in any blisters under toenails).
Loose Laces
There was a warm day a few days in and swelling was becoming a comort issue for competitors. So there was a lot of loosening of laces. This coincided with a run of blisters under and around the toenails. Loosening a little is fine, but you've got to stop your foot from sliding forward and your toes hitting the end of the shoe. That middle ground is a fine line, but it's achievable with some readjusting and some consciousness for where the toes are relative to the end of the toebox.
Blister Preparedness
It continues to disappoint me that competitors suffer with blisters, completely unnecessarily. There is an obvious lack of awareness that blisters are completely preventable, and lack of preparedness of many. On the other hand, there were some competitors who were very well prepared, had their preventions in place before they started, and tended to their own feet. This was fantastic to see!
But what struck me at this year’s event was quite a few people had taken at least one step to being prepared, but hadn’t actually implemented anything, or to an adequate level. For example:
- Some people had ENGO Patches and Gel Toe Protectors, but didn’t have them in place, only to get the blisters these products could have easily prevented.
- Some people had enrolled in my courses or read my blister articles around specific blister locations and how preventions work, but not actually acted on the advice.
A Gym Membership Doesn’t Get You In Shape
If you decide to go to the gym to get in shape, the first step is to buy the gym membership. It’s an important step, but on its own its not enough. You can poke your head in the door and see what equipment they’ve got. It’s another step in the right direction, but it’s not enough either. To get in shape, you’re going to have to dive in and start using the equipment. You need to find out which equipment you need to use to have the desired effect, and how to use it. Then, you have actually use it.
It’s the same with blister prevention. It’s not enough to read about blisters. It’s not enough to take a gander at all the different blister gear available. And it’s not enough to buy some blister gear. You have to actually take it out of its packaging and implement it.
By the way, you don’t have to be a podiatrist to be an expert at preventing and treating blisters. You can learn to become the master of your own blister destiny. If you need a hand, here are some resources for you to check out:
- The Blister Prevention website – use the learning hub
- Fix My Foot Blisters Fast course – my BEST resource helping you find the advice relevant to YOUR blisters, fast.
- Telehealth consultation with me – Either get this on its own, or get it free when you enroll in Fix My Foot Blisters Fast (reach out if you haven’t used yours yet)!
The Magic of the Blister Medic
When I’m treating blisters, it feels like competitors and lookers-on thinking I have magic powers. While I’d like to take the credit, there is nothing special about lancing a blister, putting a fancy bandaid on it. But there is something that seems to set me apart from others. Find out what that is and how you can harness it for your own blister-free benefit.
A Final Treat
During about the 4th hour of the race, while legs were still relatively fresh, I took some videos of your feet as you passed by, just to see the various running, walking and grounded-running gaits, especially for stride length (relevant to tibialis anterior DOMS and tendinopathy) and strike patterns. I thought you might appreciate me sharing these with you. Sorry if I didn't catch your feet!
PS: Please don't forget to read this as I have a favour to ask.
