John Vonhof 5 th Edition FEET * People Who Push the Limits of Their Feet — Runners, Walkers, Hikers, Adventure Racers, Climbers, Soldiers, Dancers injury prevention and treatments for ATHLETES* FIXING YOUR WILDERNESS PRESS I have had the distinct pleasure of seeing John Vonhof work with endurance ath- letes before, during, and after some of the world’s toughest foot races, and I can say with great confidence that no one knows feet better than John. Based on years of research and experience, he has compiled the ultimate guide on foot care for athletes. Fixing Your Feet contains practical treatments of foot problems and reveals tried-and-true secrets about how to prevent them. Whether you are a recreational hiker, an adventure racer, or an elite ultramarathon runner, this book has the answers you’ve been looking for. —Lisa Bliss, MD, Medical Director of the “World’s Toughest Foot Race,” the Badwater Ultramarathon John Vonhof has more practical experience fixing feet than anyone I know. At the Badwater Ultramarathon he helps participants by working on blister preven- tion and repairing feet, enabling them to endure exposure to heat, friction, and moisture (the main causes of blisters). John is the expert, has the experience, and is the go-to guy for feet. Fixing Your Feet is comprehensive and complete; it is a must-read for foot care. —Marshall Ulrich adventure racer and seven summiter who has crossed Death Valley 22 times; author of Running on Empty If you are an extreme athlete, you need this book. It’s confession time. As a veteran of more than 80 marathons as well as ultramarathons up to 100 miles, and being a podiatrist for 18 years, I thought I knew it all. John’s comprehensive approach of asking the so-called medical experts as well as the real experts out in the trenches for their tried-and-true advice will bring you more value for your endurance event than a podiatry degree ever will. —Bill Johncock, DPM Fellow, American Academy of Sports Medicine Board Certified, American Board of Podiatric Surgery Just about everything I have learned and passed on about working on endurance athletes’ and soldiers’ feet I have learned from watching John completely and patiently repair blistered feet that I would have considered candidates for amputa- tion. I am truly in awe of what John does with bad feet. The shame is that his reservoir of knowledge is so comprehensive that had his patients listened to him ahead of time on prevention, they would likely not have needed his services. There is no one alive today, in my experience, who has the knowledge and experience on how to prevent and—if you didn’t listen the first time—fix endurance athlete foot problems than John. I cheerfully and humbly doff my hat to him. —Anthony C. “Woofie” Humpage, CSCS, FMS USA Triathlon Certified Coach Badwater Ultramarathon medical team Developer of SELECTED! a program for U.S. Army Special Forces I consider Fixing Your Feet a must-have for every sports podiatrist! It is an invalu- able resource. —Rob Conenello, DPM Global Clinical Advisor, Special Olympics Honorary Police Surgeon, New York Police Department Vice President, American Academy of Podiatric Sports Medicine When a foot problem arises, this book’s clear, concise explanations and fixes are wonderful. The book is comprehensive; every relevant topic is addressed. If you run ultras and you have at least one foot, you should have Fixing Your Feet —Karl King president of SUCCEED Sportsdrink, LLC, and inventor of S! Caps Fixing Your Feet is the go-to foot care reference for the endurance athlete, period. Don’t prepare for your next event without it. —Tim Jantz, DPM podiatrist and ultrarunner; www.foot-doc.net If there’s one thing that can turn an ultrarun or adventure race into a nightmare experience, it is sore and injured feet. Blistering and other foot ailments are not a “luck,” or lack thereof, situation. Prerace care and conditioning, maintenance during a race, and the knowledge of how to deal with issues as they arise are crucial. Vonhof is the undisputed foot guru. His advice is sound and simple, and it comes as much from his own experience as his time spent at hundreds of races, working with thou- sands of athletes. Fixing Your Feet guides you through caring for and maintaining your feet. Although he teaches you how to patch blisters and deal with a variety of foot ailments, his objective is to have you running pain free from start to finish. He promotes prevention. And the recipe is easy. Read Fixing Your Feet. Do. Run. —Lisa de Speville, adventure racer, ultrarunner, and editor of www.ar.co.za, South Africa’s adventure racing website I began using John’s techniques from a photocopied handout at my very first expedition race and it was a godsend. As soon as I got home, I ordered the book and it became my bible. John and I became friends when we met at Primal Quest and I consider him my mentor. I highly recommend Fixing Your Feet to anyone who puts their feet through adverse conditions. You will wonder how you ever raced without it! —Maddalena Acconci, also known as M. A. Emergency Medical Responder/Advanced Wilderness First Responder Medical Coordinator, Frontier Adventure Racing, Canada In preparing for the 2009 four-day, 120-mile Nijmegen March in Holland, I had issues with shoe fit, blisters, toenail problems, and much more. While searching for answers, I found Fixing Your Feet and even e-mailed John. I was put on the right path, corrected all the errors in my training, and learned foot care—enabling me to cross the finish line and win my medal. —William Hunter 93rd Nijmegen Marches, Medal reward #1, 50 x 4 kilometers www.trainingforthenijmegenmarch.com I have always had issues with blisters, particularly on long mountain runs. Since reading Fixing Your Feet and implementing John’s techniques, I have not had any blister issues. This includes long runs in the mountains and pacing at Badwater for four years, including one double crossing and one starting at Las Vegas. For those with foot issues, this book is the solution to your foot problems. —Scott Morgan ultrarunner, endurance athlete, climber, and coach for www.sealfit.com Thank you for your amazing ability to give the runners such superb foot care and to educate while doing it. Your vast and incomparable knowledge of foot care for athletes in Fixing Your Feet is, without a doubt, the best in the entire world! I marvel always when I get the chance to work with you, as each time I come away learning more yet craving more. With your medical background and amazing focus and memory, each runner gets the unique opportunity to learn about his individual needs while you expertly patch and care for those sore feet. —Denise Jones, Badwater Blister Queen I can’t praise Fixing Your Feet enough. It’s written for us, the walkers and hikers and runners who need advice on what to do before and after we stress our feet. —Wendy Bumgardner About.com Guide to Walking, walking.about.com This is it—the best book ever written on foot care. Everyone who has been bothered by foot problems or wants to prevent them should own this book. —Bill Trolan, MD, author of the Blister Fighter Guide and medical consultant to adventure racing teams I reference Fixing Your Feet often when consulting with customers about their foot troubles. There simply is no replacement for the amount of relevant content introduced in Fixing Your Feet . The product recommendations are unbiased and based on experience with real athletes. Fixing Your Feet is a must-read for serious runners, hikers, and team sports athletes. —Jason Pawelsky, Tamarack Habilitation Technologies, ENGO Patches; www.goengo.com Last week I successfully completed the Racing the Planet: Australia 2010, 250K race. It is the first time that I have completed a race of this distance, and having read your book really helped make the race a truly enjoyable experience. Of the 185 starting competitors, only 118 completed the race, and most competitors had a lot of problems with blisters from the first day. I truly believe that if I had not read Fixing Your Feet three months prior to the event, I would have been exactly in the same position. Instead I managed to complete the week with feet in great condition—and not a single blister. —Nathan Wilson, ultrarunner, Australia As a walker, runner, hiker, and podiatrist, I have found Fixing Your Feet full of essential information for athletes at all levels. Anyone with a foot problem would benefit from this book. An absolute must for runners, adventure racers, and ultrarunners! —Christine Dobrowolski, podiatrist and author of Those Aching Feet Fixing Your Feet is the encyclopedia of foot care! Whether you’re looking for daily foot health tips or ways to survive prolonged and severe foot floggings in ultra- endurance sports, this is your one-stop source of foot info. John has done his homework and presents it in an organized and easy read. You’ve saved my feet! —Terri Schneider, ultrarunner, adventure racer, and triathlete; www.terrischneider.net Fixing Your Feet is the most comprehensive, easy to read, organized foot care guide on the market. Originally I purchased it for personal use; now I carry it with me during my travels, often using it as a conversation stimulator. Everyone likes to talk about their feet, and John does a great job helping me help others. —Tammy Hanna, ENGO Patches; www.goengo.com Through our experience as ultrarunners, we’ve noticed that our foot care needs continue to change, due to different environments, changes in training and racing, and even changes in our feet. We keep coming back to Fixing Your Feet for the most useful and comprehensive foot advice, and we always find the answers we’re looking for. This new edition keeps us up to date with the latest products and trends. We couldn’t ask for anything more! —Gillian Robinson and Don Lundell ultrarunners and founders of www.zombierunner.com Fixing Your Feet is the most comprehensive book that I have ever seen on foot care. As a person who has been running for more than 31 years and has run more than 100,000 miles, I know just how important it is to maintain proper care of your feet. I appreciate John’s statement that there is no one method to treat each problem. What works for one runner may or may not work for another runner. I encourage every runner to use this book as a valuable resource. —David Horton, ultrarunner and Pacific Crest Trail speed record holder; www.extremeultrarunning.com FixinG YouR Feet prevention and treatments for athletes John Vonhof Fifth Edition WILDERNESS PRESS Fixing Your Feet: Prevention and Treatments for Athletes 1st Edition 1997 2nd Edition 2000 3rd Edition 2004 4th Edition 2006 5th Edition 2011 Copyright © 1997, 2000, 2004, 2006, 2011 by John Vonhof Front cover photo copyright © 2011 by Dan Campbell Back cover illustration copyright © 1997, 2000, 2004, 2006, 2011 by Adam Caldwell Interior photos and illustrations, except where noted, by John Vonhof Cover design: Andreas Schueller and Scott McGrew Book design: Emily Douglas Manufactured in the United States of America Published by: Wilderness Press c/o Keen Communications P.O. Box 43673 Birmingham, AL 35243 (800) 443-7227; FAX (205) 326-1012 info@wildernesspress.com www.wildernesspress.com Visit our website for a complete listing of our books and for ordering information. Distributed by Publishers Group West Many of the designations used by manufacturers and sellers to distinguish their products are claimed as trademarks. Where those designations appear in this book and the author is aware of a trademark claim, they are identified by initial capital letters. These products are listed in alphabetical order for the sake of simplicity. The order does not imply one product is more helpful or less helpful than another. All rights reserved. No part of this book may be reproduced in any form, or by any means electronic, mechanical, recording, or otherwise, without written permission from the publisher, except for brief quotations used in reviews. SAFETY NOTICE: Although Wilderness Press and the author have made every attempt to ensure that the information in this book is accurate at press time, they are not responsible for any loss, dam- age, injury, or inconvenience that may occur as a result of using this book. The information contained here is no substitute for professional advice or training. Readers are encouraged to seek medical help whenever possible. Library of Congress Cataloging-in-Publication Data Vonhof, John. Fixing your feet : prevention and treatments for athletes / John Vonhof. -- 5th ed. p. cm. ISBN-13: 978-0-89997-638-9 ISBN-10: 0-89997-638-7 1. Foot—Care and hygiene. 2. Running injuries—Prevention.3. Hiking injuries—Prevention. I. Title. RD563.V63 2011 617.5’85—dc22 2010037007 Dedication This fifth edition of Fixing Your Feet is dedicated to Denise Jones, the Badwater Blister Queen. Denise is my sounding board as we talk about foot care and how to fine-tune our taping, patching, and product ideas. She is a special, caring per- son who loves to help others with her foot care expertise. I value her friendship immensely—she walks the talk. Thanks, Denise. Acknowledgments Thank you to the thousands of athletes who, over the life of this book, have shared their experiences, asked for foot care help, and given me encouragement to keep writing about Fixing Your Feet. Special thanks go to my wife, Kathie, for her continued patience through yet another rewrite and research process, and my son, Scott, who, after one of my 12-hour track runs in 1996, gave me the original idea for this book. Thanks to the staff of Wilderness Press for believing in the ongoing potential for this fifth edition of Fixing Your Feet. Again, they continue to take it to a high level of professionalism. My Motivation Run with perseverance the race marked out for you. — Hebrews 12:1 Foreword Whether participating in a 5K or 150K race, all athletes need to train appropriately to avoid injury. Train correctly and you can experience the wonders of the outdoors and the thrill of competition. Train incorrectly and you may sustain a significant injury that will not allow you to compete, nor reach your goal. In extreme situations, where athletes are out in the wilderness, injuries can have deadly consequences. Good ath- letes train appropriately and prepare for whatever obstacles might come their way. Spending years competing as an endurance athlete, including adventure racing and triathlons, has taught me the importance of preparation and prevention. I can remember finishing 24-hour races having crossed several riverbeds, hiking over mountain passes and through slot canyons, thankful that my feet, though sore, were fine. Unlike the poor soul I passed at a checkpoint tending to a horrific blister requiring him to drop out of a race, I’ve learned the importance of taking care of one of the most important parts of my body—my feet. Our feet connect us to the surrounding terrain, propelling us toward our next destination. Take care of your feet and the world is yours to enjoy. Ignore your feet and life can be a miserable experience. I’ve witnessed the impact of injuries to the feet as Medical Director for Racing the Planet ( www.racingtheplanet.com ). These ultraendurance running events challenge athletes to cross more than 150 miles over seven days through some of the harshest terrains around the world. My research has shown that for the majority of athletes who experience some sort of race injury, it’s an injury related to their feet. Yet almost 25% of these athletes will not need medical care. How can that be? The answer lies in training and prevention. The majority of foot injuries are blisters, which can be managed appropriately if identified early. In fact, our medical team spends a good amount of time reminding athletes to protect their feet. Strategies include using lubricants, changing socks, checking skin for hot spots, and staying well hydrated and well nourished. However, mismanage blisters or other lower-extremity injuries, and athletes can experience serious illnesses, including skin infections, that cause them to drop out of the race. That is why Fixing Your Feet is such an important resource. This comprehensive book provides some of the most detailed information regarding your feet and how to prevent or treat injuries, from one of the experts in the field. Looking through the pages, you’ll learn about the basics of footwear, including new information regard- ing minimalist and barefoot running versus shod or traditional footwear. Preventive strategies focus on the role of clothing, compounds, taping, and the impact of various extreme conditions on your feet. Treatment recommendations will help you manage typical foot injuries relating to skin, muscles, and ligaments. Throughout, practical tips abound. It’s why I typically recommend the book as a resource for any medical personnel helping with an ultraendurance running event or a wilderness expedition. Whether you are an athlete competing in a race or part of the medical team taking care of athletes, I recommend you keep Fixing Your Feet nearby. —Brian J. Krabak, MD, MBA Medical Director, Racing the Planet 4 Desert Series Sports Medicine Physician, University of Washington and Seattle Children’s Hospital Rehabilitation, Orthopedics, and Sports Medicine Contents Foreword viii introduction 1 Getting the Most out of Fixing Your Feet 4 The Best of 15 Years of Foot Care 6 Part one: Foot Basics 19 1. Seeking Medical Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 2. You Can Have Healthy & Happy Feet . . . . . . . . . . . . . . . . . 24 Think “Feet” ...................................................................................... 24 A Daily Ritual.................................................................................... 24 Talk to Your Doctor ........................................................................... 25 Summer Foot Care Basics .................................................................. 25 Winter Foot Care Basics .................................................................... 26 Aging Feet ........................................................................................ 26 3. Sports & Your Feet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Sport Similarities .............................................................................. 29 Differences in Terrain........................................................................ 30 Conditioning .................................................................................... 32 Biomechanics ............................................................................. 34 Part Two: Footwear Basics 41 4. The Magic of Fit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Buying Footwear .............................................................................. 45 Know Your Feet................................................................................ 47 Components of a Good Fit ................................................................ 50 Tips for a Good Fit ........................................................................... 52 Customizing Your Footwear .............................................................. 53 5. Footwear & insoles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Brand Loyalty in Footwear ................................................................ 57 The Anatomy of Footwear ................................................................. 58 Running Shoes ................................................................................. 59 Sports Shoes .................................................................................... 62 Hiking Boots .................................................................................... 64 Choosing Lightweight Footwear ......................................................... 68 Custom Shoes .................................................................................. 69 Sandals ........................................................................................... 70 Insoles ............................................................................................. 72 6. Barefoot & Minimalist Footwear . . . . . . . . . . . . . . . . . . . . . . . 76 Shoes vs. Minimalist Footwear............................................................ 77 The Value of “Going Bare” ................................................................ 78 The Science on Barefoot Running........................................................ 79 Function & Form ................................................................................ 80 Barefoot Precautions .......................................................................... 81 Minimalist Footwear Choices .............................................................. 85 7. Socks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Sock Fibers & Construction................................................................ 96 Buying Socks.................................................................................... 99 Specialty Socks .............................................................................. 100 Going Sockless............................................................................... 105 Part Three: Prevention 107 8. Making Prevention Work . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Components of Prevention............................................................... 112 Finding the Right Combination ........................................................ 115 9. Compounds for the Feet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 Powders......................................................................................... 117 Lubricants ...................................................................................... 119 Skin Toughening Agents & Tape Adherents ...................................... 121 Antiperspirants for the Feet ............................................................. 124 10. Taping for Blisters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 Tapes ............................................................................................ 130 Working the Tape ........................................................................... 133 Three Taping Techniques................................................................. 135 Taping the Feet .............................................................................. 137 11. orthotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 Custom-made Orthotics .................................................................. 145 Over-the-counter Orthotics .............................................................. 147 Using Your Orthotics ....................................................................... 147 12. Gaiters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150 Making Your Own Gaiters ............................................................. 151 Repairing Gaiter Straps .................................................................. 152 13. Lacing options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 Lacing Tips..................................................................................... 157 Lacing Methods .............................................................................. 157 14. Self Care for Your Feet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 Skin Care ...................................................................................... 162 Pedicures ....................................................................................... 165 Foot Massage ................................................................................ 167 Hydration, Dehydration, & Sodium .................................................. 169 Changing Your Shoes & Socks ........................................................ 171 Keeping Your Shoes Fresh .............................................................. 173 15. Extreme Conditions & Multiday Events . . . . . . . . . . . . . . 174 Cold & Wet ................................................................................... 176 Trench Foot .................................................................................... 180 Frostbite......................................................................................... 181 Snow & Ice .................................................................................... 182 Heat .............................................................................................. 185 Sand ............................................................................................. 187 Jungle Rot ...................................................................................... 189 Foot Care in Multiday Events........................................................... 191 Aching Feet ................................................................................... 195 16. Teamwork & Crew Support . . . . . . . . . . . . . . . . . . . . . . . . 197 Teamwork ...................................................................................... 197 Planning for Foot Care ................................................................... 198 Team Responsibilities ...................................................................... 199 Crew Support................................................................................. 199 17. Providing Foot Care for Athletes ................................. 201 Being Part of a Foot Care Team ....................................................... 201 Setting Up Your Station.................................................................... 202 Tips on Managing Blisters ................................................................ 202 Advising about Post-event Care ........................................................ 204 Your Tools ...................................................................................... 204 18. 12 Mega-distance Athletes Talk about Foot Care . . . . 205 19. Preventing Blisters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218 Things You Can Do for Your Feet ..................................................... 219 Things You Apply to Your Feet ......................................................... 219 Things You Put Around Your Feet ..................................................... 220 Things You Do in Combination ......................................................... 221 Things You Do in General ................................................................ 221 Part Four: Treatments 223 20. Treating Your Feet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225 21. Blisters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228 Hot Spots ....................................................................................... 229 Beyond Hot Spots: Blisters ............................................................... 230 Types of Blisters ............................................................................... 235 General Blister Care ....................................................................... 236 Advanced Blister Patching ............................................................... 241 Extreme Blister Prevention & Patching .............................................. 245 Beyond Blisters ............................................................................... 254 Fixing Blisters, Their Way or Yours .................................................. 255 Post-event Blister Care .................................................................... 256 22. Strains & Sprains, Fractures & Dislocations . . . . . . . . . . 257 Strains & Sprains ........................................................................... 257 Strengthening Exercises .................................................................. 264 Fractures........................................................................................ 268 Stress Fractures .............................................................................. 269 Dislocations ................................................................................... 271 23. Tendon & Ligament injuries . . . . . . . . . . . . . . . . . . . . . . . . 273 Treating Tendon Injuries .................................................................. 274 Achilles Tendinitis ........................................................................... 278 Ankle Tendons ................................................................................ 282 Bursitis ........................................................................................... 284 Plantar Fasciitis ............................................................................... 284 24. Heel Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 294 Heel-pain Syndrome ....................................................................... 294 Heel Spurs ..................................................................................... 294 Haglund’s Deformity ....................................................................... 296 25. Toe Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299 Strengthening Your Toes .................................................................. 299 The Basics: Toenail Trimming .......................................................... 299 Black Toenails ................................................................................ 300 Big Toe Problems............................................................................. 304 Hammertoes, Claw Toes, & Mallet Toes ........................................... 305 Ingrown Toenails ............................................................................ 307 Morton’s Toe .................................................................................. 308 Overlapping Toes ........................................................................... 309 Stubbed Toes ................................................................................. 309 Toenail Fungus ............................................................................... 310 Turf Toe ......................................................................................... 313 26. Forefoot Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315 Bunions ......................................................................................... 315 Metatarsalgia ................................................................................. 317 Morton’s Neuroma ......................................................................... 318 Sesamoiditis ................................................................................... 320 27. numb Toes & Feet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 322 Transient Paresthesia ...................................................................... 322 Peripheral Neuropathy ................................................................... 323 Raynaud’s Syndrome ...................................................................... 324 28. Skin Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 326 Athlete’s Foot ................................................................................. 326 Calluses ......................................................................................... 327 Corns ............................................................................................ 331 Fissures.......................................................................................... 332 Plantar Warts................................................................................. 332 Rashes ........................................................................................... 334 29. Cold & Heat Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 336 Cold Therapy ................................................................................. 336 Heat Therapy ................................................................................. 337 Combination Cold & Heat Therapy .................................................. 338 30. Foot Care Kits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 340 Basic Self-care Kit for Home Use ..................................................... 342 Fanny-pack Kit ............................................................................... 342 Event Kit ........................................................................................ 343 Part Five: Sources & Resources 345 Appendix A: Product Sources. . . . . . . . . . . . . . . . . . . . . . . . . . . 347 Appendix B: Shoe & Gear Reviews . . . . . . . . . . . . . . . . . . . . . 349 Appendix C: Medical & Footwear Specialists . . . . . . . . . . . . 350 Appendix D: Feet-related Websites . . . . . . . . . . . . . . . . . . . . . 351 notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 352 Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 355 Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 359 About the Author . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361 index 362 1 introduction “One thing is for sure: when one’s feet hurt ... it definitely gets one’s attention.” —Denise Jones, the Badwater Blister Queen F or years, I have signed copies of Fixing Your Feet with the following inscrip- tion: best wishes for happy and healthy feet. That and helping people have been my motivations for more than 15 years of learning as much as possible about foot care. I love to see athletes able to finish their races without foot problems. Those reading this fifth edition of Fixing Your Feet are, by their very nature, active people. They love the outdoors. They love challenges, often pushing their bodies beyond the norm. Oftentimes this is done in less than ideal conditions— rain, cold, snow, sand, and on feet that hurt. And more often than not, on blistered feet. If there is one injury that has plagued the majority of athletes, it’s blisters. Mark Swanson, an ultrarunner, sent an e-mail to a listserv in response to a com- ment about blister prevention. He wrote: “Let’s remember the lesson John keeps emphasizing—what works for you may not work for the next person and what works for you now may not work for you next time. But what works for you will help some people and may work for you for a long time!” There is a lot of value in these two sentences. A common saying is, “We are each an experiment of one.” That applies to foot care, and especially blister prevention. Ever since I wrote the first edition of Fixing Your Feet, I have tried to get people to learn about how to prevent blisters with a variety of techniques and products. Fixing Your Feet Yes, blisters are the number one issue, the number one question that athletes ask about. I wish I could tell you the one answer that would solve all your blister problems. But there’s not one solution. In this book are hundreds of tips to help prevent blisters and, if you get them anyway, products to fix them. You need to find which ones work for you. By doing your homework, you’ll be closer to solving your foot problems. This goes for other foot problems too. Fixing Your Feet is filled with information to help you keep your feet happy and healthy. Rather than looking only for a quick solution to your problem or injury, I encourage you to learn as much as you can about what caused the problem or injury. It is important to eliminate the cause to achieve a long-term solution. Start with the new chapter on “Getting the Most Out of Fixing Your Feet .” In the publishing world, not many books make it to a fifth edition. Fixing Your Feet has done so because it continues to offer solutions. In each edition, the foreword has presented a perspective that emphasized a unique point: n Our feet are our primary mode of transportation and require our atten- tion and preparation. —Billy Trolan, MD, first edition n Most of our foot problems could have been avoided with proper care. —David Hannaford, DPM, second edition n Our feet will take us to new challenges and adventures if we make the conscious choice to care for them. —Dan Barger, the Primal Quest Expedition Race founder, third edition n If your feet are happy, you’re happy. If your feet are miserable and want to quit, you are miserable and want to quit. —Demetri “Coup” Coupounas, fourth edition n Our feet connect us to the surrounding terrain, propelling us toward our next destination. Take care of your feet and the world is yours to enjoy. Ignore your feet and life can be a miserable experience. —Brian J. Krabak, MD, fifth edition This edition includes two new chapters. The first, “Barefoot & Minimalist Footwear,” was prompted by the changing footwear marketplace. The second, “Providing Foot Care for Athletes,” is aimed at those who work at events to pro- vide foot care to runners, walkers, and adventure racers—anyone needing help. I have a special place in my heart for those trying hard to repair feet so the athlete can continue. The fifth edition has updates and changes throughout, including coverage of new products and new techniques, particularly in the “Taping for Blisters” and “Blisters” chapters. Fixing Your Feet is for you—solutions for your feet. I would love to hear from you. Send me an e-mail at john@fixingyourfeet.com and let me know your story about your feet. 2 F i x i n g Y o u r F e e t: Introduction Foot Fetish My feet are runner’s feet; a little rough around the edges, with black nails on the toes where I have nails at all Lovingly decorated with bright colors. My toes are warriors, of a sort. They carry the entire continent of my body on adventures and rise to challenges that could crush them. Some days they are worn and calloused, but they are strong and fierce adversaries for the rocks they overtake. My arches are the springboard of my soul. They give me lift with every step I take and cushion all my landings. They are always ready when I want to jump for joy. My heels respond when the shepherd of my spirit nips at them to run. They strike again and again, to thwart frustration, to redeem the day. My feet are runner’s feet; a little rough around the edges, but they are strong and they are willing and oh, I love them. —Lisa Butler, ultrarunner introduction 3 4 Getting the Most Out of Fixing Your Feet i n the 15 years since Fixing Your Feet first came out, I have answered many questions about foot care. I have patched thousands of feet at ultramarathons, multiday stage races, adventure races, marathons, and walking events. If there is one thing I have learned, it is this: the majority of athletes wait until they have problems to learn how to care for their feet. When problems develop, everything becomes reactive—working to solve an existing problem. Preventing foot problems is being proactive—working to solve problems before they develop. Being proactive takes time up front. Being reactive takes time and resources often when they are not available or when using them may jeopardize the outcome of the event. I prefer proactive. So here you are, holding this book in your hands. Maybe it’s the first time you’ve seen it or