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The Enemy of the Feet

by MASS4D® Prescription Orthotics January 21, 2018


The authors aimed firstly, to identify blister incidence, localisation and severity during a multi-day ultramarathon footrace and secondly, to study risk factors and determine preventive measures used by ultramarathon runners to help reduce blister formation and severity.

The authors conducted a prospective observational field-based study during the 2010 and 2011 Al Andalus Ultimate Trail in southern Spain.

Participants’ characteristics were collected before the race by the direct interview technique on standardised questionnaires by trained researchers.

Data on preventive measures used by the ultramarathon runners were recorded in the same manner.

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After each stage, participants were interviewed and blisters were inspected by the research team members using standardised questionnaires about blister formation, number of blisters, severity as judged by the competitors during the race before treatment and localisation of blisters.

After stage 1, just short of a standard marathon distance, 34% of runners developed blisters.

After 4 days of running, with increasing distance and a combined distance of 182 km, 76% of runners observed blisters.

110 blisters were observed in total, with most blisters localised on the toes, followed by blisters on the ball of the foot, heel and sole.

Exposure of the skin to repeated low-intensity friction forces creates blisters most frequently at the distal phalanges, under the metatarsals, and behind the calcaneus.

A tendency was observed for blisters on the sole and heel of the foot to cause more discomfort than those in other areas.

Prophylactic measures studied included type of sock, antiperspirant, lubricant, talcum powder, and taping, but there was no clear evidence of their effectiveness.

In male ultramarathon runners, previous race experience was found to be associated with a reduced blister rate.

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  1. Scheer, B. V., Reljic, D., Murray, A., Costa, R. J. S. (2014) The Enemy of the Feet. Journal of the American Podiatric Medical Association: September/October 2014, Vol. 104, No. 5, pp. 473-478

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