Barefoot Running and Blood Blisters

If you really don't like to think about blisters, blood, or other sports-related injuries, then don't read this post. I swear I kept the gross-ness to a minimum.

So Sunday morning, I woke up and decided to go for a run. I pulled on my Vibrams, put on my University of Colorado hat (in support of KM's undergrad years), turned on the tunes on my phone, and set out. It was going pretty well, and then my left big toe started hurting about a mile it. It wasn't too bad, so I kept running. One more mile later, I decided to stop at a bench and see if gravel had gotten into my shoe or something. Lo and behold, when I pulled off my shoe, I had a nice large blood blister on my big toe. So, I slid the shoe back on, turned around, and awkwardly walked the two miles back to my apartment, trying not to put pressure on my toe. During my walk I called my parents for advice. My dad is my source of knowledge when it comes to injuries of any kind. Seriously. For every medical issue or injury that I have, I place a phone call that starts out like this: "Mom, can you put dad on the phone?" Sunday was no different. My dad looked up blood blisters in his handy-dandy Kaiser Permanente book (see, HMOs are good for some things), and told me what to do. So for those of you who are curious about how to handle a blood blister, it's basically like a regular blister, just with blood. Here are a combination of the recommendations from the book and from WebMD, but check with your doctor if you're unsure of what to do.

If the blister is less than 1 inch in size, do NOT drain the blister. Wash the area with soap and water, and dry thoroughly. Lightly wrap the blister with a band-aid. If the blister is in a load-bearing area of the body, such as your foot, use a piece of moleskin cut into a doughnut shape to place around the blister, which reduces pressure on the blister itself. You can find moleskin at most grocery stores or pharmacies. You can also find the moleskin intended for corns, which are conveniently pre-cut into a doughnut shape for you. How nice of them.

If the blister is greater than 1 inch in size, it's time to perform small surgery on yourself. Just kidding. All you need is a needle and isopropyl alcohol. Start by cleaning your foot with soap and water. Grab a clean paper towel or gauze (you'll see why in a second). Sterilize your needle with the rubbing alcohol. Now poke a small hole at the edge of your blister. Place the towel or gauze over your blister/at the edge of your blister, and use your CLEAN finger to squeeze the fluid in your blister out on the hole you just created. Sounds pretty, right? After you've disposed of the gauze, again clean the blister with soap and water. Dry thoroughly and wrap the area with a band-aid, remember to do so lightly. From here, you need to make sure the area stays dry. If your blister is on your foot, try to wear shoes that have air flow, such as sandals. If you don't have this option and have sweaty feet, make sure you change your socks more frequently than normal, and use moisture-wicking socks. You should change the band-aid at least once per day. And don't wear socks to bed.

Now, if you have a blister that got ripped open. Do not remove any skin unless the flap of skin is very dirty. If the skin was completely ripped off, you don't need to keep that. Obviously. Treat the ripped blister similarly to how you would an open wound. You can use antibiotic ointment on the wound before putting the band-aid on. I use water-proof band-aids. And when I do have a blister, I'll frequently use blister band-aids. They stick really well and will last for a while, even through showers.

And finally, if you're like me and have slightly allergic reactions to the adhesive of band-aids if you leave the band-aid on for more than 12 hours, change the band-aids frequently, or invest in sensitive skin band-aids, or other sensitive skin tapes (like paper tape). There are options. 

Barefoot Running

I found this pair on sale for half off, plus an extra 10% because they were the last pair.
And they fit perfectly. It must be a sign!

Barefoot running, also known as natural running, is based on the theory that humans were designed to run barefoot. Think about how you run while wearing running shoes. It's a heel-strike-to-toe motion, right? Well the downside of this is that by landing on your heel, there's no way to absorb the shock of impact so that you don't injure your joints from the repetitive stress of pounding the pavement. Barefoot running on the other hand consists of running on the balls of your feet, which removes the pounding force impact on your joints. See the photo and graphs below for a comparison of shod and barefoot running.

Impact on Foot: Shod Running vs. Barefoot Running

Also, the muscles of the longitudinal arch may allow the foot to dampen impact and may remove stress from the plantar fascia, which could help people with plantar fasciitis. FYI, plantar fasciitis is the inflammation of the thick tissue on the bottom of the foot and can be very painful.

The practice of running barefoot is still followed by the Tarahumara tribe in Mexico. The people of this tribe have been known to run up to 200 miles (320 km) at one time. This 200-mile run can take place over two days through their homeland of rough canyon country. Three of the five canyons are deeper than the Grand Canyon(1). The Tarahumara can travel between 50-80 miles everyday at a "race" pace. Because of the terrain, travel using domesticated animals (i.e. horse and wagon) isn't possible and running is needed for inter-village communication and transportation, as well as to hunt. The Tarahumara use a persistence hunting technique, which basically means that they chase down an animal until it slows from exhaustion. Because humans sweat, our bodies have a mechanism to cool down while continuing to run, and although many mammals sweat, few can effectively thermoregulate via sweating, thus often relying on panting to cool the body. Unfortunately for these four-legged animals being hunted, they aren't blessed with the ability to pant while galloping (such as while being chased), so they have to slow down to pant.

The barefoot running movement got some of the spotlight after Christopher McDougall's book, Born to Run, was published in May 2009. After dealing with running injuries himself, the author traveled down to the Mexican Copper Canyons to learn more about how the Tarahumara tribe can run with  minimal foot support (homemade sandals) and without significant injuries. 

Watch the video below for the perspective of Daniel Lieberman, PhD, Professor of Human Evolutionary Biology at Harvard University.

Because so many of us live in cities and run on roads and sidewalks, running barefoot might not be the best idea because of the potential to injure the bottom of our feet due to puncture wounds, bruising, or thermal reasons such as running on ice or very hot surfaces like pavement in Texas. Therefore, options such as Vibrams FiveFingers or moccasins are available for barefoot/minimalist running. As a side note, the modern-day running shoe was developed in the mid-1970s.

If you plan to switch from running with shoes to running barefoot, you should do it gradually. It significantly changes HOW you run. It works different muscles that may be unaccustomed to being used so much. My Vibrams came with a nice little tag that recommended that I wear the shoes 1-2 hours per day for a week or so in order to get used to them. Transitioning too fast could result in pulled calf muscles, Achilles tendinitis, and metatarsal stress fractures.

Interesting fact: Abebe Bikila was an Olympic marathoner who ran a marathon barefoot at the 1960 Olympics and won. Yes, you read that right, he WON an Olympic marathon while barefoot!

My reactions to Vibrams: 

I've found my new personal trainer for my calves. Now, every time I walk down stairs I have to give myself an internal motivational pep-talk to convince myself to take that step and to convince my calves not to cramp up or collapse on me. If I even kind of point my toe I feel like my calves are going to cramp into a charley horse at any moment. (Side note, Charley Horses can result from high or low blood pH, hormonal imbalances, low levels of potassium or calcium, or as side effects of medication.)

Anyways, this past Tuesday evening I ran one mile without stopping, then walked a half-mile, before running another half-mile. Because of the lack of heel support like I'm used to with running shoes, my first few steps were rough on my heel. However, I immediately changed my stride without much thought. It was a very natural transition to running on the balls of my feet... as in, "no thinking required" transition. My calves were aching by the time I got home, but I didn't have any ankle pain, which I was getting every time I had gone running since I injured my ankle last fall. On Wednesday I ran on the treadmill using my regular running shoes and was rewarded with pain in my left ankle. For now, I'm still on the fence as to whether this way of running is better, but I'm going to give it a try. And maybe it'll end up being like my switch to Paleo: a great decision for my health. Check back for more updates!

(1) http://www.lehigh.edu/~dmd1/art.html

(2) Daoud, Adam. "Foot Strike and Injury Rates in Endurance Runners: A Retrospective Study." American College of Sports Medicine. http://www.fas.harvard.edu/~skeleton/pdfs/2012b.pdf

(3) "Barefoot Running: How Humans Ran Comfortably and Safely Before the Invention of Shoes." ScienceDaily. Feb. 1, 2010.  http://www.sciencedaily.com/releases/2010/01/100127134241.htm

(4) "Long-Awaited Barefoot Running Study Finds Sneakers Are Harmful"

http://www.popsci.com/science/article/2010-01/barefoot-running-study-finds-your-sneakers-are-unnatural