Foot guru and author of ‘Fixing your Feet‘, John Vonhof, has worked on feet at the 55-mile aid station and the finish line at many a Western States 100 (and many others). He has seen many cases of foot maceration. In a classic blog post, from July 2014, John offers some insight into the cause of this condition and how to prevent and deal with it. 

“While maceration is commonly caused by stream and river crossings, it also happens when runners pour water over their heads and body and it runs down into their shoes. Feet also sweat a lot, some people’s more than others, and this also can lead to maceration,” John writes in a post ‘Maceration at Western States‘ on his blog.

“For some, it was minor skin softening and maybe a few surface creases. Others had more severe maceration, with creases that were deeper over widespread areas on the bottom of their feet.  A few were really bad – deep creases and skin folding over on itself.  In extreme cases, the folded skin can split open.”

He explains that severe maceration manifests as a burning sensation and the feeling of large blisters all over the bottom of the feet. He made two observations out on the course. Firstly, that the longer a runner is out there, the worse their feet can become; and that not changing one’s shoes and socks during the race can magnify the effects of maceration.

In John’s post he shows photos of one runner’s feet which clearly show the bottom of the foot with its whitened skin with creases that run over much of the foot. In addition, her little toe was covered in a ‘flap’ of skin – pretty much skin that has come loose and is pinched and pulled outwards from the bottom of the toe. She also had a fold of skin on the inside of the ball of the foot.

“Unfortunately, there is no quick fix for maceration,” John says.

“Typical treatments include warming the feet, moisture-absorbing powder, dry socks, allowing the feet exposure to air to dry, and time. In talking to this runner, she did not change her shoes nor socks during the 100 miles. I don’t recall the type of shoe, but my guess is that it did not allow water to drain.”

To manage maceration be recommends coating the sole of the foot with a zinc oxide or anti-chafe product – something that helps to control moisture on the skin.

“Another helpful tip is to make sure your shoes drain well. Whether that means mesh uppers, mesh or a draining material down to the shoes upper sole, or making drain holes with a heated nail, draining water out of the shoe is important. Then of course, changing your shoes and socks is also important.”

John’s original post can be read on his Fixing Your Feet website. You can also subscribe there to receive his post updates by email (which I’ve been on for many years). John’s book, ‘Fixing Your Feet’ is THE foot care book. It’s in its 6th edition and is available in printed and e-book versions.