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The Enemy of the Feet

Blisters in Ultraendurance Runners

Bernd Volker Scheer Team Axarsport, Santa Cruz del Comercio, Spain.
Sports Medicine Department, Olympic Training Centre, University of Heidelberg, Heidelberg, Germany.

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Dejan Reljic Sports Medicine Department, Olympic Training Centre, University of Heidelberg, Heidelberg, Germany.

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Andrew Murray Team Axarsport, Santa Cruz del Comercio, Spain.
SportScotland Institute of Sport, Stirling, Scotland.

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Ricardo Jose Soures Costa Department of Nutrition and Dietetics, Monash University, Notting Hill, Australia.

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Background

Blisters are the most common dermatologic problem in ultraendurance runners. Their incidence, localization, pain scores, and risk factors in field conditions are poorly understood.

Methods

We conducted an observational field-based cohort study during the 5-day multistage 2010 and 2011 Al Andalus Ultimate Trail (219 km). Daily postrace data on blister frequency, localization, severity, and preventive measures from 50 ultramarathon runners were collected through the direct interview technique.

Results

After 4 days of running (182 km), blisters occurred in 76% of the participants (P < .001 versus stage 1) compared with 34% after day 1, 54% after day 2, and 72% after day 3 (P < .001 versus stage 1). Most of the blisters formed on the toes (65%) (P < .001), followed by blisters on other locations of the foot: the ball of the foot (16%), heel (14%), and sole (5%). Blisters were more painful toward the end of the race, and those on the sole and heel tended to be the most painful, although this did not reach statistical significance. Prophylactic measures studied (type and fabric of socks; application of antiperspirants, talcum powder, or lubricant to feet; and prophylactic taping) did not show any reduction in blister rates. The only predictive marker for reduced blister incidence was previous ultramarathon experience in men (r = −0.44, P < .05).

Conclusions

Blisters are extremely common in multistage ultramarathon races. Race experience in male ultramarathon runners is associated with reduced blister rates.

Corresponding author: Bernd Volker Scheer, MD, Pasaje 13 de Febrero, 2, 4D, 03013 Alicante, Spain. (E-mail: volkerscheer@yahoo.com)