Ask Angie

Your irreverent guide to questions you wouldn’t want to ask your own doctor.

SKIN CARE

Skin--The largest organ you have and often the most overlooked. Most runners don't think any more of it than the average couch potato until something hurts! Calluses, blisters, wind burn, black toenails (ok not technically skin), and then there is the dreaded chafe...butt crack, nipples, inner thighs, under the bra straps. Regardless, chafe is what elicits the blood curdling scream when you get into the shower without knowing it is there. Let's talk a bit about theses issues; how to treat them and what steps to take so you can hopefully prevent them in the first place.

Calluses

By definition a callus is a thickened area of skin caused by repeated friction or by an abnormality in the under lying bone structure of the foot. They are usually painless and despite the insistence of pedicurists' around the world they should (for the most part) be left intact. They act as a natural protection to the skin underneath the pressure site.

As with all things, some runners get calluses and some don't. Some people really hate them and others just live with the fact that they are there. For those of you looking to prevent or lessen the severity of them there are a few things you can do.

To reduce friction when you run be sure you are wearing properly fitting shoes and socks that wick moisture away form the foot. Moisture will increase the friction factor and can lead to blisters as well.

When a callus is just starting to develop you can file it with a foot file, mild grit sandpaper, or a pumice stone. Many people like to do this after a bath when the skin is soft but my personal preference is while the skin is dry. "Why?" you ask. Because when the skin is wet and soft you could tear the skin with the vigorous scrubbing of the sandpaper or file. I have done this...it doesn't feel good! When done on the dry, tough skin, the chances of the skin tearing are much less. You just file away and check the area off and on to be sure you are not filing too much off. Follow this up with a thick layer of moisture lotion, Aquaphor or Lanolin works well, and then cover your feet with thick socks to allow it to soak in.

It is important not to let the callus get too big or thick. They can crack and become infected. If that should happen see a podiatrist or sports physician for proper treatment.

Blisters

Blisters are also caused by friction. The shearing force causes tears in the epidermal layer of the skin creating a gap between the layers of the skin. Fluid seeps into this space creating the blister.

There are several things you can do to help prevent or lessen the chance of developing blisters:

• SHOES Proper fit is a must. Too tight and you will certainly rub, too loose and the foot is able to slide around in the shoe also creating a rubbing effect. Ensure a ½ inch space between your longest toe and the end of the shoe. For those of you with that goofy looking longer second toe~ that would be the one you need to measure off of. You also need to be sure the toe box is wide enough to accommodate any bunions so that your foot can wiggle freely without sliding around. Shoe fabric is important. These days most shoes are made of breathable mesh rather than leather.



• SOCKS Also very important as they are right next to the skin. You may have to experiment with the many varieties to figure out what works best for you. Look for fabrics that are going to wick sweat away from your foot rather than hold it in. Many runners like the double layer socks on the market and the newer "toe socks" by Injinji are also a popular choice for preventing blisters.



• STAY DRY Along with the proper sock you can use powder to help absorb moisture. Gold Bond is popular as well as your basic baby powder, which also provides the lovely scent of a clean babies butt!



• BARRIER METHODS No, we aren't talking birth control. These are products that you place on the areas prone to blister and it protects from the friction. Second Skin, Spyroflex and my favorite, Blister Block are some of the ones out there. Think of them as high tech band-aids. Speaking of which~ low tech band-aids can be used as well but often times don't stay on well due to moisture. Taping with athletic tape is also a very commonly used.

So~ once you have the blister what do you do? Pop it, leave it, cover it??? Generally for a small blister (the size of a dime or less) the body can reabsorb the small amount of fluid and the skin will heal back into place. In larger blisters where the skin is thick and the amount of fluid is large the body can't re-do that mess. Here are some things you can do to treat this type of blister:

Be sure to use caution to minimize the chance of infection. If you are a diabetic you should consult your doctor before popping any blister on your feet.

1. Wash your hands using a disinfectant soap.
2. If you have gloves fine, use them. If not you should be ok. It's your own germs anyway.
3. Clean the blistered area with rubbing alcohol.
4. Sterilize the tip of a needle but soaking it for 3 minutes in rubbing alcohol or heating it till the end glows red. Allow it to cool completely or you'll have to treat the burn as well.
5. Make a tiny puncture at the base of the blister. Leave the rest attached as it will protect the raw tissue underneath.
6. Gently push the fluid out of the blister.
7. Apply an antibiotic ointment and cover with gauze or band-aid.
8. For extra protection you can use moleskin with a spot cut out the size of the blister. This will keep some pressure off the blistered area.
9. Change the bandage daily and watch for signs of infection: heat, increased pain, swelling, redness, yellow discharge or fever. Seek medical attention for any of these symptoms.

As the raw layer of skin underneath heals the outer layer of skin will dry up. When it does you can carefully trim off the dead dry skin that once covered the area. Just do this with care so as to not cause injury to any surround tissue.

Windburn

With many of you braving the winter weather I thought I would throw in a bit about wind burn. I really haven't had too much of a problem with it which kind of surprises me. Maybe it means I am really greasy???

Windburn happens when the skin is exposed to extreme temperatures and windy conditions. It can actually happen in both cold and hot temps. The oil is stripped from the skin and if looks like a sun burn, but what it needs is replacement of oil and moisture.

Prevention involves keeping the skin covered and protected. I guess a beard would be the best but since most women don't really like the look of facial hair on themselves that option makes it a bit tough for them! So, for those women and men who can't or won't grow facial hair there are a few things you can do.

• Apply moisturizer to your face and any exposed skin before you head out on your run. Find one that doesn't contain alcohol (believe it or not some have it in it).
• Some who run in extreme conditions will even go so far as to apply Vaseline of Aquaphor to their face. If I did that I would be one huge zit!
• There is a product called Kiehl's All-Sport "Non-Freeze" Face Protector that acts as a moisturizing barrier to your skin from the harsh winter weather.

If you should get wind burn it is recommended you apply 1% Cortisone cream (available over the counter) to the area. This will calm the irritation and help with inflammation under the skin.

Black Toenails

This pretty by-product of running seems to be something that either you get them or you don't. And once you do you always do...or so it seems. Black toenails are caused by a pooling of blood under the toenail. So why does the blood pool under the toenail you ask? Well, it is basically a blood blister and like other blisters it is caused by pressure to that area. It could be caused by repeated rubbing or hitting of the toe on the top of the shoe or it could be caused by the natural way the foot strikes and rolls and where the pressure of the stride hits to foot. The natural "pressure vector" of the stride so to speak. It would seem that one cause would be fixable but the other is not.

If your shoes don't fit properly you can get the rubbing/hitting of the nails on the shoe. This can happen if they are either too big or too tight. Proper fit should be a thumbs width gap between your longest toe and the front of the shoe. It is also helpful to keep the toenails trimmed straight across. These things may help prevent black toenails but I know many runners who have done these things and they still get them.

As far as the "pressure vector" concept goes~ that too is something that is based on how your foot hits the road and where the pressure disperses. In this case unless you change your gait you probably can't change the pressure vector of your foot strike.

So~ you may just have to live with these pretty toenails! They basically are harmless and in general most will end up falling off naturally and not be a problem. They can become painful if too much pressure builds up under the nail.

There is a lot of info out there on how to self treat black toenails and the painful pressure that may result from them. I myself would defer to a podiatrist or physician because I am not sure I could stomach poking a needle through my own nail! But~ for those of you who can tolerate such a thing, here are some directions to perform your own Black Toenail Puncture!

• To relieve the pressure, you need to make a hole in the nail and drain the blood. Either heat the tip of a small, straightened paper clip and use it to burn through the nail until a drop of blood comes out, or sterilize the tip of an X-Acto knife or 1/16-inch drill bit with heat or alcohol, and drill a hole in the nail by spinning the instrument between your finger and thumb.



• Stick your foot in a pan of water until all the blood comes out. (If you're squeamish about doing this, ask a friend to help, or see a sports-oriented physician.)



• Apply an antibacterial cream.



• Relieve inflammation with ice and anti-inflammatories.

If your black toenail isn't painful, you don't have to drain the blood. Lubricate with antifungal cream and cover it with a bandage. But monitor the nail, as it will probably loosen and fall off over the next few months. When it gets loose, pull it off and continue to apply the antifungal cream.

OK~ that's nasty……enough on that. Oh wait, for the ladies~ feel free to paint your black toenail and once it falls off and the skin underneath is not tender to the touch feel free to paint the skin as well. No one will ever know there is a missing toenail!!!

Alrighty then…one more topic on this journey of skin. And of course I have saved the best for last. That being:

Chafe!!!

Chafing occurs as the result of sweating and friction from body parts and fabrics rubbing together. It often occurs on the inner thighs, groin area, armpits, nipples and the butt crack! The best treatment for this is prevention.

CLOTHING. Be sure you have proper fitting running wear. Not too tight but not too loose. Extra fabric is just going to shift and rub on your skin. Be sure they are made of a wicking material...no cotton!!!! Many things today are made with seamless technology and the seams that are present are flat to minimize irritation. It is recommended you wash new clothing before wearing it and give it a test run on a short run to see how your body responds to it.

POWDERS. Powders can be used to prevent friction--Gold Bond is a commonly used one.

BARRIERS. There are a variety of lubricants on the market and you may want to invest in some as your runs get longer. I have found thru informal surveys of running friends that butt crack chafe and other forms of chafe really start to show up after the 10 mile mark.

Vaseline is a popular option and is often seen at medical tables during races. It is cheap and readily available at any drug store. It is pretty goopy though and can stain clothing. Aquaphor is similar to Vaseline but it is not petroleum based and isn't quite as goopy. It also can stain clothing but I find it to work well and holds up to profuse sweating. It is particularly useful in the crotch region. Bag Balm, Utter Balm and Chamois Butter are also similar type products.

Body Glide is probably the most commonly used lube and it comes in a stick form like deodorant. It won't stain clothes and is very easy to apply. If you are going to lube your nether regions please be sure to mark your lube sticks appropriately~ you would hate to rub your butt crack stick on your nipples or under your bra straps!

As for what to lube~ anywhere really. And often times for long runs or marathons I will lube places that I have not necessarily chafed~ just to be safe! Men, do your nipples, women do anywhere your bra touches your skin. It is far better to over lube than to get into a shower after a run and scream in pain. If that does happen here is what you can do to help it heal.

The goal is to treat it and allow it to heal without becoming more irritated. Wash gently and apply an antibacterial ointment. Cover with band-aid or gauze. A&D ointment also works well but it does have that "baby butt/fish oil" smell to it. Just be sure to keep it covered to prevent more friction and then be sure to lube up well before you run again!

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