Q: After training for the marathon and increasing my mileage I have found that with the long walks my hip flexors ache when my mileage reaches 12 miles or more. What causes this and how could I have trained better to alleviate this? I can barely lift my foot up on a curb when I finish these long walks. Is this normal?

A: Hip flexor fatigue and muscle ache is very common as conditioning level and mileage increase. Primary causes include too long of a walking stride, dominant quadriceps with concurrent deactivated buttocks and hamstring muscles, and excessive foot pronation. All of these generate mechanical inefficiencies that can hide with lower mileage. Including technically correct squats in your training it is a great way to condition and assess yourself simultaneously. If you experience knee pain or leg/ankle instability while squatting, this indicates trouble is ahead with longer distances. Accurate pelvis and leg mechanics first will yield fun and high performance second. An experienced athletic or personal trainer can help greatly for detailed instruction. Good luck with your marathon.
— Bryan Baisinger, DC

Q: I am training for the marathon and had never had any problems with blisters until now. I walked the training walk of 21 miles and by mile 15 I started feeling some hot spots. By mile 18 I knew I was developing blisters. I finished but not without some major blisters on my heels and on the balls of both feet. I did not change my shoe brand, nor did I change socks. I changed nothing! Why did I get blisters now? And what can I do to get me through the marathon?

A: Blisters are one of the most common and annoying problems for walkers. Blisters are generally caused by a combination of heat, moisture, friction, and shearing forces.

All of these will happen to a walker’s feet over the course of a long walk such as a marathon, so let’s focus on some measures to prevent them from getting out of control and ruining your big day. Although nothing seemed to have changed for you in terms of footwear or socks, likely the size of your feet changed to a size that your footwear could no longer accommodate. The reason for this is that endurance walking brings a lot of blood into your feet, especially towards the later stages of your walk. This extra blood is trying to nourish your hard working feet and quickly remove waste products from your muscles and tissues. Over time this extra blood builds up in your feet and causes swelling.

Ultimately, your feet end up becoming bigger in size. Consequently your feet no longer fit your shoes. Sometimes simply getting a shoe that allows for the additional swelling towards the later stages of the marathon may help. You may also find some relief from loosening your laces later in your walk to allow more room for your swelling feet. It is possible that at the 18-mile point in your walk, when you first noticed your blisters, you had accumulated a lot of moisture in your shoes that was not only produced by your hard working feet, but also may have dripped down your hard working legs to saturate your socks.

You should be wearing wicking fiber socks and not cotton socks, as cotton allows moisture to accumulate next to your skin and contributes to blister formation.

Add powder, such as baby powder, to your shoes to help absorb some of the moisture buildup. Apply a topical antiperspirant, such as Arrid Xtra Dry, or similar product, to your feet several days a week to inhibit the production of sweat from your feet during your walking.

If your feet are flexible feet that move a lot in your shoes, you may benefit from foot beds, arch supports or orthotics, to reduce some of the excessive movement.

You may also benefit from methods to dehydrate the skin of your feet by soaking in Epsom salts for 10 to15 minutes several times per week prior to the marathon.

If you happen to represent a small percentage of the population who excessively perspire, there are prescription medications available to slow perspiration from your feet. These are products such as Drysol and Xerac. It should be noted that these products feature aluminum chlorhydrate, which is the same active ingredient as Arrid Xtra Dry, so try the over-the-counter product before consulting a foot care specialist.

Recap on the preventive protocol:
1. Wear shoes that allow for increases in size/volume in your feet over the course of the marathon.
2. Wicking fiber sock technologies, such as Cool-Max, acrylic and polypropylene fibers. Avoid cotton socks. Double-layer sock systems are recommended.
3. Powder, such as talcum or baby powder added to the insole of your walking footwear to help absorb excessive moisture.
4. Topical antiperspirants, such as Arrid Xtra Dry or similar products to inhibit the amount of perspiration feet produce.
5. Dehydrating measures such as Epsom salt soaks.
6. For those rare individuals with excessively flexible feet, foot beds, arch supports, or orthotics to reduce some of the excessive motion between feet and footwear.

If you develop a blister along the way, you can:
1. Lubricate the area to try to inhibit the friction with Vaseline, Body Glide, etc.
2. Cover the area with duct tape, athletic tape, moleskin, or hydrogels, such as second skin, or blister block to buffer the friction.
3. Lance the blister to relieve the pressure and reduce the friction.

Perhaps the most ingenious blister prevention method is one that I learned from one of my endurance mountain biking patients. He sprayed the skin of his feet with tape spray (tincture of benzoin), and then put his socks on over his sticky, tape-sprayed feet. According to him, this eliminated the movement between his socks and his feet, and greatly inhibited blister formation during his 24-hour mountain bike adventures.

Additional information on blisters can be found at www.nwfootankle.com, under the common foot conditions section, titled Friction Blisters. Wishing all of you blister-free walking!
— Ray McClanahan, DPM

This issue’s experts:
Bryan Baisinger, DC, is owner of Clearwater Chiropractic & Massage. To contact Dr. Baisinger call 503-279-0205 or email bryan@clearh2o.org.

Ray McClanahan, DPM, is a sports medicine podiatrist. To contact Dr. McClanahan call 503-243-2699 or email footdr@nwfootankle.com