ArticlePDF Available

Paper Tape Prevents Foot Blisters: A Randomized Prevention Trial Assessing Paper Tape in Endurance Distances II (Pre-TAPED II).

Authors:
Article

Paper Tape Prevents Foot Blisters: A Randomized Prevention Trial Assessing Paper Tape in Endurance Distances II (Pre-TAPED II).

Abstract and Figures

Objective: To determine whether paper tape prevents foot blisters in multistage ultramarathon runners. Design: Multisite prospective randomized trial. Setting: The 2014 250-km (155-mile) 6-stage RacingThePlanet ultramarathons in Jordan, Gobi, Madagascar, and Atacama Deserts. Participants: One hundred twenty-eight participants were enrolled: 19 (15%) from the Jordan, 35 (27%) from Gobi, 21 (16%) from Madagascar, and 53 (41%) from the Atacama Desert. The mean age was 39.3 years (22-63) and body mass index was 24.2 kg/m 2 (17.4-35.1), with 31 (22.5%) females. Interventions: Paper tape was applied to a randomly selected foot before the race, either to participants' blister-prone areas or randomly selected location if there was no blister history, with untaped areas of the same foot used as the control. Main Outcome Measures: Development of a blister anywhere on the study foot. Results: One hundred six (83%) participants developed 117 blisters, with treatment success in 98 (77%) runners. Paper tape reduced blisters by 40% (P , 0.01, 95% confidence interval, 28-52) with a number needed to treat of 1.31. Most of the study participants had 1 blister (78%), with most common locations on the toes (n = 58, 50%) and heel (n = 27, 23%), with 94 (80%) blisters occurring by the end of stage 2. Treatment success was associated with earlier stages [odds ratio (OR), 74.9, P , 0.01] and time spent running (OR, 0.66, P = 0.01). Conclusion: Paper tape was found to prevent both the incidence and frequency of foot blisters in runners.
Content may be subject to copyright.
ORIGINAL RESEARCH
Paper Tape Prevents Foot Blisters: A Randomized
Prevention Trial Assessing Paper Tape in Endurance
Distances II (Pre-TAPED II)
Grant S. Lipman, MD,*Louis J. Sharp, MD,Mark Christensen, MD,*Caleb Phillips, PhD,
Alexandra DiTullio, MD,*Andrew Dalton, DO,Pearlly Ng, MD,§ Jennifer Shangkuan, MD,¶
Katherine Shea, MD,*and Brian J. Krabak, MDk
Objective: To determine whether paper tape prevents foot blisters
in multistage ultramarathon runners.
Design: Multisite prospective randomized trial.
Setting: The 2014 250-km (155-mile) 6-stage RacingThePlanet
ultramarathons in Jordan, Gobi, Madagascar, and Atacama Deserts.
Participants: One hundred twenty-eight participants were
enrolled: 19 (15%) from the Jordan, 35 (27%) from Gobi, 21
(16%) from Madagascar, and 53 (41%) from the Atacama Desert.
The mean age was 39.3 years (22-63) and body mass index was 24.2
kg/m
2
(17.4-35.1), with 31 (22.5%) females.
Interventions: Paper tape was applied to a randomly selected foot
before the race, either to participantsblister-prone areas or randomly
selected location if there was no blister history, with untaped areas of
the same foot used as the control.
Main Outcome Measures: Development of a blister anywhere
on the study foot.
Results: One hundred six (83%) participants developed 117
blisters, with treatment success in 98 (77%) runners. Paper tape
reduced blisters by 40% (P,0.01, 95% condence interval, 28-52)
with a number needed to treat of 1.31. Most of the study participants
had 1 blister (78%), with most common locations on the toes (n = 58,
50%) and heel (n = 27, 23%), with 94 (80%) blisters occurring by the
end of stage 2. Treatment success was associated with earlier stages
[odds ratio (OR), 74.9, P,0.01] and time spent running (OR, 0.66,
P= 0.01).
Conclusion: Paper tape was found to prevent both the incidence
and frequency of foot blisters in runners.
Key Words: blisters, feet, ultramarathon, runners, injury prevention,
paper tape
(Clin J Sport Med 2016;00:17)
INTRODUCTION
Friction foot blisters are one of the most common
injuries encountered in hikers, runners, and endurance
athletes.
1
Although most are of minor medical signicance,
they can impair concentration, decrease athletic performance
and enjoyment, and be potentially debilitating. Blister rates in
the outdoor community range from 54% of backpackers to
64% of long-distance hikers.
2,3
Blister incidence in marathons
has been reported as high as 39%
4
and 76% to 100% in
multistage ultramarathon runners.
5,6
Foot blisters have been
the most commonly reported injury in adventure racing
7
and
are the most common factor that adversely affects perfor-
mance in single-stage ultramarathon nishers.
8
Foot care ac-
counts for 20% of all medical visits in marathons
912
and up
to 76% of medical visits in multistage ultramarathons.
13,14
In
addition to sports and outdoor recreationalists, blister preven-
tion is a problem in both training and active duty military
personnel. Studies report blister rates of 48% to 65% after
short marches
15,16
in 57% of trainees
17
and 33% during a 12-
month period of deployment.
18
Furthermore, 84% of cellulitis
in military recruits was caused by blisters, with an average
loss of 8 training days per case.
19
Sixteen percent to 22% of
those affected with blisters received temporary duty restric-
tions, which may impact troop readiness.
20
There is currently
no proven efcacious technique for blister prevention.
Blister injury arises from friction between the skin and
another object.
2123
The skin surface is subjected to normal
forces (F
n
), the perpendicular force or force of contact,and
tangential shear forces.
24
When an external force is applied at
Submitted for publication June 11, 2015; accepted February 3, 2016.
From the *Department of Emergency Medicine, Stanford University School of
Medicine, Stanford, California; Department of Emergency Medicine,
Presence Resurrection Medical Center, Chicago, Illinois; Computational
Science, University of Colorado, Boulder, Colorado; §Department of Sur-
gery, University of Utah, Salt Lake City, Utah; ¶Department of Emergency
Medicine, New York University, New York, New York; and kDepartment
of Orthopedics and Sports Medicine, University of Washington, Seattle,
Washington.
The researchers were supported with a travel stipend by a 2014 RacingTh-
ePlanet Research Grant.
Presented as oral presentations at the Wilderness Medical Society Winter
Meeting; February 15, 2015; Park City, Utah; Society of Academic
Emergency Medicine, Western Regional Meeting; March 27, 2015;
Tucson, Arizona; and a poster at Society of Academic Emergency
Medicine National Meeting; May 15, 2015; San Diego, California.
The preventive taping techniques studied are promoted in Dr Lipmans book,
The Wilderness First Aid Handbookand app: www.wildernessaid.com.
The other authors report no conicts of interest.
Corresponding Author: Grant S. Lipman, MD, Department of Emergency
Medicine, Stanford University School of Medicine, 300 Pasteur Dr,
Alway M121, Stanford, CA 94305 (grantlip@hotmail.com).
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
Clin J Sport Med !Volume 00, Number 00, Month 2016 www.cjsportmed.com |1
Copyright !2016 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
the skin interface, small irregularities create an opposing fric-
tional force (F
f
), which prevents sliding across the skin.
23,25
The magnitude of a frictional force is dened by the formula:
F
f
=m·F
n
, where mis the coefcient of friction or ratio of
shear force to normal force.
25
When external forces exceed
the opposing frictional force, movement occurs at the skin
surface interface and shear stress extends horizontally
between the skin layers.
26
Repeated sliding at a friction point
causes exfoliation of the stratum corneum with development
of erythema and a sensation of warmth, the hot spot.
23,24
Continued friction causes delamination between the cells of
the stratum spinosum, and a cleft forms that then lls with
a low-protein transudate resulting in a blister.
21,24,27,28
Despite extensive studies on the impact of shear forces
on blister development, there has been scant research on the
efcacy of various blister prevention modalities (eg, powders,
antiperspirants, lubricants, tapes, or adhesive pads). In our
previous blister prevention study in multistage ultramarathon
runners (Pre-TAPED), we found that paper tape applied to the
majority of common blister-prone areas of one foot compared
with the other untaped foot was not efcacious.
6
As paper
tape was well tolerated and 84% of the study participants
would choose to use it again for blister prevention, we
believed that the studys methodology limited insight into
the reduced shear-stress area under the tape itself compared
with the surrounding skin, and subsequently may have under-
estimated the effectiveness of paper tape. Therefore, we
wanted to investigate the individuals blister-sensitive areas
with focal preventive taping. The objective of this study was
to examine whether paper tape could prevent hot spots and
blisters on specic blister-prone areas in multistage ultramar-
athon runners.
METHODS
Setting and Selection of Participants
This randomized, prospective cohort trial was under-
taken during the 2014 RacingThePlanet 250-km (155-mile),
6-stage, ultramarathon foot races through the Gobi Desert in
China, Atacama Desert of Chile, Jordan, and Madagascar
Deserts. These races had 4 consecutive 25 mile (40 km) days,
a combined fth and sixth day of 50 miles (80 km), and
nished with a 5 to 6 mile (10 km) day. Participants carried
their own equipment for the duration of the race, including
a minimum of 2000 calories per day and were offered 1.5 L of
water per 6 to 7 miles (10-12 km). As each race had similar
distances and logistical demands, the cohorts were combined
for analysis. Approval was obtained from the institutional
review boards of Stanford University School of Medicine and
Resurrection Medical Center. ClinicalTrials.gov identier:
NCT01945112.
Research Design
All English-understanding race competitors were pro-
vided the opportunity to enroll at race registration the day
before the race start, and informed consent was obtained
before completing a demographics questionnaire. Exclusion
criteria were any blister or hot spot on either foot at the time
of enrollment or an allergy to paper tape. Each participant had
an intervention foot randomized by coin toss (with the
opposite foot not studied). Paper tape was applied by medical
staff trained in application procedures described by study
manual and on-site researcher the evening before the rst day
of racing. The intervention foot was dried and brushed clean
of residual grit, then covered with 2.5-cm (1-inch) 3M
FIGURE 1. Example of a pretaped foot.
TABLE 1. Demographic Data
Variable Mean Range SD
Age, yrs 39.3 22-63 8.3
Height, cm 175.1 144-201 9.1
Weight, kg 74.5 44-105 12.9
BMI, kg/m
22
24.2 17-35 3.0
Pack weight 10.3 6-25 2.4
Geographic area
North America 37
South America 5
Asia* 16
Africa 3
Oceana* 18
Europe 48
Russia/Eurasia 2
N = 128, 31 (24%) females.
*1 participant from both Asia and Oceana; Oceana = Australia and New Zealand.
Lipman et al Clin J Sport Med !Volume 00, Number 00, Month 2016
2|www.cjsportmed.com Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
Copyright !2016 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Microporepaper tape (3M, St Paul, Minnesota) at the par-
ticipants blister-prone area(s) (directed application). If the
study participant was not susceptible to blisters, 1 randomly
selected area was chosen (undirected application) based on the
most common blister locations: a toe, instep (head of the rst
metatarsal), outstep (head of the fth metatarsal), or the heel
(calcaneal tuberosity).
5,6
Toes were taped with a 1.3- to 2.5-cm
(0.5- to 1-inch)-wide longitudinal strip of tape applied along
the dorsum and plantar aspects that covered the distal phalanx
and nail bed. Another piece of tape was applied circumferen-
tially around each toe at the distal phalanx, with the cut ends of
the tape located on the dorsum of the toe. The width of the tape
size depended on adequate coverage based on a subjects toe
size. The rst and fth metatarsal heads were taped with a 5.1-
cm (2-inch)-wide strip perpendicular to the foot axis, and the
heel was taped with a 5.1-cm (2-inch)-wide horizontal piece of
paper tape covering the calcaneal tuberosity (Figure 1). Tape
corners were smoothed at. After the initial application of tape,
either the participant or medical personnel could reapply tape at
any time on the course or at the medical tent as necessary for
the duration of the study. The study end point was the devel-
opment of a hot spot or blister (described as blister) any-
where on the randomly chosen foot, with the uncovered
portion of the same foot serving as the control. When the study
end point was reached, an exit questionnaire was completed.
Statistical Analysis
The sample size was calculated to achieve 80% power
(a= 0.05, 2-tailed test). Based on our previous work with
paper tape in similar races, we assumed that a single foot
would have a blister rate of at least 35%.
6
A total of 82
participants were required to detect a signicant difference,
dened a priori as a reduction in blister incidence of 25%.
Outcome measures were analyzed by the x
2
test and indepen-
dent samples ttest, with independent predictors of the number
of blisters analyzed by analysis of variance and logistic
regression for treatment success (dened as no blister devel-
opment underneath the paper tape). Time-adjusted incidence
[incidence density rate (IDR)] of the outcome measure was
calculated by stage times of blister occurrence, and partici-
pantsperformance was analyzed per quintile of nishers (eg,
.10%, .10%-25%, .25%-50%, .50%-75%, .75%). P,
0.05 was considered signicant. All analysis was done with R
statistical computation software version 3.1.1.
RESULTS
One hundred twenty-eight participants were enrolled,
with 19 (15%) participants from the Jordan, 35 (27%) from
Gobi, 21 (16%) from Madagascar, and 53 (41%) from the
Atacama Desert. Table 1 describes the characteristics of the
study cohort, and the participant ow diagram is shown in
Figure 2. For all study participants, there were a total of 240
applications of paper tape (Table 2), with a total of 117 blis-
ters that occurred in the locations described in Table 3, most
commonly on the toes. The majority of participants developed
1 blister (Table 4), with 94 (80%) of all blisters occurring by
the end of stage 2 (Figure 3).
FIGURE 2. CONSORT study diagram.
TABLE 2. Paper Tape Application Sites
Toe,
n = 135 (%)
Heel,
n = 35 (%)
Instep,
n = 46 (%)
Outstep,
n = 14 (%)
Ball,
n = 7 (%)
Sole,
n = 3 (%)
Right foot 85 (63) 23 (66) 30 (65) 10 (71) 4 (57) 1 (33)
Average applications per subject 1.09 0.29 0.38 0.13 0.05 0.01
Left foot 50 (37) 12 (34) 16 (35) 4 (29) 3 (43) 2 (67)
Average applications per subject 1 0.24 0.32 0.08 0.06 0.04
Clin J Sport Med !Volume 00, Number 00, Month 2016 Paper Tape Prevents Foot Blisters
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. www.cjsportmed.com |3
Copyright !2016 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
A total of 109 (85%) participants were compliant with
the study protocol, with 6 reasons for noncompliance found
in 19 participants; the most common being lack of adhesion
(n = 10, 53%). In those compliant with the protocol, there
were 97 blisters (89%), 28 (26%) blisters under the paper
tape, and 74 (68%) on the untaped areas. Blisters occurred at
uncovered areas rather than underneath the paper tape in 81
(74%) runners. The blister incidence and treatment success
per race location is described in Table 5. Intent-to-treat anal-
ysis of the 128 enrolled participants found that 106 (83%)
developed blisters, with treatment success in 98 (77%) run-
ners. Paper tape had an absolute reduction of blister inci-
dence of 40%, with a number needed to treat of 1.31. There
was similar statistical signicance observed in both the pro-
tocol compliant and noncompliant groups (Table 6). Of the
97 (89%) who had directed application of paper tape, there
were 89 (92%) blisters, a treatment success in 70 (72%),
with a statistically signicant reduction in blister incidence
in the taped versus untaped area [P,0.01, 95% condence
interval (CI), 27-55].
Exploratory logistic regression modeling showed that
the stage of race was the best predictor of treatment success
[odds ratio (OR), 74.9, P#0.01, 95% CI, 4.7-3277.7], fol-
lowed by time spent racing (OR, 0.66, P= 0.01, 95% CI, 0.5-
0.9) (Figure 4) and opposite dominant handedness (relative to
which foot was taped) (OR, 3.7, P= 0.05, 95% CI, 1.1-15.2).
Variables that were not statistically associated with treatment
success included height, age, sex, weight, pack weight, body
mass index (BMI), and race performance.
Multiple linear regression and analysis of variance were
used to test correlation between the number of blisters and
BMI, performance, pack weight, age, and race stage. Stage of
race was most strongly correlated (P,0.01, R
2
= 0.17).
Normalizing for time spent racing, analysis of variance of
the number of blisters per hour shows the strongest relation-
ship for race location (P,0.01, R
2
= 0.19) and whether tape
was reapplied (P,0.01, R
2
= 0.07). Factors that did not have
a signicant association with the number of blisters included
age, weight, sex, BMI, use of Injinji socks (San Diego, CA),
and pack weight.
DISCUSSION
We found that paper tape had a robust protective effect
on blister formation on runnersfeet in multistage ultramar-
athons. Paper tape is an inexpensive, readily available, and
easy-to-apply intervention that prevented blisters in approxi-
mately 3-quarters of the people who applied it. This study was
the rst to show that a simple adhesive tape can prevent foot
blisters.
Blisters may lead to pain and inability to complete
a race, with 6% to 16% of nonnishers of ultraendurance
events citing blisters as the primary reason for withdraw-
ing.
7,13
These rates of nonnishers due to blisters may be an
underestimation because the pain associated with blisters may
lead to a modied gait, which can exacerbate underlying in-
juries.
5,29
Runners citing sprains or muscle injuries as reasons
for withdrawal may in fact have blisters that are worsening
these injuries. Military trainees with blisters were found to
have a higher incidence of overuse injuries, particularly to
their knees and ankles,
17,19
and those with blisters were
50% more likely to experience additional injuries.
21
Prospective studies on blister reduction often examined
strategies to decrease friction between the skin and other
objects,
21,23,30
because the magnitude of the F
f
is the major
factor found to contribute to blister formation.
24
Despite over
40 years of clinical trials on blisters, multiple interventions
have not provided a solution to this enemy of the feet.
Petroleum jelly was found to increase friction and subsequent
blister formation an hour after application.
24
Application of an
emollient combined with antiperspirant was not shown to
reduce blister incidence,
31
another attempt with antiperspirant
alone was more successful,
15
but the excessive irritation in the
majority of study subjects has discouraged use except in cases
of hyperhidrosis.
15,32,33
A comparison of common blister pre-
vention bandages (eg, Band-Aid, Moleskin, New-Skin,
Compeed, Tegaderm) and a proprietary adhesive bandage
Blist-O-Ban (Seaberg Company Inc, Newport, OR) found
the lowest coefcient of friction in the adhesive pad
34
; how-
ever, paper tape was not included for comparison. Paper tape
has a lower prole than that of most of these commercially
available products, with the added advantage of affordability
and ease of application to the toes and intertriginous areas.
There was high user satisfaction of paper tape in this study,
with 81% of compliant study participants who agreedor
strongly agreed(on a 5-point Likert scale) to use paper tape
for blister prevention in the future.
Previous ultramarathon studies have found that the
most common location for blisters is the toes, accounting for
TABLE 3. Blister Locations
No Blister,
n = 23 (%)
Toe,
n = 58 (%)
Heel,
n = 27 (%)
Instep,
n = 15 (%)
Outstep,
n = 1 (%)
Ball,
n = 10 (%)
Sole,
n = 3 (%)
Right foot 15 (65) 37 (64) 18 (67) 10 (67) 0 4 (40) 2 (67)
Average/subject 0.19 0.47 0.23 0.13 0 0.05 0.03
Left foot 8 (35) 21 (36) 9 (33) 5 (33) 1 (100) 6 (60) 1 (33)
Average/subject 0.16 0.42 0.18 0.1 0.02 0.12 0.02
There was no statistical signicance when comparing equivalent sites of either feet (P= 0.93), an additional area that developed blisters on the left foot only was under
foot(n = 3, 6%).
TABLE 4. Number of Blisters
0 Blister
(%)
1 Blister
(%)
2 Blisters
(%)
3 Blisters
(%)
Compliant 13 (12) 85 (78) 9 (8) 2 (2)
Overall 25 (20) 91 (71) 10 (8) 2 (1)
Lipman et al Clin J Sport Med !Volume 00, Number 00, Month 2016
4|www.cjsportmed.com Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
Copyright !2016 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
52% to 65% of encountered blisters.
5,6
This locational trend
was conrmed in this study with toes representing 56% of
pretaped areas, and 50% of blisters occurring on the toes.
Increased blister rates on the toes may be due to the greater
contact time of this area of the plantar surface, with blister-
prone individuals found to have signicantly increased pres-
sure and magnitudes of shear stress.
35
Paper tape is uniquely
suited to protect these blister-prone areas as its soft
surface minimizes abrasion and friction blister development
to the neighboring toes.
36
Contrary to the ndings of our smaller previous study,
6
there was no correlation with blisters and Injinji socks, likely
because those who wore these toe-separated socks did not get
blisters at that location, so chose not to directly apply paper
tape to the toes. Injinji socks are popular among ultraendur-
ance runners, used by 45% (n = 49) of our compliant study
participants Although we did not see signicant correlation
with toe blisters and Injinjis, it seems reasonable to avoid the
use of paper tape on the toes with Injinji socks.
Feet of ultramarathon runners are exposed to heat,
moisture, and repetitive activity for extended periods of time.
The number of times a frictional stress is applied has been
shown to increase blister rates.
24
By analysis of IDR, we
found that those who developed a blister under the tape (treat-
ment failure) encountered it early in the race, whereas those
who had treatment success had blisters developing apprecia-
bly later in the race in the noncovered locations. Figure 4
supports the efcacy of paper tape for blister prevention. This
intervention likely minimized the shear stress at the blister
vulnerable areas, as these areas have been found to have
a 50% increase in shear time integral values compared with
nonblistered sites.
35
Of the compliant participants, there were 47 people
(43%) who reapplied tape a total of 121 times. The need for
tape reapplication was associated with an increased number of
blisters, although not with treatment success or failure. It
stands to reason that race locations (such as Madagascar and
the Gobi) with wetter courses may have led to treatment
failure by poor tape adhesion as seen by the lowest success
rates. These wet conditions are also more apt to contribute to
increased blister formation, represented by the greater number
of blisters encountered. Repetitive rubbing on moist skin
produces higher F
f
than on dry or very wet skin.
21,23,27
Wetter
environments likely increased the need for frequent reappli-
cations, possibly minimizing the overall benet of paper tape.
Although the most common reason for protocol noncompli-
ance was the lack of tape adhesion, there is a benet of the
weak adhesive qualities of paper tape in that it minimizes the
possibility of unroong a blister upon its removal. The intact
supercial epidermal cells of the stratum corneum and
stratum granulosum form the blistersroof.In blister
FIGURE 3. Number of blisters per stage of race.
TABLE 5. Incidence of Blisters Per Race Location
Location N Total Incidence (%) Treatment Success (%)
Jordan 19 10 (53) 17 (90)
Gobi 35 29 (83) 22 (63)
Madagascar 21 21 (100) 14 (67)
Atacama 53 46 (87) 45 (85)
Clin J Sport Med !Volume 00, Number 00, Month 2016 Paper Tape Prevents Foot Blisters
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. www.cjsportmed.com |5
Copyright !2016 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
prevention and treatment, the maintenance of the roofs integ-
rity optimizes healing rates,
28
which highlights the utility of
paper tape for dermatologic maintenance.
There are multiple variables at play over a 155-mile
6-stage ultramarathon that may have an effect on blister
incidence and the success of a prophylactic. There was wide
variation in treatment success between the study sites, which
may be a reection of these factors, but interrace conclu-
sions are limited by combination of the cohort for study
power. Interrace data were combined for the analysis as each
race had similar design, length, and logistical demands; as
the environmental and race conditions varied between the
study locations, this assumption may have led to disparate
results. However, our cohort grouping was similar to
multiple studies that have combined athletes from different
races for analysis.
6,8,38
The Pre-TAPED II study methodology examined the
areas at highest risk for blister development unique to each
runner on 1 randomly assigned foot. The study participants
directed 92% of the taped areas. Although the larger surface
area of the foot that was untaped may have biased the results
toward a positive study outcome, the historical predilection of
blister development in these taped areas offered greatest
protection and thus provided us maximal insight into
intervention efcacy.
39
Participants were not blinded to outcomes, as the end-
of-study data collection was by self-reported questionnaire.
This was logistically unavoidable. Although all study partic-
ipants were requested to avoid taping the study foot, we could
not standardize other foot care interventions that could
possibly have led to unknown variables affecting outcomes.
CONCLUSIONS
We demonstrated than an inexpensive and easy-to-
apply adhesive tape prevented foot blisters in runners. Foot
care represents a substantial burden on medical teams at these
races, and blisters cause signicant discomfort to athletes,
TABLE 6. Blister Incidence
N
Taped
Area (%)
Untaped
Area (%)
Total
Incidence (%)
Treatment
Success (%) P
Blister
Reduction 95% CI IDR NNT
Compliant 109 28 (26) 74 (68) 97 (89) 81 (74) ,0.01 29%-55% 7.6 1.35
Overall 128 30 (23) 81 (63) 106 (83) 98 (77) ,0.01 28%-52% 5.4 1.31
NNT, number needed to treat.
FIGURE 4. Treatment success versus time spent
racing.
Lipman et al Clin J Sport Med !Volume 00, Number 00, Month 2016
6|www.cjsportmed.com Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
Copyright !2016 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
which may negatively impact race performance. This simple
pretaping technique of blister-sensitive areas may substan-
tially improve utilization and enjoyment of the outdoors
by minimizing both the number and occurrence of friction
foot blisters.
ACKNOWLEDGMENTS
The authors gratefully acknowledge Mary Gadams and
RacingThePlanet staff for their support of scientic research
and the athletes whose participation and enthusiasm for
endurance running made this study possible.
REFERENCES
1. Krabak BJ, Waite B, Lipman G. Evaluation and treatment of injury and
illness in the ultramarathon athlete. Phys Med Rehabil Clin N Am. 2014;
25:845863.
2. Twombly SE, Schussman LC. Gender differences in injury and illness
rates on wilderness backpacking trips. Wilderness Environ Med. 1995;4:
363376.
3. Boulware DR, Forgey WW, Martin WJ II. Medical risks of wilderness
hiking. Am J Med. 2003;114:288293.
4. Mailler EA, Adams BB. The wear and tear of 26.2: dermatological in-
juries reported on marathon day. Br J Sports Med. 2004;38:498501.
5. Scheer BV, Reljic D, Murray A, et al. The enemy of the feet blisters in
ultraendurance runners. J Am Podiatr Med Assoc. 2014;104:473478.
6. Lipman GS, Ellis MA, Lewis EJ, et al. A prospective randomized blister
prevention trial assessing paper tape in endurance distances (Pre-
TAPED). Wilderness Environ Med. 2014;25:457461.
7. Townes DA, Talbot TS, Wedmore IS, et al. Event medicine: injury and
illness during an expedition-length adventure race. J Emerg Med. 2004;
27:161165.
8. Hoffman MD, Fogard K. Factors related to successful completion of
a 161-km ultramarathon. Int J Sports Physiol Perform. 2011;6:2537.
9. Caselli MA, Longobardi SJ. Lower extremity injuries at the New York
city marathon. J Am Podiatr Med Assoc. 1997;87:3437.
10. Roberts WO. A 12-yr prole of medical injury and illness for the Twin
cities marathon. Med Sci Sports Exerc. 2000;32:15491555.
11. Purim KS, Leite N. Sports-related dermatoses among road runners in
Southern Brazil. An Bras Dermatol. 2014;89:587592.
12. Tang N, Kraus CK, Brill JD, et al. Hospital-based event medical support
for the Baltimore Marathon, 20022005. Prehosp Emerg Care. 2008;12:
320326.
13. Krabak BJ, Waite B, Schiff MA. Study of injury and illness rares in
multiday ultramarathon runners. Med Sci Sports Exerc. 2011;43:
23142320.
14. Scheer BV, Murray A. Al Andalus Ultra Trail: an observation of medical
interventions during a 219-km, 5-day ultramarathon stage race. Clin J
Sport Med. 2011;21:444446.
15. Knapik JJ, Reynolds K, Barson J. Inuence of an antiperspirant on foot
blister incidence during cross-country hiking. J Am Acad Dermatol.
1998;39:202206.
16. Levy PD, Hile DC, Hile LM, et al. A prospective analysis of the treat-
ment of friction blisters with 2-octylcyanoacrylate. J Am Podiatr Med
Assoc. 2006;96:232237.
17. Van Tiggelen D, Wickes S, Coorevits P, et al. Sock systems to prevent
foot blisters and the impact on overuse injuries of the knee joint. Mil
Med. 2009;174:183189.
18. Brennan FH, Jackson CR, Olsen C, et al. Blisters on the battleeld: the
prevalence of and factors associated with foot friction blisters during
Operation Iraqi Freedom I. Mil Med. 2012;177:157162.
19. Bush RA, Brodine SK, Shaffer RA. The association of blisters with
musculoskeletal injuries in male marine recruits. J Am Podiatr Med
Assoc. 2000;90:194198.
20. Ressman RJ. Epidemiology of friction blisters. J Assoc Mil Dermatol.
1976;2:1317.
21. Akers WA, Sulzberger MB. The friction blister. Mil Med. 1972;137:17.
22. Comaish JS. Epidermal fatigue as a cause of friction blisters. Lancet.
1973;1:8183.
23. Naylor P. The skin surface and friction. Br J Dermatol. 1955;67:
239248.
24. Knapik JJ, Reynolds KL, Duplantis KL, et al. Friction blisters. Path-
ophysiology, prevention and treatment. Sports Med. 1995;20:
136147.
25. Bueche F. Principles of Physics. New York, NY: McGraw-Hill Book
Company; 1972.
26. Sanders JE, Greve JM, Mitchell SB, et al. Material properties of
commonly-used interface materials and their static coefcients of friction
with skin and socks. J Rehabil Res Dev. 1998;35:161176.
27. Sulzberger MB, Cortese TA, Fishman L, et al. Studies on blisters pro-
duced by friction. I. Results of linear rubbing and twisting technics. J
Invest Dermatol. 1966;47:456465.
28. Cortese TA Jr, Sams WM Jr, Sulzberger MB. Studies on blisters pro-
duced by friction. II. The blister uid. J Invest Dermatol. 1968;50:
4753.
29. Van Gent RN, Siem D, van Middelkoop M, et al. Incidence and deter-
minants of lower extremity running injuries in long distance runners:
a systematic review. Br J Sports Med. 2007;41:469480.
30. Comaish S, Bottoms E. The skin and friction: deviations from amontons
laws and the effect of hydration and lubrication. Br J Dermatol. 1971;84:
3743.
31. Reynolds K, Darrigrand A, Roberts D, et al. Effects of an antiperspirant
with emollients on foot-sweat accumulation and blister formation while
walking in the heat. J Am Acad Dermatol. 1995;33:626630.
32. Lipman GS, Scheer BV. Blisters: the enemy of the feet. Wilderness
Environ Med. 2015;26:275276.
33. Darrigrand A, Reynolds K, Jackson R, et al. Efcacy of antiperspirants
on feet. Mil Med. 1992;157:256259.
34. Polliack AA, Scheinberg S. A new technology for reducing shear and
friction forces on the skin: implications for blister care in the wilderness
setting. Wilderness Environ Med. 2006;17:109119.
35. Yavuz M, Davis BL. Plantar shear stress distribution in athletic individ-
uals with frictional foot blisters. J Am Podiatr Med Assoc. 2010;100:
116120.
36. Lipman GS, Krabak BJ. Foot problems and care. In: Auerbach PS, ed.
Wilderness Medicine. 6th ed. Philadelphia, PA: Elsevier; 2012:
580593.
37. Noakes TD, Sharwood K, Speedy D, et al. Three independent biological
mechanisms cause exercise-associated hyponatremia: evidence from
2,135 weighed competitive athletic performances. Proc Natl Acad Sci
U S A. 2005;102:1855018555.
38. Lipman GS, Krabak BJ, Waite BL, et al. A prospective cohort study of
acute kidney injury in multi-stage ultramarathon runners: the Biochem-
istry in Endurance Runner Study (BIERS). Res Sports Med. 2014;22:
185192.
39. Sian-Wei Tan S, Kok SK, Lim JK. Efcacy of a new blister prevention
plaster under tropical conditions. Wilderness Environ Med. 2008;19:
7781.
Clin J Sport Med !Volume 00, Number 00, Month 2016 Paper Tape Prevents Foot Blisters
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. www.cjsportmed.com |7
Copyright !2016 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
... The incidence of foot blisters varies widely depending on the study population and environment. Incidents have been reported as high as 33% among U.S. military personnel during deployment to Iraq (6), 57% during 6 wk of basic military training (50), and 64% to 100% in 5-to 7-d multiple stage ultramarathons of 182 and 250 km (31,32,43) and long-distance hikes (2,4,9). It also has been reported that blisters or ''hot spots'' on the feet are a primary issue impacting performance in 161-km trail ultramarathons, with finishers reporting this as the main issue affecting performance (22). ...
... Prophylactic taping or patching also may cause a reduction in focal skin shear by distributing shear across a broader area of skin. Interestingly, a study of paper tape found it to not be effective at preventing blisters, and that it may even increase blister formation when used between toes in combination with toe socks (31), but another study (32) found paper tape to be effective at reducing blisters in a multiple stage ultramarathon. Because it appears that most blisters occur at the toes, heels, and forefoot (9,31,32), depending on the activity, it would be these sites where prophylactic taping or patching would likely be most effective. ...
... Interestingly, a study of paper tape found it to not be effective at preventing blisters, and that it may even increase blister formation when used between toes in combination with toe socks (31), but another study (32) found paper tape to be effective at reducing blisters in a multiple stage ultramarathon. Because it appears that most blisters occur at the toes, heels, and forefoot (9,31,32), depending on the activity, it would be these sites where prophylactic taping or patching would likely be most effective. ...
Article
This work outlines the etiological factors for exercise-related foot blisters and the pertinent prevention strategies related to these causes. Blisters result from shear forces within the epidermis causing cell necrosis. The extent of skin shear is influenced by friction at the skin and other interfaces, various skin characteristics, bony movement, and the shear modulus of the foot ware. The number of shear cycles is another factor in the development of blisters. Key preventative strategies include limiting the number of shear cycles, avoiding moisture and particulate accumulation next to the skin, frequent use of skin lubricants, elimination of pressure points through proper fitting and broken in shoes and callous removal, use of low shear modulus insoles, and induction of skin adaptations through proper training. Other methods requiring further research, but with theoretical support, include the use of taping and low friction patches over high-friction areas, and double-layered or toe socks.
Chapter
Ultramarathon and ultra-endurance events have seen increasing popularity over the last few years. Due to long durations of exercise in training and competition, these activities put extreme demands on the human body and test its limits. Musculoskeletal injuries affect mostly the lower limbs particularly in ultra-endurance runners. Nutritional and hydration strategies are important and if not addressed properly can lead to life-threatening conditions such as exercise-associated hyponatremia and other conditions such as gastrointestinal distress, acute kidney injury, thermal injuries, and dehydration. Generally, less serious medical problems that can adversely affect performance include skin problems such as blisters and muscle cramping. Recognition and appropriate acute management of these conditions are important to allow for safe participation in these events.
Chapter
Skin conditions in athletes are common. These can lead to athletes missing competitions as well as spreading the conditions to other competitors. The conditions range from bacterial to viral to dermatophyte in origin. The clinician should be able to recognize these conditions, decide whether the athlete can safely continue to compete, and treat these appropriately. Other skin conditions can be related to the sport itself, and the primary care clinician is often faced with the task of helping the athlete deal with these problems as well.
Article
Full-text available
Introduction The Special Forces Assessment and Selection (SFAS) is an extremely physically and mentally demanding 19- to 20-day course designed to determine whether Soldiers are qualified to enter the Special Forces Qualification Course. As a first step to understand medical problems during SFAS, this study examined injuries, illnesses, and activities associated with injuries during the course. Materials and Methods Medical events during the SFAS course were compiled from Sick Call Trackers (a log of medical encounters maintained by medical personnel in the field) and Chronology of Medical Care (Standard Form 600). Descriptive statistics were calculated for each injury and illness and injuries were compiled by the activities performed when the injuries occurred. Results Of the 800 Soldiers who volunteered for the study, 38% (n = 307/800) and 12% (n = 97/800) experienced one or more injuries and/or illnesses, respectively. The most common injuries were blisters and abrasions/lacerations with incidences of 20% (n = 158/800) and 13% (104/800), respectively. The most common illnesses were respiratory infections, other infections, contact dermatitis, and allergies with incidences of 7% (n = 57/800), 2% (n = 14/800), 2% (n = 14/800), and 2% (n = 13/800), respectively. Among all injuries recorded (n = 573), the most common were blisters (46%), abrasions/lacerations (24%), pain (not otherwise specified) (19%), tendonitis (3%), and sprains (3%). Among all illnesses recorded (n = 133), the most common were respiratory infections (56%), allergies (11%), contact dermatitis (11%), and other infections (11%). Most injuries were experienced during land navigation (44%), team events (20%), and foot marching (11%), running (6%), and the obstacle course (5%), but when the estimated time involved for each event was considered, activities with the highest injury rates were the obstacle course (65 injuries/hr), running (27 injuries/hr), the Combat Readiness Assessment (activity involving combat-related tasks) (20 injuries/hr), and foot marching (16 injuries/hr). Conclusion The major limitations of this investigation were: 1) the low specificity with regard to many of the diagnoses/complaints; and 2) the fact that the medical problems reported here are only those seen by medical care providers and are likely an underestimate of the total morbidity in the SFAS course. Soldiers often self-treat and some may be reluctant to see medical personnel because of how it might affect their rating in the course. Nonetheless, this investigation alerts medical personnel to the injuries and illnesses to expect, and public health workers and leadership with activities to target for injury prevention measures during SFAS.
Article
Objective: : To provide medical kit recommendations for short mountain wilderness recreation trips (hiking, trekking, backpacking, mountaineering etc.) based on the epidemiology of injury and illness sustained and best treatment guidelines. Additionally, to compare these recommendations to the medical kit contents of mountain climbers in Colorado. Methods: : A primary literature review concerning the epidemiology of injury and illness in mountain wilderness settings was performed. This information and literature on the efficacy of given treatments were used to derive recommendations for an evidence-based medical kit. The contents of 158 medical kits and the most likely demographics to carry them were compiled from surveys obtained from mountain climbers on 11 of Colorado's 14 000-foot peaks. Results: : Musculoskeletal trauma, strains, sprains and skin wounds were the most common medical issues reported in the 11 studies, which met inclusion criteria. Adhesive bandages (Band-Aids) were the most common item and non-steroidal anti-inflammatory drugs were the most common medication carried in medical kits in Colorado. More than 100 distinct items were reported overall. Conclusion: : Mountain climbing epidemiology and current clinical guidelines suggest that a basic mountain medical kit should include items for body substance isolation, materials for immobilization, pain medications, wound care supplies, and medications for gastrointestinal upset and flu-like illness. The medical kits of Colorado mountain climbers varied considerable and often lacked essential items such as medical gloves. This suggests a need for increased guidance. Similar methodology could be used to inform medical kits for other outdoor activities, mountain rescue personnel, and travel to areas with limited formal medical care.
Article
Objective: Blisters are common foot injuries during and after prolonged walking. However, the best treatment remains unclear. The aim of the study was to compare the effect of 2 different friction blister treatment regimens, wide area fixation dressing versus adhesive tape. Design: A prospective observational cohort study. Setting: The 2015 Nijmegen Four Days Marches in the Netherlands. Participants: A total of 2907 participants (45 ± 16 years, 52% men) were included and received 4131 blister treatments. Interventions: Blisters were treated with either a wide area fixation dressing or adhesive tape. Main outcome measures: Time of treatment application was our primary outcome. In addition, effectiveness and satisfaction were evaluated in a subgroup (n = 254). During a 1-month follow-up period, blister healing, infection and the need for additional medical treatment were assessed in the subgroup. Results: Time of treatment application was lower (41.5 minutes; SD = 21.6 minutes) in the wide area fixation dressing group compared with the adhesive tape group (43.4 minutes; SD = 25.5 minutes; P = 0.02). Furthermore, the wide area fixation dressing group demonstrated a significantly higher drop-out rate (11.7% vs 4.0%, P = 0.048), delayed blister healing (51.9% vs 35.3%, P = 0.02), and a trend toward lower satisfaction (P = 0.054) when compared with the adhesive tape group. Conclusions: Wide area fixation dressing decreased time of treatment application by 2 minutes (4.5%) when compared with adhesive tape. However, because of lower effectiveness and a trend toward lower satisfaction, we do not recommend the use of wide area fixation dressing over adhesive tape in routine first-aid treatment for friction blisters.
Data
Full-text available
Article
Full-text available
Friction foot blisters are a common injury occurring in up to 39% of marathoners, the most common injury in adventure racing, and represent more than 70% of medical visits in multi-stage ultramarathons. The goal of the study was to determine whether paper tape could prevent foot blisters in ultramarathon runners. This prospective randomized trial was undertaken during RacingThePlanet(®) 155-mile (250-km), 7-day self-supported ultramarathons in China, Australia, Egypt, Chile, and Nepal in 2010 and 2011. Paper tape was applied prerace to one randomly selected foot, with the untreated foot acting as the own control. The study end point was development of a hot spot or blister on any location of either foot. One hundred thirty-six participants were enrolled with 90 (66%) having completed data for analysis. There were 36% women, with a mean age of 40 ± 9.4 years (range, 25-40 years) and pack weight of 11 ± 1.8 kg (range, 8-16 kg). All participants developed blisters, with 89% occurring by day 2 and 59% located on the toes. No protective effect was observed by the intervention (47 versus 35; 52% versus 39%; P = .22), with fewer blisters occurring around the tape on the experimental foot than under the tape (23 vs 31; 25.6% versus 34.4%), yet 84% of study participants when queried would choose paper tape for blister prevention in the future. Although paper tape was not found to be significantly protective against blisters, the intervention was well tolerated with high user satisfaction. Copyright © 2014 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.
Article
Full-text available
BACKGROUND: Road running is a growing sport. OBJECTIVES: To determine the prevalence of sports-related dermatoses among road runners. METHODS: Cross-sectional study of 76 road runners. Assessment was performed by means of a questionnaire, interview, and clinical examination. The chi-square and linear trend tests were used for analysis. RESULTS: Most athletes were men (61%), aged 38±11 years, who ran mid- or long-distance courses (60.5%) for 45 to 60 minutes (79%), for a total of 25-64 km (42.1% ) or more than 65 km (18.4%) per week. The most prevalent injuries were blisters (50%), chafing (42.1%), calluses (34.2%), onychomadesis (31.5%), tinea pedis (18.4%), onychocryptosis (14.5%), and cheilitis simplex (14.5%). Among athletes running >64 km weekly, several conditions were significantly more frequent: calluses (p<0.04), jogger's nipple (p<0.004), cheilitis simplex (p<0.05), and tinea pedis (p<0.004). There was a significant association between the weekly running distance and the probability of skin lesions. Of the athletes in our sample, 57% trained before 10 a.m., 86% wore clothing and accessories for sun protection, 62% wore sunscreen, and 19.7% experienced sunburn. Traumatic and environmental dermatoses are common in practitioners of this outdoor sport, and are influenced by the weekly running distance. CONCLUSION: In this group of athletes, rashes, blisters, sunburn, and nail disorders were recurrent complaints regardless of running distance. Calluses, athlete's foot, chapped lips, and jogger's nipple predominated in individuals who ran longer routes.
Article
Full-text available
Participation in ultramarathon races and our knowledge of these athletes continues to grow as the sport becomes more popular. With such growth, it is apparent that both physicians and athletes need to better understand the impact of the unique aspects of ultramarathon races, such as race environment (temperature, humidity, and altitude), race distance, race stages, nutritional requirements and equipment, on athlete injuries and illness. Proper treatment of injuries and illnesses during an ultramarathon race is important for avoiding long term medial issues. The goal of this article is to review the evaluation and treatment of common musculoskeletal injuries and medical illnesses in ultramarathon runners.
Article
Full-text available
The purpose of the study was to evaluate the prevalence of acute kidney injury (AKI) during a multi-stage ultramarathon foot race. A prospective observational study was taken during the Gobi 2008; Sahara 2008; and Namibia 2009 RacingThePlanet 7-day, 6-stage, 150-mile foot ultramarathons. Blood was analyzed before, and immediately after stage 1 (25 miles), 3 (75 miles), and 5 (140 miles). Creatinine (Cr), glomerular filtration rate (GFR), and incidence of AKI were calculated and defined by RIFLE criteria. Thirty participants (76% male, mean age 40 + 11 years) were enrolled. There were significant declines in GFR after each stage compared with the pre-race baseline (p < 0.001), with the majority of participants (55-80%) incurring AKI. The majority of study participants encountered significant renal impairment; however, no apparent cumulative effect was observed, with resolution of renal function to near baseline levels between stages.
Article
Early military investigations of blister treatment using tissue adhesives have shown promise, finding that these agents provide pain relief, prevent infection, and allow continuation of recruit training. A trial was conducted to compare a 2-octylcyanoacrylate treatment with military standard therapy. Patients were recruited during foot evaluation at the end of a 10-km military road march. Seventy-five patients were screened, and 51 were enrolled. Twenty-six patients received 2-octylcyanoacrylate and 25 received standard treatment. A total of 80 blisters were treated (40 in each group). The mean (SD) blister size in the 2-octylcyanoacrylate group was 12.7 (6.2) mm and in the standard group was 12.0 (5.7) mm. There were no statistically significant differences in any of the baseline variables. Baseline and repeated-measures visual analog scale scores demonstrated no statistically significant differences in initial or repeat pain scores. Both groups showed a similar change across time, with a nonsignificant trend toward improvement in the standard therapy group at 10 min (28.5 versus 24.9) and in the 2-octylcyanoacrylate group at 3 days (42.9 versus 50.1). Mean Likert scores were similar, indicating no difference in patient satisfaction. Time to resumption of normal activity was similar, with one patient in each group unable to return to activity at the time of follow-up. There was a trend toward an increased proportion of patients in the 2-octylcyanoacrylate group who were able to return to normal activity within 48 hours, but this did not reach statistical significance. 2-Octylcyanoacrylate was associated with a greater degree of procedural discomfort. No infected blisters were noted in either group.
Article
Objective: To summarize the medical encounters (injury/illness) for runners and the meteorologic data collected in the medical area of a large marathon race. Design: Prospectively transcribed medical records were analyzed for encounter rate, injury/illness type, treatment rendered, and outcomes. The environmental conditions for each race day are compared with injury/illness rates and types. Setting: An urban 42-km marathon located at 44 " 53'N latitude and 93 " 13'W longitude, scheduled on the first Sunday of October with an early morning start time. Participants: 81,277 entrants in the Twin Cities Marathon from 1982 to 1994. Main Results: The start temperature range was -4 to 16 degrees C and the 4-h temperature range was 5-20 degrees C. The average dew point was 3 degrees C at the start and 4 degrees C at 4 h. The finish area medical encounter rates for marathon runners were 18.9 per 1000 entrants and 25.3 per 1000 finishers. Mild injury/illness accounted for 90% of finish line medical encounters. Runners presented with exercise-associated collapse (59%), skin problems (21%), musculoskeletal problems (17%), and other medical problems (3%). Only 112 runners received intravenous fluids and 30 runners were transferred to emergency medical facilities. One death occurred in 1989. Conclusions: Marathon racing in cool conditions is a safe activity and most of the medical encounters are of minor severity. An early morning start time contributes to a cool racing environment and a low injury rate. More than 99.9% of runners who finish this race leave the finish area without hospital or emergency room care. The injury/illness profile can be used to tailor medical care at the finish area of marathons.
Article
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.