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Care for the Aches and Pains That Come with Long Days on the Trail

Ultrarunners’ bodies endure a lot of wear and tear. Take some advice from top ultrarunner Hal Koerner to minimize the damage—or better yet, prevent it.

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All ultras hurt, but they do not have to leave a physical mark, other than that proud hobble you may sport for a few days following the race. A stitch in time will save you in a big way, and knowing how to take care of yourself is crucial because a bad blister, mangled toenail, raw chafing, or worse can sideline you and ruin all your hard efforts. Knowing how to avoid or deal with common ultra maladies will allow you to reach your objectives.


Blisters are one of the most common foot problems that can occur on race day. Although it is a seemingly small thing relative to bigger catastrophes such as dehydration and heatstroke, even a dime-sized blister can quickly make your day miserable, at the very least, or can even end your race. The foot has a great amount of neural feedback and is therefore extremely sensitive; that repetitive pounding on a sore can be excruciating. (Blisters may also be telling you something about abnormalities with your feet, foot strike, and weight dispersion over time, so don’t take them lightly. A hotspot is not always a symptom of poor moisture management.)

The best way to deal with a blister is to not get one in the first place. When blisters do appear, several smart techniques, both offensive and defensive, are appropriate. For excellent, detailed recommendations about general foot care, pick up the book Fixing Your Feet by John Vonhof. Vonhof’s aggregated insights from his own and others’ ultrarunning experiences serve as an indispensable tool that goes into far more precise detail than I can here.

Practically speaking, when I develop a blister during a race, I pop it immediately with a pin. Use a pin from your bib, or get one at the aid station. The aid station should also have alcohol and a needle, if you would prefer to be more hygienic about it. A medic or willing volunteer can even lance it for you when you stop for refueling. Puncturing the blister with an unsterilized instrument does pose a risk of infection and is not recommended for blisters with blood in them, which indicates access for a potential infection to reach the bloodstream.

When popping a blister, leave the blister roof intact, and insert the pin at a point where the impact of running will naturally force the fluid out (usually at the opposite end from where the force is occurring). Once it is popped, push all the fluid out, pat the roof of the blister down on the base, and put your socks back on over the popped sore. I don’t generally cover the sore because it is difficult to get anything to stay on the affected area; some people, however, find that duct tape or a band-aid is effective in preventing recurrence. Use caution, though, because additional materials in your shoe can sometimes lead to more chafing and discomfort in the long run.


Let’s face it, black or missing toenails are something of a fashion statement and a badge of honor for ultrarunners. But do everything you can to avoid them, or suffer the painful consequences.

Your first best defense is properly sized shoes. I wear a size 12 or 12.5 in training, but on race day I wear a size 13. When running tens of miles, especially in hot conditions, there is much you cannot predict. One thing that you can count on, though, is that your feet will swell at least half a size. Moving up half a size and thus giving yourself that extra room in the toe box is imperative.

Smashing painfully up against the front of your shoe on every downhill step when your foot is already swollen will traumatize your toenails, separating the nail from the skin. Pre-race trimming of your toenails, straight across and just above where the nail plate emerges from the side nail folds, may help. Cutting the tops off of your shoes is a last-ditch move but an effective solution. However, having open-toed shoes on a trail race is certainly not optimal. In sum, ensure that you have ample room in your shoes going into the race.

While toe box space is key, also ensure that the instep and heel feel secure. Lace the shoe snugly, leaving wiggle room for toes, but a secure fit from the ball of the foot back.

If you’re in need of a nail clipping, be sure to do it a few days prior to the race. If you clip them the day before and accidentally cut them too short, there is no time for the nails to grow back a little, and running can be painful.

If, despite your best efforts, a nail is hanging loose during a race, remove it at the aid station. I suggest then covering the exposed toe with duct tape so that it doesn’t become irritated by your sock.


If you have ever chafed, then you already know how painful it is. It’s a feeling you don’t soon forget. You probably also have become intimately acquainted with petroleum jelly and Bodyglide as a result. If you have not chafed, consider yourself lucky and do everything you can do proactively to avoid it.

Chafing is caused by the friction between a skin surface and other skin or clothing as they constantly rub together in movement. The raw skin reaction is expedited by sweat or moisture, especially when salt crystals are entered into the abrasive equation.

At the Ultra-Trail du Mont Blanc in 2011, I had regrettably worn ladies capris, not realizing that they had a special seam running through the crotch. That seemingly innocent seam wasn’t noticeable at first, but believe me, by mile 35, I was painfully aware of it.

Using my hands and eventually a ziplock bag as barriers down below allowed me to hobble to the 50-mile aid station, whereupon I searched out some different clothing and lubrication. I ended up finishing the race, but having been utterly taken out of my game, I was 20 hours behind the winner. In that instance, chafing cost me my competitive finish in a big race.

You likely already know where your chafing hot spots are. Apply an ample layer of lubricant such as Bodyglide to those high-friction spots before your race. If you are thorough with it at the race start, you should not need to reapply, but make sure your crew has some on hand and do reapply later if needed.

If nipples are your hotspot, as they are for many male runners, you no longer are stuck with duct tape as your only solution. Running companies have come to the rescue with nipple guards, which are easy to put on and will stay put.

For those who chafe in the thigh and nether regions, compression shorts are your best friend. Wear them preventively, or keep them in a drop bag so that you will have them to change into if needed.

If, despite your best efforts, you do find yourself chafing, try your best to keep salt out of the wound by drying off your perspiration as much as possible and changing into dry clothes when you can.

Cuts and Bruising

Generally speaking, scrapes and cuts are par for the course (literally) and for the most part can be ignored. Clean off the blood with a wipe or some antiseptic and make a quick assessment of the damage done. Cover the wound as necessary, although between sweat and movement, a bandage is likely to fall off. It should go without saying that if you are bleeding from the head or if blood is flowing heavily from any part of your body, you need to monitor the situation closely and very likely get off the course.

Bruising indicates a pooling of blood beneath the skin. Bruises can result from minor trauma, such as a fall or swipe against a rock, or be an indication of something more foreboding. My good friend, ultrarunner Tim Olson, noticed bruising during his winning Western States 100 run in 2013; it turned out that the bruising he was experiencing resulted from his tearing of the muscles that attach at the knee. Blood had begun to pool internally, and at that point he ran the risk of injuring more than his legs; blood clots can cause pulmonary embolisms.

Ask yourself: How bad is the pain? Is the swelling rapidly accelerating? Is a wound clotting?


Be honest with your assessment. As with all of these ailments, treating them promptly will ensure you’ll be fit enough to run in the days and weeks to come.

Adapted from Hal Koerner’s Field Guide to Ultrarunning by Hal Koerner with permission of VeloPress.

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