Meet Mr. Fixing Your Feet
Interview with John Vonhof

As an emergency room technician, Californian John Vonhof has seen his fair share of physical trauma over the years, but it's in the greatoutdoors where his medical skills and expertise have been put to the greatest test. A hiker, ultramarathon runner, and organizer of a 50K trail race, he does volunteer medical aid at endurance events such as the Western States 100 and Badwater Ultramarathon where his specialty is mending the aching and banged-up feet of racers. RailRiders spoke with Vonhof, 54, who is the author of the highly acclaimed "Fixing Your Feet: Prevention & Treatments for Athletes."

Q: Just how many feet have you fixed over the years?

John Vonhof: By my estimate, over 500 in races! There have been races whereI have treated the same feet several time as I moved from aid station to aid station to the finish line.

Q: What is your own background, career and athletically speaking?

JV: I have completed the Western States 100-Mile Endurance Run three times,The Gibson Ranch 72-Hour Run, 12 24-hour track runs, many shorter trail androad races, and have fast-packed John Muir Trail. In 1995, after a 12-hour track run, my son suggested I write about foot care. "Fixing YourFeet," which is in its second-edition, has been a joy to write. Over the past few years I have seen a higher degree of foot care than in the past and I like to think I have played a small role in helping so many athletes achieve their goals. By profession I'm an emergency room and trauma technician at Eden Medical Center inCastro Valley in the San Francisco Bay Area. Never a dull moment.

Q: How long did it take you to fast-pack the John Muir Trail?

JV: It took eight and one-half days to cover 221 miles, with about 26 miles per day on average. One observation that I have never forgotten was an encounter with a group who were hiking with huge 65-pound packs that seemed to include the kitchen sink. They were a stark contrast to our 25-pound packs.

Q: What's it like to work an aid station at the Western States 100?

JV: For five years I provided medical aid at the Highway 49 aid station at Western States which is about mile 94. Most runners have some type of foot problems by that point, yet will finish by gutting it out. They have almost gone the distance and as long as they stay focused, they will finish, nomatter what shape their feet are in. Many suffer because they failed tomanage their feet after getting them soaked crossing streams or cooling off,or because of the dust and grit from the miles of trail. Others have changed shoes mid-race and found that to be a mistake. There are lots of toe blisters.In many cases simple care early on would have prevented problems later in the race. In extreme cases, excess moisture of the feet's skin has caused separation of the outer layers of skin on the bottom of the feet. I cringe just thinking about that.

Q: Why is duct tape better than almost anything else in fixing blisters and hot spots?

JV: Duct tape is one of the greatest all-purpose tools for the outdoor athlete. A good grade of duct tape is very sticky, slippery on the outside to reduce friction over any surface, and conforms to the shape of the user'sfoot. Properly applied, duct tape will provide protection to the skin and can be worn for days. It can patch hot spots and blisters anywhere on the foot,even between the toes.

Q: What are the most important things for backpackers to know about proper foot care?

JV: Backpackers are fairly evenly divided between wearing lightweight shoes and leather boots. In each case, the most important factor is fit. The shoe or boot must fit well and be comfortable for days, weeks, or months. Moisture-wicking socks help keep the skin healthy. Whenever stopping for abreak or to eat, take off your shoes and socks and allow your feet to breath, and change socks mid-day.

Q: Ruined feet knock have knocked more adventure racers out of competition than virtually anything else. Any advice here?

JV: First and foremost, pick your shoes carefully. For any athlete, fit is vital. Bring proactive can save your feet. Five minutes of patching a hotspot can prevent blisters later. Keeping moisture under control can help reduce skin maceration and its resulting blisters. All the uphills and downhills require good toe room in your shoes otherwise toe blisters andblack toenails will slow your speed. For a race of any length, make a foot care kit and learn how to fix any problem.

Q: What is trench foot? I heard it was a big problem for racers in Borneo, Philippines, and Brazil.

JV: Trench foot is a serious nonfreezing cold injury that develops when the skin of the feet is exposed to the combination of moisture and cold for extended periods. The combination, in boots or shoes that constrict the feet, for periods of 12 hours or longer, can cause skin tissue to die. Due to the cold, wet, and constricting environment inside the shoe, blood vessels constrict, reducing circulation to preserve heat loss. With the resulting lack of oxygen and nutrients in the blood, toxins build up and skin tissue begins to die. The skin reddens and becomes numb. Swelling follows with associated itching and tingling pain. When the skin rewarms, blisters form and when they fall off, ulcers develop, then open and weep or bleed. This is sometimes called ‘jungle rot'. Open blisters and cracks on the skin allow bacteria to enter the body. Fungal infections love this environment. When feet appear swollen and blisters develop, medical attention is necessary. Left untreated, amputation may be required.

Q: What is your stance on barefoot running? Do shoes actually lead to foot and ankle injuries?

JV: I know several runners who swear by barefoot running or running without socks. I see no harm in trying it, but personally, I like shoes and socks around my feet. Going barefoot can help toughen the skin of the feet, and without the support of the shoe, your ankles can become stronger but most people cannot do that on a regular basis. However, over the past years shoeshave improved dramatically. The components of today's shoes and boots give wearers more stability, comfort, and motion control.

Q: The Tarahumara Indians are known for running 100 miles in sandals made from discarded tires. What is their secret for success?

JV: Years of hill running have toughened their feet. Because of the footwear they use, the muscles, tendons and ligaments of the feet have all become stronger and tougher. We, on the other hand, have soft feet and ours are accustomed to the comfort and support of shoes. In a sense we have become creature of comfort.

Q: What bangs up an athlete's feet more? A race in the desert heat like the Badwater, or Western States with all of the elevation climbing and descending?

JV: Each has the ability to wreck a racers feet. Any mountainous event with relentless uphills and downhills, mixed with trail dirt and grit, and stream and river crossings, can destroy feet. The extreme heat of Badwater, coupled with running on the cantered side of the asphalt road or the rocks on its side, can cause swelling of the feet, and horrendous blisters. An Eco-Challenge type event, over multiple days with extreme ranges of temperature and terrain, will stress your feet to the maximum. A desert event, like the six-day Marathon des Sables, with its heat and unforgiving sand and rocks, will tear up the skin on your feet. In each case, knowing how to prevent problems, how to fix problems, and having the necessary foot care kit is vital. I always emphasize, in my book and to those with whom I talk, that all our feet are different and we must each find what works for us, in the conditions we play in.

Q. Which brand of running and hiking shoes do you own?

JV: I choose my running and hiking shoes for function and purpose, just like my clothes: Nike Air Max for road training and Montrail for trails. Just as important are the socks, and I swear by SmartWool socks for great wear and comfort.

Q: Your thoughts on RailRiders clothing and how they perform for you.

JV: I discovered RailRiders clothing when I was preparing to help at the 2000 Badwater in Death Valley. I wore the Eco-Mesh Shirt, Rampage Shorts and Weatherpants throughout the four days of working in the heat with runners and their crews. After living in RailRiders for days, I can see why they are the clothes of choice for serious athletes.

To subscribe to Vonhof's footcare e-zine, go to Fixing Your Feet is available through RailRiders. 300 pages. $15.95.