Relentless Forward Progress_ A Guide to Running Ultramarathons - Bryon Powell [55]
Proper attention prevents your feet from turning into a disaster. (Photo courtesy of Alison Hanks)
If you routinely experience blistering during long runs, consider pre-taping the areas of your feet that give you the most problems. Pre-taping techniques are also outlined in Mr. Vonhof ’s book.
Hang around ultrarunners long enough and you’re bound to hear about black toenails. No, these runners aren’t necessarily into nail polish. Rather, they’ve experienced blood or other fluid pooling under one or more of their toenails, technically known as subungal hematoma. Black toenails can be caused by acute trauma such as kicking a rock or by the toenail repeatedly hitting the front of the shoe, especially during downhills. If the toenail pain becomes unbearable, you can lance it to relieve the pressure. When the discoloration or pooled fluid extends to the tip of the toe, you can lance the pool by inserting a sterilized needle through the skin in front of the nail. When the fluid doesn’t extend to the front of the toenail, you’ll have to gently lance the pool through the toenail itself. Be sure to sterilize any lancing tools, to apply antibiotic ointment to the opening, and to monitor the affected toe in the days that follow. It is normal for the toenail to fall off in the months that follow.
Rhabdomyolysis and Kidney Failure
It should come as no surprise that severe muscle breakdown is common in ultramarathons. When skeletal muscle breaks down, it releases the protein myoglobin and other muscle components into the bloodstream. When severe, this muscle breakdown, known as rhabdomyolysis (rhabdo), can be harmful to the kidneys and, rarely, lead to acute kidney failure as the kidneys become clogged with myoglobin. I will stress that kidney-damaging rhabdo is rare; however, ultrarunners must be aware of the condition, its causes, its warning signs, and how to avoid it.
Rhabdo is most frequently seen in hot, mountainous, 100-mile races. There are good reasons for this. Rhabdo-inducing muscle breakdown is enhanced by eccentric muscle contractions. Eccentric muscle contractions occur when running downhill. Damage caused during eccentric muscle contractions is exacerbated by running down technical terrain and steeper descents as well as when descending when your running form has broken down due to fatigue. Obviously, the farther you run, the more opportunity there is for muscle breakdown to occur. In addition, the dangers of rhabdo are greatly increased by dehydration, which frequently occurs during ultras, particularly in hot weather. While it’s common for urine to transition from clear to yellow during an ultra, precautionary steps for rhabdo should be taken when urine becomes cola-colored.
If you’re a pacer, crew, or aid station volunteer and you suspect that a runner in your care has rhabdo, err on the side of caution in seeking medical attention. That often comes in the form of medical staff at the race.
Initial treatment of possible rhabdo is the same as for dehydration. That means oral rehydration with an electrolyte beverage or intravenous saline solution, depending on severity and availability. Finishing a race and heading right off to bed to recover is one of the worst things you could do. Rhabdo and associated kidney risks persist after the run is complete. Sleeping deprives you of the chance to rehydrate, while your kidneys remain subject to clogging. You’re in the clear once you can urinate well with the urine color returning to normal shades. On the other hand, if flu-like symptoms develop, seek medical attention.
In extreme cases, hospitalization and hemodialysis will be necessary to prevent further kidney damage. On the upside, numerous ultrarunners who have been hospitalized for rhabdo have returned to top-level