Injuries of Endurance Barefoot Water Skiing
The following is a discussion about foot injuries due to endurance barefoot water skiing. This article is merely the point of view and experiences of barefoot water skiers who have dealt with these injuries on one level or another. It also includes information from several physicians who have treated barefooters’ injuries. What is being presented here are opinions with no medical endorsement- purely the experiences of barefooters, and the medical professionals who have been interviewed to gain some additional information and understanding. The range of barefooters that have offered information is what will be referred to as beginners to world class and all levels in between. Hopefully this information will help other barefooters and possibly physicians in treating these wounds because what really matters is how you deal with the wound so that you heal quickly and get back on the water.
Barefoot endurance water skiing has been around since barefooting began in 1947. Barefoot water skiers have been trying to go farther and longer since the very first step off. The human competitive spirit takes over when the competition begins whether it is individuals out for a weekend ski or an organized tournament. What comes next is how many different ways we can compete: timed oval, figure eight, head to head, or team endurance racing. In all cases there has been one common problem many barefooters have had to deal with and that is blisters or deep tissue bruises, as we will refer to them for this discussion.
How do you practice for endurance? It is simple, you go as far and as long as you can. For racing you add one other component; you go as fast as you can. You continue to do this repeatedly to build muscle, strength and basic endurance. The feet swell and get sore but that soon goes away and the skier is right back out there pushing the body to the next level.
Many people will experience some sort of blister or deep tissue bruise. Some blisters are just what you picture when you hear the word blister, a raised circular area filled with fluid just under the surface of the skin. The fluid can be clear or a mixture of blood and fluids.
The deep tissue bruise is different in that the area might not be raised or might have just a slight swelling. It shows up as a dark spot under the skin or might look like a large blood blister without the normal accompanying bump. The skin also might “blanch” and look like no blood is circulating there. This can last minutes, days or months.
There are very few podiatrists or doctors who know what these injuries look like or understand anything about them. Some are gaining knowledge from having repeat patients. Some wound clinics seem to be the best equipped to deal with such wounds because they try to get to the root of the injury for proper healing. Their approach to the injury is to heal it not deal with it.
Among the barefooters the age old question is to cut the blister or bruise or not to cut it. Most doctors or podiatrists shy away from opening any injury. It seems the wound clinics will lean toward trying to get the injury to heal from the inside out which is likely to lead to eventually opening up the wound.
Some of the smaller blood blister injuries have been healed rather uneventfully by opening the injury and allowing the fluid to escape so that the healing process can begin. The larger injuries might not heal as easily due to the amount of injury below the skin, much like an iceberg. In these situations the surface skin heals before the inner tissue. It is similar to having a large blister or bruise and not opening it.
It seems that larger bruises that are left to heal on their own so that the body can absorb whatever is under the surface can eventually open up. This results in a small crater with or without some type of fluid that may show signs of infection. Either way, the area is now an open wound that does not seem to heal quickly due to scarred or damaged tissue, or immature tissue and damage that has resulted in several months of not healing. It is also possible to have infection in the deteriorating tissue.
These open areas most likely must be scrapped or cleared of any dead or infected tissue to allow proper healing. Wound clinics will use different materials, (silver nitrate or colloidal) to pack the open wound to promote healing. This process can also lead to several months of no water time. Most clinics will request that the individual limit their walking activity at the very beginning of the injury. Peter Fleck has found that buying a pair of Crocks and cutting a space in the sole of the shoe helps take the pressure off the wound to allow it to heal and also removes some of the discomfort. It is important to make the hole in the footwear large enough to keep the skin from sliding on the underlying skin.
Mike Jenkins
Barefoot-endurance injury
My personal experience of a foot injury wasn’t the best time of my life. I’ve had many injuries before from wrecks and stiches, to back and neck pain, to bruised ribs.
The day it all started I was skiing around 41-42 mph practicing for distance and of course my friends were pushing me and cheering for me to go just a little bit farther until I felt a burning sensation. So, I figured I’d try to change my position or start to move around more and it just got worse, so I let go.
After getting into the boat, I had a black and blue bubble on the heel of my right foot. Of course, I had blood blisters before but never like this. So, I sent a few pictures to some topnotch barefooters and some said I should cut it some said don’t. I went to the ER and they told me to keep it closed and clean. I figured the doctors knew best. I continued on the healing journey so to speak and after a week or so the injury area got very hard and flat like a rock. I figured after that point the area would heal underneath and the top layer would come off and be good to go.
I started skiing on the injury again and went to the Buckethead race in Ohio. After skiing I checked the injury and it was still closed at that point. I figured suck it up and keep skiing. I went home after the race and practiced for Mon Mania. So, I went to ski Mon Mania and after that race the hard flat area became an open deep wound. I made some phone calls and ended up at a wound clinic.
So now I’m at the wound clinic and the doctor told me they were going to have to open the area up even more and start the healing process with packing using collagen, repacking and cleaning everyday twice a day. They told me that the blood hardened and created tunneling underneath the area. I could stick my pinky finger down inside the wound area.
They told me if I would of come to them or cut and drained the injured area within the first couple of day’s it would have healed in 2-3 weeks. Since skiing created more trauma and deeper bruising, I could barely walk on the foot. So, the injury happened in August and after returning to the wound clinic weekly until December, and being on crutches November and December because I kept walking on it which created an area that still had bleeding and pressure, I was finally released at the end of December.
I had a scab on it until March when I skied at WBC. When I skied there, I used glue on the area to protect the scab from coming off. Well that didn’t work! So, I went another month or so without skiing on the foot until the new scab came off on its own. Still to this day the area is a callus and still feels bruised.
From my experience with this injury, I’d recommend that if you get an injury like this please go to the wound clinic because they specialize in this type of injury. The ER had no clue other than keep it clean. I missed out on what I love to do. I missed out on traveling to WBC to train and enjoy time with my friends. If this happens to you, don’t be stubborn and not get it checked because we all think were tough and don’t need help. Playing with my kids, hunting and just everyday tasks were harder.
Please use caution and take care of our feet! Because if you have a love for skiing and can’t do it, your body and mind will be affected by this injury if not properly checked by a wound clinic.
Respectfully submitted by
Michael Jenkins, ABC Eastern Region Director, 3 year barefooter
Mike Jenkins foot injury and during the healing process.
Dr. Martin Levine
Those of us that get to barefoot waterski as regularly as I have (multiple times a week between early April and into December) experienced foot burn and or bruising. Sometimes your first run of the day needs to be cut short because of constant increasing irritation and possibly damage. If we stop our run early enough, we can get back into the rotation and find that we have no symptoms on the second run. Why? Unfortunately, I haven’t found anyone with the answer. Sure, faster speed, hotter water, longer runs all seem to make the symptoms occur more frequently.
My first blister on my left heel was at the Blairfoot Bananza around 2005. It occurred on a 19 second run! (Yes, the seaplane landed, crossed the lake and took off again in front of the boat) I fell on the wake and didn’t rate a re-ride from driver Paul McDonald. I relieved the pain by opening the blister to let out the blood. It healed on its own but has been a weakness ever since. Why didn’t I get a blister on the right foot? Same speed, water temp, etc. I don’t know. But whenever I have pain from bruising or discolored (white) skin, it’s always the left heel. I also cannot explain why I was able to ski at 44-45 mph 120 feet behind an outboard in preparation for Mon Mania without having any symptoms on that heel. Sure it looked white, but didn’t hurt or blister.
Those that saw me ski at this year’s Blairfoot Bananza may have noticed that I wore a 1.5 mm booty on my left foot. I preceded that tourney with a few days in Ocklawaha with BF3/Don Simon where I again burned a blister on my first run. Then I opened the blister and kept skiing with the booty on that left foot. While it did heal over, the deep pain continues. I waited two weeks before starting weekly debridement at a wound center. Concern about it healing slowly and maybe compromised blood flow prompted an MRI which was negative for infection, inflammation, circulation issues or tissue derangement. While I am almost completely healed, I know this will probably continue to be a weak spot, prone to future issues.
Submitted by Dr. Martin Levine, long time barefooter
Martin Levine’s foot injury at its worst
John Cornish
My experience of barefooting spans 56 years. I have seen many foot injuries and have had a few of my own, which I will briefly describe here. In my years of barefooting I have done my share of endurance barefooting from the early oval endurance tournaments, figure 8’s, recreational and endurance racing.
Years ago I developed a small black blister, about the size of a pencil eraser, which I elected to open. It drained and healed rather quickly and I had no further problems. I should point out that I was much younger then when wounds heal quickly.
In 2021, at age 69 I got involved in endurance racing again. I entered the Buckethead, Mon Mania and Dam to Dam-it. I was able to do my part in each race making runs of 2.5 – 6 minutes at top speed. Prior to the Dam to Dam-it I was practicing at speeds of around 48 mph. I had no signs of injury or problems
At the Dam to Dam-it I was the starting skier for our team going for 5.5-6 minutes at 47 mph in various kinds of water at about 66 degrees. As soon as I got in the boat I knew there was a bad spot on my right heel on the inside. I skied 4 more times about 2.5-3 minutes each time icing it in between runs.
The injury was oval shaped, approximately 1” long and .5“wide. It looked like a black spot under the surface of the skin with no bubble or anything on the surface except for feeling a bit hard. There was no real pain just an odd feeling, like a numbness or maybe like having something in your shoe.
After 2 months I went to a podiatrist that did a sonogram but it seemed he did not really understand the injury or my questions. The sonogram showed a very thin dark line in the tissue of my heel.
A month later I went to an orthopedic surgeon, Dr. James Jackson, who specializes in foot and ankle injuries. He immediately identified my injury as a Morel-Lavallee lesion. He Googled this injury to show me some images to further explain it. In simple terms it is a separation of one of the layers of skin/tissue from the others, basically due to the pulling and friction of the water on the outer layer of skin. He explained how it is common on the hip or butt of motorcycle crash victims from hitting and sliding across the pavement. The example sonograms of hips and thighs looked identical to mine except on a smaller scale. There was also a diagram showing how the injury occurs.
I am treating my injury with a compression sock and tape in an attempt to help the separated tissue reattach. Only time will tell if this will be successful and what might follow. Below is a picture of John
Cornish’s foot 3 months after the injury occurred.
While we discuss these injuries, we must remember that there are numerous variables. Every barefooter has a different body type and structure in addition to having a variety of medical issues that can impact how our bodies work and deal with bruises an/or injuries. A veteran barefooter’s feet will most likely react differently to the continuous pounding when compared to that of a rookie because of accumulated fitness. However, a more aged skier may also begin to see that fitness diminish.
Another variable that can have an impact on our injuries is the water temperature as well as the water conditions: being rough, glass or just a slight ripple. The chemical composition or the sediment content of the water may also be a variable.
Every individual is different and barefoot water skis in different conditions and situations but we all have the unfortunate risk of getting a bruise or blister. Podiatrist Dr. Joe Funk describes the barefoot injuries as a“repetitive contusion injury” in the soft tissue of the foot due to the pounding, the friction and generated heat.
He also talked about the mindset of the barefooter who pushes themselves and their bodies to the limits which allow for the creation of these foot injuries. Over time, after years of accumulating these blisters or deep tissue bruises, there may be a cumulative problem. Peter Fleck, a World Record holder barefoot water skier and Endurance Champion has had surgery to remove the residual tissue from his foot. Once his doctor opened his foot he found numerous pieces of tissue that he removed. This tissue might be called scar tissue by the layman but professionals may refer to it as” bursa”. This recovery took a couple of months and the full results are not yet known however the early indications are positive.
Dr. Funk recently performed surgery on Peter’s foot to remove damaged tissue. The following pictures are Peter Fleck’s foot injuries in various stages and the damaged tissue removed from his foot.
“Superficial blisters are a result of torsion, tissue planes moving against each other. The deep tissue change Peter had started as a blister, the repetitive contusion resulted in the deep tissue changes. The foreign body and infection necessitated the surgical resection.” Dr. Joe Funk
It seems that there are different levels and or types of barefoot water skiing foot injuries. The Morel-Lavallee lesion may be the beginning or early injury before it turns into a blister. The diagram below taken from Google explains how the injury occurs.
What does all this mean about how we handle these injuries and what do we do to prevent them?
The purpose of this article is just that, to start more of a discussion and raise more questions. Barefooters need to know what to do with injuries and how to approach the medical professionals. The question still remains as to which medical professional you should approach. How do we share this information with the medical field? We know the injuries will occur with the question of how we deal with them.
All barefoot water skiers that experience a foot injury are encouraged to seek medical attention as things sometimes can only get worse. The treatment of these injuries is still a work in progress.
The next subject for consideration is how we prevent these injuries. We know that coats of glue and other substances may help but are not the answer. Is taping a solution? What are your thoughts on these discussion issues?
Contributors:
Dr. Martin Levine,
Dr. Joe Funk
Mike Jenkins,
John M. Cornish II, Ed. D.
