The Skin Battle: Endurance Training in Prosthetics and Orthotics

Leaning against a sun-baked streetlight, I untie my shoe, raise my right leg, and investigate the damage. A flap of skin hangs loose beneath a wound. The sting itself is nothing, pain is familiar territory. What upsets me is the math that follows: infection or pressure sores equal downtime.

I’m only one mile into a seventeen-mile run.

I weigh pride against caution and head home, clean the wound, bandage it, and layer with lubricant. The run isn’t over yet, but caution flags are raised. 

In 2024, I developed a brutal pressure sore on my lower right limb. The skin became so sensitive that even a light gust of Mojave desert wind shot pain signals to my brian. Every time I wore the Exosym, a sharp burning sensation flared across the sore, like a lit match pressed against the skin. This friction was due to the carbon fiber support on the lateral side of the device.

I tried everything, such as prosthetic and running skin ointments, bandages, wound care routines, and none of it worked. I sent the Exosym back to the clinic multiple times for adjustments, hoping each modification would finally relieve the pressure. It never did.

The worst moment didn’t happen running. It happened at Disneyland. Right outside Star Tours, I sat down on a bench with my family, trying to regroup from the pain. I was close to tears and this surprised me. I’ve endured reconstructive surgeries to my face and lower limbs. I understand pain. Compared to those experiences, this sore was minor, but pain doesn’t always scale logically. This was different because it was constant, sharp, impossible to ignore once it reached its peak, and the only thing that relieved the pain was not moving.

Worst of all, the pressure sore was derailing my training for my first ultramarathon in April 2024. Every missed mile felt like the race was slipping further away.

Eventually, I flew to the Exosym clinic in Gig Harbor. This time, inside the clinic, Ryan Blanck worked his magic and the Exosym was adjusted and I could run without that sharp burning pain. But healing lagged behind progress. 

Even two months later, on the starting line of my first ultramarathon, the pressure sore still hadn’t fully disappeared. I was able to finish my first ultramarathon because of Ryan’s adjustments.

Skin problems are common for individuals wearing AFOs, hybrid prosthetic-orthotics, and prosthetics. For Exosym runners, building the skin tolerance necessary for ultramarathon distances will take years. 

As my mileage increased, my skin gradually became more resilient. Between 2022 and 2025, I experienced hundreds of separate skin tears caused by friction, most of them beneath the cuff. This was the same when I wore dynamic AFOs prior to wearing hybrid prosthetic-orthotics. The vast majority of tears were incredibly minor. They became part of the routine, another maintenance issue to manage alongside hydration, pacing, and recovery.

Through experimentation, I learned that to minimize skin breakdown I need to do the following:

1. Dial in my devices to ensure correct fit and thus avoid unwanted movements that cause friction. This especially includes ensuring the cuff is not overly tight or loose.
2. Wearing quality prosthetic sleeves and running socks mattered more than I initially realized. I use Zensah prosthetic sleeves designed specifically for the Exosym. Zensah is the best option. Even outside of the prosthetics world, Zensah makes some of the best athletic sleeves available.
3. On meaningful long runs, lubrication of the skin is mandatory. I use the Trail Toes, Squirrel Nut Butter, or AdaptSkin. I am hoping to develop my own.
4. Check skin every 10-15 miles on long runs. Yes I lose a lot of time by doing this, but losing some minutes to prevention is much better than losing weeks to an injury.

When the skin breaks down, then treatment becomes a balancing act between protection, healing, and continuing training, so I do the following:

1. Cover the wound with Tagaderm. If the wound is especially painful, then I will place a thin piece of gauze, coated with neosporin, beneath the Tagarderm. After which, I will add a very small amount of skin lubricant over the center of the tagaderm itself and then slide on my Zensah prosthetic sleeve. The key is minimizing bulk because too much padding will create new friction points. Learning what works requires experimentation. 
2. Change prosthetic sleeves and running socks often, especially when it’s hot. This will minimize bunching that accelerates skin breakdown. 
3. Remove device(s) as much as possible. I remove Exosyms when on the couch, etc.

People see the finish lines. They don’t see the destroyed skin beneath the prosthetic sleeves or the constant fight to keep friction from ending the run before it begins.

Ultrarunning in an Exosym requires years of conditioning skin to withstand the friction created by pressure, movement, heat, sweat, and swelling. These forces are powerful enough to tear tissue apart at any given moment. 

Reality is, the races lasted hours to several days.

The skin adaptation took years.

 

Published on May 27, 2026