So What’s the Rub on Blisters?

Brandon RaceI remember my first cross country race all too painfully.  I was a naive high schooler who had just started running cross country half way through the season.  I always hated running and decided the best way to learn to love it was to jump in head first.  At my first run I made two huge mistakes: 1) Try out my new running shoes and 2) Try out my new arch supports.  Needless to say, but the end of the run I felt like I had needles lining the arch of my foot and I ended up with bilateral 3in x 2 inch blisters lining the arches of my feet that kept me out of running shoes for the next week.

Blisters are all too common in hiking, sports and even poorly broken in women’s footwear.  As always the best practice is to try to prevent them before they happen.

How do I prevent them?

Barriers are the best method, placed either before the blisters form or as soon as they develop.  Whatever the barrier is (Micropore paper tape, cloth tape, Elastikon, Kinesio tape, Moleskin, Spenco Blister pads, Blisto-O-Ban, duct tape), it needs to be adherent to the skin and resistant to the normal shear forces and humidity which will inevitably occur (1).  This way, the shear forces will occur between the barrier and the shoe instead of the skin and the shoe.  The advantages of paper tape are its thin and seamless application, whereas ductape is thick and tends to wrinkle which can lead to pressure points.  As well, its stickiness causes a tendency to remove the top layer of epidermis with removal (ouch!) (1,2).  Acrylic socks (vs. cotton) have also shown to have benefits in the prevention of blister formation by wicking away moisture (3).

Here is a quick break down on the different barrier products (1,2):

  • Micropore Paper Tape: Porous, easy to apply, multi-day; not water resistant, best for preventive taping
  • Leukotape: Porous, easy application (slightly thicker)
  • Blist-O-Ban: easy application, very thin, water resistant, multi-day; use over mild blister 
  • Elastikon: Porous, easy application; best for heel or sole of foot
  • Moleskin: Easy application, best to form doughnut around a blister for protection
  • Spenco 2nd Skin: Easy application, best for blisters with no skin cover
  • Compeed: easy application, water resistant, multi-day; difficult to remove
  • Duct tape: Strong, easy application, multi-day; difficult to remove, tendency to wrinkle

There is conflicting data regarding antiperspirant use, and its benefits seem to be rivaled by the increased incidence of skin irritation seen with its use (2).  Powders are also best avoided due to their tendency to clump, and may actually increase propensity for blisters.  Lubricants provide a very brief decline in the rate of blister formation, but their benefits are virtually gone within an hour of application (shown to probably increase friction over the ensuing hours) and are probably not worth it in the end (1,3).J Run

What if I already have a blister?

The best way to treat a symptomatic blister is to drain it, but care should be taken to clean the instrument used to puncture the blister as well as the overlying skin to avoid infection.  However, if the blister is not painful and unlikely to rupture, drainage may not be necessary.  Either one small hole or several small holes should be created at the margins of the blister to drain the fluid, and care taken to keep the roof as intact as possible.  Keeping the holes at the margins allows the pressure of walking to continue to express fluid.  Afterwards, cover it with an absorbent adhesive bandage that extends past the blister’s edge.  Paper tape is a good first layer overlying the blister, followed by a shaped adhesive tape to secure it (1,2).  However, on toe blisters it is best to only use paper tape.  If wrapping circumferentially, try not to overlap the tape as it may constrict the blood supply to the digit.  Heel blisters are generally covered with a ‘cup’ fashioned out of Elastikon that is cut in an “H” shape, where the middle part of the “H” is placed at the apex of the heel and the two arms are wrapped one parallel to the sole around the heel and the other perpendicular to the sole cupping the plantar aspect of the heel (1).  The ball of the foot can be taped using paper tape similar to other blisters and then a butterfly shaped piece of adhesive tape in which the middle portion of the butterfly lies between the digits (1).   Blood blisters should not be drained if possible, and if they are drained should be covered with antiseptic ointment before taped.  Uniquely, infected blisters should be de-roofed, cleaned with povodone-iodine and covered with antiseptic ointment before taping.

 

1. Auerbach, P. (2012). Foot Problems and Care. In Wilderness medicine(6th ed., pp. 580-591). Philadelphia, PA: Elsevier/Mosby.

2. Lipman, G., & Scheer, B. (n.d.). Blisters: The Enemy of The Feet.Wilderness & Environmental Medicine, 275-276.

3. Quinn, R., Wedmore, I., Johnson, E., Islas, A., Anglim, A., Zafren, K., . . . Mazzorana, V. (n.d.). Wilderness Medical Society Practice Guidelines for Basic Wound Management in the Austere Environment: 2014 Update.Wilderness & Environmental Medicine.