Blister Treatment Strategies

[davebugg]

As with most things in life, there are two variables for treating blisters:

1. Do not drain the blister.
2. Drain the blister and keep it drained.

The concern about draining a blister is that it can provide a route of infection because the skin is opened, allowing some exposure to a wound. While this is true, it is also true that with proper care the risk is low.

To keep a blister intact, a highly experienced Forum member, dougfitz, provided this guidance:

• The first step is to leave an intact blister intact a,nd not to puncture it as a first response.
• The priority should be to protect the blister roof by using an island dressing or cutting a doughnut shape to fit over the blister that will protect it from both direct pressure and further shear stress.
• You can make the doughnut from a couple of layers of ordinary moleskin, or a single layer of padded moleskin, and keep that in place with Fixomull or a similar conforming tape.

This post is primarily focused on treating a blister by draining it. It is meant to provide guidance into the best practices in order to be able to walk more comfortably with a blister. However, it assumes some things:

• You are not going to take time off to let your blister start to heal.
• You are needing or wanting to continue walking with your blister.
• The blister is prominent and large enough to cause discomfort while walking.
• There is some likelihood that the blister’s ‘roof’ will become ripped or torn while you are walking.

Blister treatment falls under hygiene level two. So, clean hands (soap and water, or hand sanitizer, or rubbing alcohol, etc.). All that needs to be done is to cleanse hands so that the level of potential pathogens is reduced to below the level which could cause infection to this type of wound.

Also, any product used to dress the blister should be clean as well. It doesn't have to be sterile, but should at least be in its protective packaging.

1. If the blister still has its 'roof', it is recommended to leave the 'roof' intact, but to drain the fluid. Needles are not the ideal tool, as the initial puncture can reseal later, allowing fluid to build up again. A disinfected tool (alcohol or flame from a lighter/match) which can create a slit at the base of the blister near the skin of the foot is best --- a pair of tiny scissors to snip a slit, or a disposable scalpel blade, or a hobby knife blade can be a part of a first aid kit.
2. If the blister has 'de-roofed', then trim off any skin tag which might flap back into the raw open wound.

Preparing the wound for dressing

1. Cleaning the wound by flushing away any debris away with clean water or a mild dilution of hydrogen peroxide. Pouring or squirting the wound is fine, but any dirt particles sticking to the wound MUST be cleared away.

2. A topical antibiotic ointment, not cream, is gently applied after the blister wound is dry. The ointment serves two purposes: it reduces any risk of infection and it prevents any dressing material from inadvertently sticking to the wound.

Blister Dressing

A primary issue is getting whatever method of dressing that is to be used -- be it taping, Moleskin, hydrogel pads, bandaids, etc. --- to stick and remain in place, which can sometimes be a huge challenge.

Here are a few strategies to help.

1. Use hand sanitizer or alcohol to clean the skin area, not the wound, to which the tape or dressing will be stuck to. Get as much dirt and body oils removed as is possible.

2. To the cleansed skin, apply a thin smear of Tincture of Benzoin then allow to dry. Do not put any directly on the wound. This will multiply the holding power of the adhesive that is used. If you aren’t familiar with it, think of it as rubber cement for the skin.

I carry a few crushable ampules of the stuff. You can get them on Amazon or at a pharmacy

3. When the adhesive is finally applied, rub the area of the tape or moleskin or Compeed or etc... The idea is to create heat from the friction to allow the adhesive to warm and adhere better.

For dressing a blister, this NOLS video does a good job of describing the methods which work best. For a blister with a roof, I like to place a hydrogel dressing, like Spenco, to the top of the blister and them use Leukotape P or Omnifix or etc... to affix the dressing in place. The hydrogel provides basic cushioning and additional protection, helping the tape to reduce additional damage to the wound.

For a de-roofed blister, the addition of the ointment to the open wound is applied prior to the hydrogel being put into place. The hydrogels are package and designed to be sterile. Bandaging is done as previously described.

IF the blistered area, whether roofed or de-roofed, is so tender it is uncomfortable to walk on as treated above, then remove the dressing and then redress the blister the same way as before, but with the addition of using the 'doughnut' padding as the NOLS video demonstrates.

Unless additional attention is needed, it is best to leave the dressing in place until the end of the day. Then, remove the dressing, re-cleanse the wound, shower, cleanse, apply ointment, and redress for evening activities. At bedtime, remove the dressing, re-cleanse and apply antibiotic ointment and wear a clean sock.

The next morning, carefully evaluate for any sign of infection, and apply ointment and redress the area for a new day of walking. Check again for signs of infection periodically during the day without removing the covering. If the wound seems worse, then think about taking at least a day off to let the wound do a bit of healing. Even a half-day off your feet can be of help.

To help evaluate a blister for infection:

With freshly and thoroughly washed hands (alcohol based hand sanitizer will work, too), feel the area around the blister for signs of:

• warmth
• foul smell
• pus
• pain
• swelling
• holes or peeling skin
• the area bleeds when you touch it or doesn’t seem to be healing at all.

If any of these symptoms occur, you need to be seen by a medical provider for proper evaluation and treatment.

Be aware that even if the blister has been left intact, it is still possible for infection to occur, so evaluate ALL blisters, intact or not.

 

[VNwalking]

Dave, once again, many thanks for this sharing.
You are a font of valuable information!

One resource to add is this is a link to a publication by Rebecca Rushton, who treats ultra runners feet for a living - and so she knows the kinds of blister problems we have while walking day after day.

https://www.caminodesantiago.me/community/resources/a-guide-for-blister-prevention.603/

 

[PadreW]

Timely advice. I've got barely a month before my Camino starts so training this year is brief and intense.

A recurring issue for me is blisters under my pointer toe. Tried the shoe string trick that puts more pressure on the front of the ankle, taped everything, and use Vaseline, still happening. Usually I drain it and have a hallow toenail for a while until it falls off. The only pain is before I drain it.

 

[Marbe2]

Dave, once again, many thanks for this sharing.
You are a font of valuable information!

One resource to add is this is a link to a publication by Rebecca Rushton, who treats ultra runners feet for a living - and so she knows the kinds of blister problems we have while walking day after day.

https://www.caminodesantiago.me/community/resources/a-guide-for-blister-prevention.603/

As with most things in life, there are two variables for treating blisters:

1. Do not drain the blister.
2. Drain the blister and keep it drained.

The concern about draining a blister is that it can provide a route of infection because the skin is opened, allowing some exposure to a wound. While this is true, it is also true that with proper care the risk is low.

To keep a blister intact, a highly experienced Forum member, dougfitz, provided this guidance:

• The first step is to leave an intact blister intact a,nd not to puncture it as a first response.
• The priority should be to protect the blister roof by using an island dressing or cutting a doughnut shape to fit over the blister that will protect it from both direct pressure and further shear stress.
• You can make the doughnut from a couple of layers of ordinary moleskin, or a single layer of padded moleskin, and keep that in place with Fixomull or a similar conforming tape.

This post is primarily focused on treating a blister by draining it. It is meant to provide guidance into the best practices in order to be able to walk more comfortably with a blister. However, it assumes some things:

• You are not going to take time off to let your blister start to heal.
• You are needing or wanting to continue walking with your blister.
• The blister is prominent and large enough to cause discomfort while walking.
• There is some likelihood that the blister’s ‘roof’ will become ripped or torn while you are walking.

Blister treatment falls under hygiene level two. So, clean hands (soap and water, or hand sanitizer, or rubbing alcohol, etc.). All that needs to be done is to cleanse hands so that the level of potential pathogens is reduced to below the level which could cause infection to this type of wound.

Also, any product used to dress the blister should be clean as well. It doesn't have to be sterile, but should at least be in its protective packaging.

1. If the blister still has its 'roof', it is recommended to leave the 'roof' intact, but to drain the fluid. Needles are not the ideal tool, as the initial puncture can reseal later, allowing fluid to build up again. A disinfected tool (alcohol or flame from a lighter/match) which can create a slit at the base of the blister near the skin of the foot is best --- a pair of tiny scissors to snip a slit, or a disposable scalpel blade, or a hobby knife blade can be a part of a first aid kit.
2. If the blister has 'de-roofed', then trim off any skin tag which might flap back into the raw open wound.

Preparing the wound for dressing

1. Cleaning the wound by flushing away any debris away with clean water or a mild dilution of hydrogen peroxide. Pouring or squirting the wound is fine, but any dirt particles sticking to the wound MUST be cleared away.

2. A topical antibiotic ointment, not cream, is gently applied after the blister wound is dry. The ointment serves two purposes: it reduces any risk of infection and it prevents any dressing material from inadvertently sticking to the wound.

Blister Dressing

A primary issue is getting whatever method of dressing that is to be used -- be it taping, Moleskin, hydrogel pads, bandaids, etc. --- to stick and remain in place, which can sometimes be a huge challenge.

Here are a few strategies to help.

1. Use hand sanitizer or alcohol to clean the skin area, not the wound, to which the tape or dressing will be stuck to. Get as much dirt and body oils removed as is possible.

2. To the cleansed skin, apply a thin smear of Tincture of Benzoin then allow to dry. Do not put any directly on the wound. This will multiply the holding power of the adhesive that is used. If you aren’t familiar with it, think of it as rubber cement for the skin.

I carry a few crushable ampules of the stuff. You can get them on Amazon or at a pharmacy

3. When the adhesive is finally applied, rub the area of the tape or moleskin or Compeed or etc... The idea is to create heat from the friction to allow the adhesive to warm and adhere better.

For dressing a blister, this NOLS video does a good job of describing the methods which work best. For a blister with a roof, I like to place a hydrogel dressing, like Spenco, to the top of the blister and them use Leukotape P or Omnifix or etc... to affix the dressing in place. The hydrogel provides basic cushioning and additional protection, helping the tape to reduce additional damage to the wound.

For a de-roofed blister, the addition of the ointment to the open wound is applied prior to the hydrogel being put into place. The hydrogels are package and designed to be sterile. Bandaging is done as previously described.

IF the blistered area, whether roofed or de-roofed, is so tender it is uncomfortable to walk on as treated above, then remove the dressing and then redress the blister the same way as before, but with the addition of using the 'doughnut' padding as the NOLS video demonstrates.

Unless additional attention is needed, it is best to leave the dressing in place until the end of the day. Then, remove the dressing, re-cleanse the wound, shower, cleanse, apply ointment, and redress for evening activities. At bedtime, remove the dressing, re-cleanse and apply antibiotic ointment and wear a clean sock.

The next morning, carefully evaluate for any sign of infection, and apply ointment and redress the area for a new day of walking. Check again for signs of infection periodically during the day without removing the covering. If the wound seems worse, then think about taking at least a day off to let the wound do a bit of healing. Even a half-day off your feet can be of help.

To help evaluate a blister for infection:

With freshly and thoroughly washed hands (alcohol based hand sanitizer will work, too), feel the area around the blister for signs of:

• warmth
• foul smell
• pus
• pain
• swelling
• holes or peeling skin
• the area bleeds when you touch it or doesn’t seem to be healing at all.

If any of these symptoms occur, you need to be seen by a medical provider for proper evaluation and treatment.

Be aware that even if the blister has been left intact, it is still possible for infection to occur, so evaluate ALL blisters, intact or not.

Dave, I can not envision (as on the vdeo) using this doughnut method for a blister.. and then walking 4 more hours? I would think doing this could potentially create another spot by creating friction from the doughnut and tape rubbing inside the shoe? I have used second skin successfully, but a doughnut? Resistant but open....

 

[Plato]

Compeed

 

[kelleymac]

I have used the doughnut method successfully. It can take up room in the shoe and create other pressure points where blisters form. This is yet one more reason you don't want too small shoes!

When I've helped people on the camino with their blisters, I often tell them they need bigger shoes-- but they are used to shoes that "support" the foot. (Support being a euphemism for "squash a bit".) I also wonder if pilgrims' feet are just growing in muscle mass and that is the reason for too small shoes...

 

[Rick of Rick and Peg]

Compeed

Please do not just recommend Compeed like that, explain its pros and cons. There are times and ways to use it where it is good but there are times and ways where it can make things worse. See my comments below.

Dave, thank you for this. I hope you won't mind me suggesting you make a few edits to clear things up a bit. I'm posting publicly so anyone whose read your original post see my suggestions too.

Cleaning the wound by flushing away any debris away with clean water or a mild dilution of hydrogen peroxide. Pouring or squirting the wound is fine, but any dirt particles sticking to the wound MUST be cleared away.

Cleaner water is even better. If you have a water filter for drinking water use it. Preferably you want to use not just clear water but water that has had bacteria removed from it or killed (say by an ultraviolet light or, if at an albergue, boiling).

A primary issue is getting whatever method of dressing that is to be used -- be it taping, Moleskin, hydrogel pads, bandaids, etc. --- to stick and remain in place, which can sometimes be a huge challenge.

Laymen may not recognize the word hydrogel. You could add that for hydrogel pads the brand name that most often comes up is Compeed.

For a blister with a roof, I like to place a hydrogel dressing, like Spenco, to the top of the blister and them use Leukotape P or Omnifix or etc... to affix the dressing in place. The hydrogel provides basic cushioning and additional protection, helping the tape to reduce additional damage to the wound.

I'm not sure about Spenco pads but I've seen plenty of warnings that using Compeed over a roofed blister is risky because its adhesive is strong enough that it can tear the roof off a blister when the bandage is removed. Also that the edge of the adhesive may come lose when walking and then adhere to the sock so removing your sock could tear the roof. I know you have advised previously that the edges of Compeed should be secured with a perimeter of tape to prevent this.

Unless additional attention is needed, it is best to leave the dressing in place until the end of the day. Then, remove the dressing, re-cleanse the wound, shower, cleanse, apply ointment, and redress for evening activities. At bedtime, remove the dressing, re-cleanse and apply antibiotic ointment and wear a clean sock.

How should this be worded for Compeed and other hydrogels? I have already mentioned the risk in tearing a roofed blister but I've also read that hydrogel bandages should be left on open wounds to do their magic.

 

[JerryStroebele]

For blister PREVENTION information, read Jon Vonhof's book "Fixing your Feet, Injury Prevention and Treatments for Athletes - People who push the limits of their feet - runners, walkers, hikers, adventure racers, climbers, soldiers, dancers and more." Vonhof treated feet of long distance runners for 20 years. Get the 6th edition, 2017, with a new chapter on blister prevention. Wilderness Press. $20 at REI.

 

[davebugg]

Cleaner water is even better. If you have a water filter for drinking water use it. Preferably you want to use not just clear water but water that has had bacteria removed from it or killed (say by an ultraviolet light or, if at an albergue, boiling).

Hi, Rick, and I do appreciate your feedback. I don't mind any suggestions at all, as I appreciate any additional insights that can be beneficial.

Tap water that has had additional treatment certainly can't hurt to use. The reason I didn't specifically state such additional treatment is that for this type of wound, normal tap water is sufficient since this is not an 'open' wound per se as there is still a dermal layer. Cleansing and flushing are designed to act in the same manner as handwashing, which is to reduce contaminants that could further damage the underlying dermal layer. If there are any lingering pathogens, the topical cream application will assist in that as the blister is dressed.

Perhaps instead of a generic 'clean' water, specifically stating bottled or tap water might be a good qualifier.

Laymen may not recognize the word hydrogel. You could add that for hydrogel pads the brand name that most often comes up is Compeed.

You are correct about the the generic term 'hydrogel' being less familiar to folks. I did mention the Spenco product as I prefer this to Compeed blister treatment coverings, which does use hydrogel technology but in a much different manner from Spenco Second Skin as a blister treatment. Compeed, due to its adhesive application, makes it more difficult to monitor blister healing, has been known to hinder blister healing, and user error can aggravate damage to the blister wound.

Given that Compeed products are a Common Camino Commodity, it may be of benefit to address these products as well.

I'm not sure about Spenco pads but I've seen plenty of warnings that using Compeed over a roofed blister is risky because its adhesive is strong enough that it can tear the roof off a blister when the bandage is removed.

You've identified one reason why I prefer Spenco pads; they are non adhesive. I never recommend Compeed on a roofed blister precisely because of your concern.

Also that the edge of the adhesive may come lose when walking and then adhere to the sock so removing your sock could tear the roof. I know you have advised previously that the edges of Compeed should be secured with a perimeter of tape to prevent this.

In applications where Compeed can be used as directed by the manufacturers, much of the delamination of the adhesive can be resolved by the steps I described using specific methods to strengthen adhesion to the surrounding skin. Removing oils and dirt with alcohol or alcohol based hand sanitizers, applying Tincture of Benzoin following instructions, and when the Compeed is applied spend time rubbing the stick-on area so that friction heat will more fully activate the adhesive. And, yes, I would still cover the entire dressing with an overlay of a tape, like Fixomull or Leukotape p.

How should this be worded for Compeed and other hydrogels? I have already mentioned the risk in tearing a roofed blister but I've also read that hydrogel bandages should be left on open wounds to do their magic.

Adhesive backed hydrogel products like Compeed products are said to create a bacteriostatic environment if applied according to direction, which is why the instructions want it left in place until it sort of falls away and is then removed. By that time, it is assumed that the dermal layers have been sufficiently regenerated, whether or not they are then proactively protected from re-blistering or injury.

So, basically, Compeed use does not allow for wound checking and monitoring, or cleansing. That issue with Compeed can probably be mentioned as a side note for that treatment stage.


Again, I much appreciate your feedback and food for thought, amigo

 

[trecile]

It's my understanding that Compeed should be used on de-roofed blisters only

 

[lisaflora]

As with most things in life, there are two variables for treating blisters:

1. Do not drain the blister.
2. Drain the blister and keep it drained.

The concern about draining a blister is that it can provide a route of infection because the skin is opened, allowing some exposure to a wound. While this is true, it is also true that with proper care the risk is low.

To keep a blister intact, a highly experienced Forum member, dougfitz, provided this guidance:

• The first step is to leave an intact blister intact a,nd not to puncture it as a first response.
• The priority should be to protect the blister roof by using an island dressing or cutting a doughnut shape to fit over the blister that will protect it from both direct pressure and further shear stress.
• You can make the doughnut from a couple of layers of ordinary moleskin, or a single layer of padded moleskin, and keep that in place with Fixomull or a similar conforming tape.

This post is primarily focused on treating a blister by draining it. It is meant to provide guidance into the best practices in order to be able to walk more comfortably with a blister. However, it assumes some things:

• You are not going to take time off to let your blister start to heal.
• You are needing or wanting to continue walking with your blister.
• The blister is prominent and large enough to cause discomfort while walking.
• There is some likelihood that the blister’s ‘roof’ will become ripped or torn while you are walking.

Blister treatment falls under hygiene level two. So, clean hands (soap and water, or hand sanitizer, or rubbing alcohol, etc.). All that needs to be done is to cleanse hands so that the level of potential pathogens is reduced to below the level which could cause infection to this type of wound.

Also, any product used to dress the blister should be clean as well. It doesn't have to be sterile, but should at least be in its protective packaging.

1. If the blister still has its 'roof', it is recommended to leave the 'roof' intact, but to drain the fluid. Needles are not the ideal tool, as the initial puncture can reseal later, allowing fluid to build up again. A disinfected tool (alcohol or flame from a lighter/match) which can create a slit at the base of the blister near the skin of the foot is best --- a pair of tiny scissors to snip a slit, or a disposable scalpel blade, or a hobby knife blade can be a part of a first aid kit.
2. If the blister has 'de-roofed', then trim off any skin tag which might flap back into the raw open wound.

Preparing the wound for dressing

1. Cleaning the wound by flushing away any debris away with clean water or a mild dilution of hydrogen peroxide. Pouring or squirting the wound is fine, but any dirt particles sticking to the wound MUST be cleared away.

2. A topical antibiotic ointment, not cream, is gently applied after the blister wound is dry. The ointment serves two purposes: it reduces any risk of infection and it prevents any dressing material from inadvertently sticking to the wound.

Blister Dressing

A primary issue is getting whatever method of dressing that is to be used -- be it taping, Moleskin, hydrogel pads, bandaids, etc. --- to stick and remain in place, which can sometimes be a huge challenge.

Here are a few strategies to help.

1. Use hand sanitizer or alcohol to clean the skin area, not the wound, to which the tape or dressing will be stuck to. Get as much dirt and body oils removed as is possible.

2. To the cleansed skin, apply a thin smear of Tincture of Benzoin then allow to dry. Do not put any directly on the wound. This will multiply the holding power of the adhesive that is used. If you aren’t familiar with it, think of it as rubber cement for the skin.

I carry a few crushable ampules of the stuff. You can get them on Amazon or at a pharmacy

3. When the adhesive is finally applied, rub the area of the tape or moleskin or Compeed or etc... The idea is to create heat from the friction to allow the adhesive to warm and adhere better.

For dressing a blister, this NOLS video does a good job of describing the methods which work best. For a blister with a roof, I like to place a hydrogel dressing, like Spenco, to the top of the blister and them use Leukotape P or Omnifix or etc... to affix the dressing in place. The hydrogel provides basic cushioning and additional protection, helping the tape to reduce additional damage to the wound.

For a de-roofed blister, the addition of the ointment to the open wound is applied prior to the hydrogel being put into place. The hydrogels are package and designed to be sterile. Bandaging is done as previously described.

IF the blistered area, whether roofed or de-roofed, is so tender it is uncomfortable to walk on as treated above, then remove the dressing and then redress the blister the same way as before, but with the addition of using the 'doughnut' padding as the NOLS video demonstrates.

Unless additional attention is needed, it is best to leave the dressing in place until the end of the day. Then, remove the dressing, re-cleanse the wound, shower, cleanse, apply ointment, and redress for evening activities. At bedtime, remove the dressing, re-cleanse and apply antibiotic ointment and wear a clean sock.

The next morning, carefully evaluate for any sign of infection, and apply ointment and redress the area for a new day of walking. Check again for signs of infection periodically during the day without removing the covering. If the wound seems worse, then think about taking at least a day off to let the wound do a bit of healing. Even a half-day off your feet can be of help.

To help evaluate a blister for infection:

With freshly and thoroughly washed hands (alcohol based hand sanitizer will work, too), feel the area around the blister for signs of:

• warmth
• foul smell
• pus
• pain
• swelling
• holes or peeling skin
• the area bleeds when you touch it or doesn’t seem to be healing at all.

If any of these symptoms occur, you need to be seen by a medical provider for proper evaluation and treatment.

Be aware that even if the blister has been left intact, it is still possible for infection to occur, so evaluate ALL blisters, intact or not.

Wow. Over the top! Good for you. It can also be much easier if you choose the simple route

As an ER physician, I always use this method:
* rupture with clean safety pin and drain
* Leave roof intact
* Wash with soapy water daily. Let dry.
* Apply triple antibiotic ointment
* Cover with protector of your choice [I cut the middles out of a bandaids..cheap] and duct tape. I hiked 3 months on App Trail with this method. No infection. No pain. Simple.

 

[trecile]

Wow. Over the top! Good for you. It can also be much easier if you choose the simple route

@davebugg is always very thorough.

 

[davebugg]

Dave, I can not envision (as on the vdeo) using this doughnut method for a blister.. and then walking 4 more hours? I would think doing this could potentially create another spot by creating friction from the doughnut and tape rubbing inside the shoe? I have used second skin successfully, but a doughnut? Resistant but open....

I know, it intuitively makes you go 'what the heck, won't that create more issues or discomfort'?

The action of the doughnut does not concentrate pressure at a singular point, but is spread out so that the relatively compressible 'doughnut' goes largely unnoticed as you begin to walk with it. A lot depends on the material of the doughnut and the thickness used, which is why something like molefoams work well; they come in various thicknesses and are very compressible which prevents underlying pressure bruising to occur. Because they are fixed into place on the skin, the do not allow shear force friction to create additional hot spotting.

The donut material does not need to be as 'thick' as in the NOLS video. it only needs to be thick enough to keep the top of the blister from further damage.

Also, the donut technique is one way to accomplish what is needed; there are other methods as well.

 

[Plato]

Wow. Over the top! Good for you. It can also be much easier if you choose the simple route

As an ER physician, I always use this method:
* rupture with clean safety pin and drain
* Leave roof intact
* Wash with soapy water daily. Let dry.
* Apply triple antibiotic ointment
* Cover with protector of your choice [I cut the middles out of a bandaids..cheap] and duct tape. I hiked 3 months on App Trail with this method. No infection. No pain. Simple.

Practical, short and concise..!

I'm sure the typical Camino pilgrim would appreciate the brevity of this protocol.

Also a good idea to use double layered socks or if not, simply wear 2 pairs of socks to minimize friction and decrease the probability of blisters.

 

[trecile]

You've identified one reason why I prefer Spenco pads; they are non adhesive

I didn't realize that some hydrogel dressings are non adhesive. Although I've only had a couple of tiny blisters in over 3000 km of Camino walking, it sounds like the Spenco product might be a good addition to my kit.

 

[davebugg]

Wow. Over the top! Good for you. It can also be much easier if you choose the simple route

As an ER physician, I always use this method:
* rupture with clean safety pin and drain
* Leave roof intact
* Wash with soapy water daily. Let dry.
* Apply triple antibiotic ointment
* Cover with protector of your choice [I cut the middles out of a bandaids..cheap] and duct tape. I hiked 3 months on App Trail with this method. No infection. No pain. Simple.

Thank you, Doc, and and I appreciate and agree with the quicker synopsis, although I prefer not using a needle to drain a blister.

As a combat medic, and as a mountaineer and backpacker who has thru-hiked the PCT and Colorado Trail in addition to the tens of thousands of trail miles over the last 5 decades, I found that draining with a needle puncture would often allow the puncture to reseal and then refill with fluid. A Navy Corpsman I met at a firebase turned me on to slitting with a sterile blade or scissors, as there is far less chance of a reseal occurring.

Duct Tape. . . . it does fix most everything.

 

[Jean-Pierre Vaillancourt]

Hi All, first post to let you know that the most recent edition of Jon Vonhof's book "Fixing your Feet, Injury Prevention and Treatments for Athletes" is coming out in August of this year. Cheers. Jean-Pierre

 

[Rick of Rick and Peg]

Dave (or others), regarding the hydrogel products, can Compeed pads, which so many carry on the caminos, be cut to get rid of the adhesive and thus turn them into something like the Spenco pads you recommend?

If so, then would you say that treatment of hot spots with Compeed as packaged would be fine for preventing hot spots from developing further but both roofed and broken blisters should treated with the modified Compeed?

I have to ask as I haven't even seen a hydrogel product.

 

[Rick of Rick and Peg]

Now, regarding draining a blister, I would advise never to keep the blister draining by running a thread through it and leaving it but what do the experts say?

 

[Former member 91017]

Now, regarding draining a blister, I would advise never to keep the blister draining by running a thread through it and leaving it but what do the experts say?

Medical anthropologist here. I can’t practice medicine, but I can recognize a bad idea when I see it.

Threading is fine for marathoners who will go home at the end of the day, not resume activities the following day, be able to stay out of the dirt etc. For long distance hikers that thread is a bacterial infection super-highway, and I’ve seen *many* threaded pilgrims with *black* wounds from the silliness.

 

[Camino Chrissy]

I have used Compeed on hot spots, and have never had a blister develop; I love it. That said, I can see why it is frowned upon for using on true blisters as its adhesive properties are amazing. I can wear it in the shower and it stays put. That daid, I imagine it would be painful pulling it off a full blown blister.

 

[trecile]

In my opinion, it's a waste of money to use Compeed on hot spots when a piece of moleskin, tape, or a bandage would work as well and be less expensive.

 

[Former member 91017]

In my opinion, it's a waste of money to use Compeed on hot spots when a piece of moleskin, tape, or a bandage would work as well and be less expensive.

Sometimes I think this is a real issue of YMMV. I’m allergic to most adhesives, but Compeed (or the equivalent product under the BandAid name in North America) works great for me. By which I mean: does what I need it to do, and not burn my skin with regular adhesive.
I still carry some form of hyrdogel all the time. But since I started wrapping trouble spots with hiker’s wool I don’t get blisters anymore anyway.

 

[Camino Chrissy]

In my opinion, it's a waste of money to use Compeed on hot spots when a piece of moleskin, tape, or a bandage would work as well and be less expensive.

I have also used moleskin instead of compeed...they have seemed pretty much "one in the same" to me. Maybe my memory is not serving me well? Oh, I've used duct tape with good results, too.

 

[Camino Chrissy]

Now, regarding draining a blister, I would advise never to keep the blister draining by running a thread through it and leaving it but what do the experts say?

From his past posts, I'd say @davebugg says "No way, Jose!"

 

[trecile]

I have also used moleskin instead of compeed...they have seemed pretty much "one in the same" to me. Maybe my memory is not serving me well? Oh, I've used duct tape with good results, too.

My point is that Compeed is pretty expensive, whereas moleskin and duct tape are cheap.

 

[JohnMcM]

There are very, very many posts with questions about blisters, their prevention and their treatment within this forum. I have found the questions to always be honest, open and genuinely seeking help and guidance. Likewise the answers offering guidance about their prention and treatment to be well meant and we’ll intentioned.

In that vein I offer my blister prevention routine as a consideration.

Carry as little weight as possible, drink lots of water, stop every 2 hours or so, take off your boots and socks, let your socks and your feet dry out. Say hello to you your toes, thank them for their work, let them see where they are and then carry on.

 

[davebugg]

Now, regarding draining a blister, I would advise never to keep the blister draining by running a thread through it and leaving it but what do the experts say?

No. . no thread. Bacteria introduced into a fluid media, kept at body temperature is perfect for culturing yucky things. You cannot sterilize threads and KEEP them sterile while inside a blister.

The thread thingy was an attempt to keep needle punctures open and draining.

 

[Marbe2]

I have used Second Skin by Spenco for many years. I much prefer it to compeed as I can easily take it off at night or as needed and reclean the wound without the gel sticking to the wound.
.

 

[Ronald Boivin]

As with most things in life, there are two variables for treating blisters:

1. Do not drain the blister.
2. Drain the blister and keep it drained.

The concern about draining a blister is that it can provide a route of infection because the skin is opened, allowing some exposure to a wound. While this is true, it is also true that with proper care the risk is low.

To keep a blister intact, a highly experienced Forum member, dougfitz, provided this guidance:

• The first step is to leave an intact blister intact a,nd not to puncture it as a first response.
• The priority should be to protect the blister roof by using an island dressing or cutting a doughnut shape to fit over the blister that will protect it from both direct pressure and further shear stress.
• You can make the doughnut from a couple of layers of ordinary moleskin, or a single layer of padded moleskin, and keep that in place with Fixomull or a similar conforming tape.

This post is primarily focused on treating a blister by draining it. It is meant to provide guidance into the best practices in order to be able to walk more comfortably with a blister. However, it assumes some things:

• You are not going to take time off to let your blister start to heal.
• You are needing or wanting to continue walking with your blister.
• The blister is prominent and large enough to cause discomfort while walking.
• There is some likelihood that the blister’s ‘roof’ will become ripped or torn while you are walking.

Blister treatment falls under hygiene level two. So, clean hands (soap and water, or hand sanitizer, or rubbing alcohol, etc.). All that needs to be done is to cleanse hands so that the level of potential pathogens is reduced to below the level which could cause infection to this type of wound.

Also, any product used to dress the blister should be clean as well. It doesn't have to be sterile, but should at least be in its protective packaging.

1. If the blister still has its 'roof', it is recommended to leave the 'roof' intact, but to drain the fluid. Needles are not the ideal tool, as the initial puncture can reseal later, allowing fluid to build up again. A disinfected tool (alcohol or flame from a lighter/match) which can create a slit at the base of the blister near the skin of the foot is best --- a pair of tiny scissors to snip a slit, or a disposable scalpel blade, or a hobby knife blade can be a part of a first aid kit.
2. If the blister has 'de-roofed', then trim off any skin tag which might flap back into the raw open wound.

Preparing the wound for dressing

1. Cleaning the wound by flushing away any debris away with clean water or a mild dilution of hydrogen peroxide. Pouring or squirting the wound is fine, but any dirt particles sticking to the wound MUST be cleared away.

2. A topical antibiotic ointment, not cream, is gently applied after the blister wound is dry. The ointment serves two purposes: it reduces any risk of infection and it prevents any dressing material from inadvertently sticking to the wound.

Blister Dressing

A primary issue is getting whatever method of dressing that is to be used -- be it taping, Moleskin, hydrogel pads, bandaids, etc. --- to stick and remain in place, which can sometimes be a huge challenge.

Here are a few strategies to help.

1. Use hand sanitizer or alcohol to clean the skin area, not the wound, to which the tape or dressing will be stuck to. Get as much dirt and body oils removed as is possible.

2. To the cleansed skin, apply a thin smear of Tincture of Benzoin then allow to dry. Do not put any directly on the wound. This will multiply the holding power of the adhesive that is used. If you aren’t familiar with it, think of it as rubber cement for the skin.

I carry a few crushable ampules of the stuff. You can get them on Amazon or at a pharmacy

3. When the adhesive is finally applied, rub the area of the tape or moleskin or Compeed or etc... The idea is to create heat from the friction to allow the adhesive to warm and adhere better.

For dressing a blister, this NOLS video does a good job of describing the methods which work best. For a blister with a roof, I like to place a hydrogel dressing, like Spenco, to the top of the blister and them use Leukotape P or Omnifix or etc... to affix the dressing in place. The hydrogel provides basic cushioning and additional protection, helping the tape to reduce additional damage to the wound.

For a de-roofed blister, the addition of the ointment to the open wound is applied prior to the hydrogel being put into place. The hydrogels are package and designed to be sterile. Bandaging is done as previously described.

IF the blistered area, whether roofed or de-roofed, is so tender it is uncomfortable to walk on as treated above, then remove the dressing and then redress the blister the same way as before, but with the addition of using the 'doughnut' padding as the NOLS video demonstrates.

Unless additional attention is needed, it is best to leave the dressing in place until the end of the day. Then, remove the dressing, re-cleanse the wound, shower, cleanse, apply ointment, and redress for evening activities. At bedtime, remove the dressing, re-cleanse and apply antibiotic ointment and wear a clean sock.

The next morning, carefully evaluate for any sign of infection, and apply ointment and redress the area for a new day of walking. Check again for signs of infection periodically during the day without removing the covering. If the wound seems worse, then think about taking at least a day off to let the wound do a bit of healing. Even a half-day off your feet can be of help.

To help evaluate a blister for infection:

With freshly and thoroughly washed hands (alcohol based hand sanitizer will work, too), feel the area around the blister for signs of:

• warmth
• foul smell
• pus
• pain
• swelling
• holes or peeling skin
• the area bleeds when you touch it or doesn’t seem to be healing at all.

If any of these symptoms occur, you need to be seen by a medical provider for proper evaluation and treatment.

Be aware that even if the blister has been left intact, it is still possible for infection to occur, so evaluate ALL blisters, intact or not.

 

[Ronald Boivin]

This advice is very sound!!!! Follow it! On my first Camino two toes became gangrenous because I only treated them with topical antibiotics. I was on antibiotics for nearly three months including my return to Canada. Nearly lost one toe. The pain oh the pain! I walked on in spite of it! On the second Camino, I also got blisters but they were treated with iodine and antibiotics twice a day. No infection! Yeah! Some people are more prone to getting blisters as I am. Please heed the wise advice above.

 

[VNwalking]

Lambswool.
Paper tape.
My foot-kit low-tech essentials.
I predictably get blisters between certain small toes, and so I swear by these two things for prevention. Each affected toe gets a wrap of the paper first aid tape, and for the worst offenders I put a thin wrap of lambswool on top of that. In the US, Dr. Scholls sells it. Both are lightweight, easy to carry - and the lambswool is as natural as they come.

Edit, after reading @Ronald Boivin 's post.
Blisters aren't trivial!
If I do get one, the betadine powder comes to the rescue. Unlike liquid, it's lightweight, never leaks, and helps dry out a seepy de-roofed blister. I get it here in Asia, and have not seen it in pharmacies in the west. But the internet has many options. I get the simple powder, not an aerisolized spray.

 

[Former member 91017]

Lambswool.
Paper tape.
My foot-kit low-tech essentials.
I predictably get blisters between certain small toes, and so I swear by these two things for prevention. Each affected toe gets a wrap of the paper first aid tape, and for the worst offenders I put a thin wrap of lambswool on top of that. In the US, Dr. Scholls sells it. Both are lightweight, easy to carry - and the lambswool is as natural as they come.

Oh, that’s interesting.

I have my problematic broken toe that healed with a 90 degree inward trajectory. Blistered on every camino… but now I also use the wool and have tested it on endurance treks of 65 K in a single day… Anyway, I use a foot chafing protector as the first step (my favourite is the Compeed brand because I like how it smells, but Life brand makes an equivalent “diabetic foot care stick” or Body Glide for feet is also good). My second step is the wool wrap, and I secure the bad toe to the one beside it with a sort of figure-8 wrap.

I have an extremely pronounced heel bone and a very pronounced ankle bone that can become quite hot, so I hit those with the stick as well.

Socks: merino, weight determined by temperature; Wright sock double-layer ankle socks if I’m wearing hiking sandals.

At night I sleep with my feet sticking out of my bedding in fresh/dry/cool circulating air (I forget what the circumstances were for learning that trick, but it was a nurse before Belorado who observed that bandages have the hazard of trapping moisture and growing bacteria, that the advice to “keep your feet dry and cool” applied also at night, and — absent a need to get up in the night — letting wounds have fresh air and an opportunity to dry was “best practice”). She was great for chiming in that I was correct about never threading blisters, and she observed that in the tremendous heat that year many pilgrims who were so happy not to be finding themselves needing to pee during the day were in “modest kidney failure” that would probably not have any lasting effects, but which was a problem all the same.

My best product lesson for blister treatment is the specially saturated burn gauze dipped in wax (Jelonet is one brand). When I received first aid care for the blister I deroofed in a misstep over a metal shower threshold, the farmacia did the saline wash, the sterile trimming, and then wrapped the fragile skin in the waxed gauze. Over that we put dry gauze and then one of those first aid toe socks. It took 3 days but it healed beautifullly and I still finished my walk in time to get the “in vicarie pro” compostela for my friend’s mother who had died the previous year on that date.

 

[Crosscheck]

I use the needle, alcohol, and thread blister treatment and I never had an infection from the procedure. The key to its success is to keep your feet clean and dry. I soak the thread in alcohol and pull the thread back and forth several times a day. I remove the thread after three days.

Your blister will not return and the area is still protected by skin. Additionally, you have not lost any trail time or speed. If you can keep you feet clean and dry this technique is remarkable, if you cannot I'd pass on the thread.

 

[trecile]

I use the needle, alcohol, and thread blister treatment and I never had an infection from the procedure. The key to its success is to keep your feet clean and dry. I soak the thread in alcohol and pull the thread back and forth several times a day. I remove the thread after three days.

Your blister will not return and the area is still protected by skin. Additionally, you have not lost any trail time or speed. If you can keep you feet clean and dry this technique is remarkable, if you cannot I'd pass on the thread.

I'd say that you have been lucky.

 

[VNwalking]

best product lesson for blister treatment is the specially saturated burn gauze dipped in wax (Jelonet is one brand). When I received first aid care for the blister I deroofed in a misstep over a metal shower threshold, the farmacia did the saline wash, the sterile trimming, and then wrapped the fragile skin in the waxed gauze. Over that we put dry gauze and then one of those first aid toe socks. It took 3 days but it healed beautifullly

Thank you, Faye. I learned something today.
So I assume you changed that dressing daily? Or?

 

[Former member 91017]

Thank you, Faye. I learned something today.
So I assume you changed that dressing daily? Or?

Yes, I did. The products in Portugal was called "ParrafinNet", and from my photos I see that I was also using a product from the farmacia called "Aquaphor" and a low adhesive tape called "Peha-Haft"... So I think the order of operations was: Aquaphor, Parrafinet, Peha-Haft, and then a Gel-sock toe cover.

3 days. Amazing.

My photo programme keeps crashing, but I will see if I can get it to work to post the products and the end result.

I tore the blister on the 10th in Porto, limped around town on the 11th, took the train to Barcelos on the 12th, and limped around there on the 13th. By the 14th I was able to start walking again, and by the 15th the blister was healed well enough to wrap it just in wool. And it had been vicious: one of those ones that starts on the bottom and then warps all the way around the nail bed etc.

 

[Crosscheck]

I'd say that you have been lucky.

not lucky but prepared. Sock, shoe, and sizing selections have a lot to do with this. Thru-hikers in the US use this technique and what is really interesting is that the guides on the Tahoe Rim Trail (TRT) do this needle and thread treatment every afternoon. They have to do this to keep a dozen clients moving

 

[JerryStroebele]

Jon Vonhof's book, Fixing Your Feet, has a lot of good information on boots, shoes, socks, etc, and treating blisters. But the chapter on blister prevention in the 6th Edition discusses a new theory of blister causes and a new product to prevent them, the Engo patch. It is a super slippery patch you apply to your boot/shoe to prevent rubbing. Rubbing causes a blister to form when the outer layer of skin stops moving -- because it is rubbing on the boot/shoe -- but the inner layer of skin keeps moving -- because the foot is moving differently than the boot/shoe. Hence, fluid forms between the two layers of skin. A blister! Getting a hot spot? Apply the Engo patch to the part of the boot/shoe where the hot spot is occurring. Actually, wear your footgear a lot well before starting a Camino and apply the patches to your nice, dry boot/shoe. They won't stick to a wet one. I have used them on my last two caminos -- Primitivo and del Norte -- and have greatly reduced, but not entirely eliminated blisters. They are not expensive. Google GoEngo. I carry a lot, to share. (They aren't heavy, either.) I look forward to reading the 7th Edition of Fixing Your Feet before starting the Via de la Plata in September. Gracias, Jean-Pierre

 

[WanderingBrian]

Loose sheep wool wrapped around toes and other potential blister areas worked perfectly for me. It molds right into your sock. Not a blister to be had.

 

[davebugg]

not lucky but prepared. Sock, shoe, and sizing selections have a lot to do with this. Thru-hikers in the US use this technique and what is really interesting is that the guides on the Tahoe Rim Trail (TRT) do this needle and thread treatment every afternoon. They have to do this to keep a dozen clients moving

I appreciate that you have had good success with the threading technique. Let me share how I see the issue.

I would gently disagree that threading a blister is something that very many backpackers in the US do. I base this on having never run across it being done while thru hiking the PCT or Colorado Trail, or over the decades and tens of thousands of backpacking miles I've done. I have not heard it recommended during Wilderness First Aid courses that I have participated in as a team instructor, nor in the various associations I have participated in.

I have heard of those who have done threading, and have even read of individuals that have done so on social media sites focused on outdoor activities like climbing and backpacking and running, so I know it has been done. But there is little objective evidence that it is a common practice. Like the guides you wrote about, the threading issue has been periodically discussed and suggested, but there has been far more negative feedback from health professionals and those of us who see and have dealt with the after effects of threaded blisters.

More importantly, the reason FOR the threading technique itself, to drain the fluid and KEEP it drained, can, ironically, be hindered by the thread material itself, preventing the draining of the fluid as the material swells and seals the punctures. In comparison, incising the blister bleb at the base very seldom will allow the blister to be resealed.

While dealing with soldiers in the field during sick call, I used the thread ( suture line) in blister technique IF the blister had a roof, was still inflated, and made walking uncomfortable. And despite daily inspections of blister wounds and the guys washing the wound areas and applying disinfecting compounds given to them, the incidence of badly infected blisters was higher than for those who had deroofed blisters, which was a higher overall risk for infections. When I was taught about incising a blister if the fluid needed to be drained, and then started implementing that technique, the incidence of drained blisters becoming infected dropped dramatically.

Unless you have absolutely sterile materials and are handling them with sterile gloving and using proper sterile techniques, the part of the thread and needle you handle, and which will be drawn through the blister, is an infection risk. The thread left in place, regardless of material used, will, once it is wet, allow the wicking of bacteria into the blister. The fluid in the blister is a perfect medium for allowing bacteria to grow.

When incising or puncturing a blister, only the tips of the scissors or the disposable blade enter the blister, they can be made and kept disinfected because that area of the instrument is never handled while performing the incision or puncturing.

Your subjective experience is good, my experience is the opposite. The mechanism of infection from threading, if objectively examined, clearly demonstrates that there is far more opportunity for bacterial contamination of a roofed blister to occur, than is the case with either simple piercing by a disinfected needle, or a slit made by blade or scissor.

How one chooses to proceed with threading is that individual's choice. However, when Best Practices clearly defines a best course to follow, individual choices and experience are outweighed - as it applies to treatment advocacy - by what can be objectively determined.

 

[davebugg]

Jon Vonhof's book, Fixing Your Feet, has a lot of good information on boots, shoes, socks, etc, and treating blisters. But the chapter on blister prevention in the 6th Edition discusses a new theory of blister causes and a new product to prevent them, the Engo patch. It is a super slippery patch you apply to your boot/shoe to prevent rubbing. Rubbing causes a blister to form when the outer layer of skin stops moving -- because it is rubbing on the boot/shoe -- but the inner layer of skin keeps moving -- because the foot is moving differently than the boot/shoe. Hence, fluid forms between the two layers of skin. A blister! Getting a hot spot? Apply the Engo patch to the part of the boot/shoe where the hot spot is occurring. Actually, wear your footgear a lot well before starting a Camino and apply the patches to your nice, dry boot/shoe. They won't stick to a wet one. I have used them on my last two caminos -- Primitivo and del Norte -- and have greatly reduced, but not entirely eliminated blisters. They are not expensive. Google GoEngo. I carry a lot, to share. (They aren't heavy, either.) I look forward to reading the 7th Edition of Fixing Your Feet before starting the Via de la Plata in September. Gracias, Jean-Pierre

Thanks, Jerry. You are basically describing sheer force friction, a blistering mechanism that was first posited quite a while ago, so it sounds like the book you keep referring to may be a good reference.

I have done a prolonged gear test with Engo patches and plan to repost the review I wrote very, very soon; I am just now finishing an assessment of what, if any, new changes to the Engo product have recently occurred and if that needs to be considered in the review. Hopefully, this will provide some insight for those who are thinking of using this product.

 

[peregrina2000]

Another sign that the Camino is really coming back to life — first @Damien’s post on hiking poles on the plane, and now this! I say it sincerely — it is a good sign, I think, that we are able to focus on the practical minutia.

I have read thousands of forum posts about blisters. According to the search function I have written 100 posts that contain the word blister. So it is a subject near and dear to my heart.

I am happy to preface my comments with the wonderful report that since I started with trail runners, about 3 years ago, thanks to none other than @davebugg, I have had no more blister problems!! Knock on wood.

I gave up on compeed early on, since the messages were so totally contradictory — ONLY use compeed on an unbroken blister vs. ONLY use compeed on a blister that has popped.

I agree that it is intuitively correct that threading the blister, especially if it closes up again, makes for a petry dish for infection. Which would be a similar issue with Compeed, I guess.

But I had gotten many warnings that cutting off a piece of the skin, big enough to let it drain and to prevent re-closing, was another huge infection risk. But some Dutch friends encouraged me to give it a try, and I had success. It always seemed to me that infection on that type of open wound would be dealt with just like the open wound I currently have on my face where my dermatologist took a scalpel to remove some stuff — keep it clean, keep it covered.

The “do not disturb” approach to blisters leads so many people to having a tiny blister turn into a huge blister. My “snip off a corner when it‘s small”, followed by careful cleaning, medicating, and covering, has nipped that process in the bud in my experience.

But part of the problem and descriptions of inconsistent strategies and treatments may have to do with the fact that blisters can be caused by either pressure (boots too tight) or rubbing (boots too loose).

Thus ends my #101st post with the words blister.

 

[hecate105]

Surely better to not get a blister in the first place...?!
Since meeting David (on the forum) at a pilgrim day in Exeter - I have followed his advice - tying boot laces off around fist - then you cannot overtighten each time you put them on... - take boots n socks off during the day, and any sign of a hot spot - a wad of sheeps wool.
I have never had a blister since!

 

[Former member 91017]

Surely better to not get a blister in the first place...?!
Since meeting David (on the forum) at a pilgrim day in Exeter - I have followed his advice - tying boot laces off around fist - then you cannot overtighten each time you put them on... - take boots n socks off during the day, and any sign of a hot spot - a wad of sheeps wool.
I have never had a blister since!

Of course; but if, for whatever mysterious reasons one remains unable to avoid them having followed advice, it's good to know how best/safest/most effectively to respond to them.

Prevention is better than cure. Effective and safe first aid skill is still a crucial item in one's kit.

 

[kelleymac]

My first camino was painful as I had too small shoes which resulted in numerous blisters and loosing my big toe nails. -- I threaded the blisters and they got infected. The thread may have wicked in bacteria, but another problem was my reluctance and lack of energy to properly clean the blisters. I just wanted to pretend there was no problem. -- My caminos since then have been relatively blister free. My shoes are big enough and I also wrap leukotape in places where I am blister prone. I also support my big toes' nails by wrapping them. And, I give my feet a break in the evenings and wear teva sandals around the albergue.

 

[Crosscheck]

I appreciate that you have had good success with the threading technique. Let me share how I see the issue.

I would gently disagree that threading a blister is something that very many backpackers in the US do. I base this on having never run across it being done while thru hiking the PCT or Colorado Trail, or over the decades and tens of thousands of backpacking miles I've done. I have not heard it recommended during Wilderness First Aid courses that I have participated in as a team instructor, nor in the various associations I have participated in.

I have heard of those who have done threading, and have even read of individuals that have done so on social media sites focused on outdoor activities like climbing and backpacking and running, so I know it has been done. But there is little objective evidence that it is a common practice. Like the guides you wrote about, the threading issue has been periodically discussed and suggested, but there has been far more negative feedback from health professionals and those of us who see and have dealt with the after effects of threaded blisters.

More importantly, the reason FOR the threading technique itself, to drain the fluid and KEEP it drained, can, ironically, be hindered by the thread material itself, preventing the draining of the fluid as the material swells and seals the punctures. In comparison, incising the blister bleb at the base very seldom will allow the blister to be resealed.

While dealing with soldiers in the field during sick call, I used the thread ( suture line) in blister technique IF the blister had a roof, was still inflated, and made walking uncomfortable. And despite daily inspections of blister wounds and the guys washing the wound areas and applying disinfecting compounds given to them, the incidence of badly infected blisters was higher than for those who had deroofed blisters, which was a higher overall risk for infections. When I was taught about incising a blister if the fluid needed to be drained, and then started implementing that technique, the incidence of drained blisters becoming infected dropped dramatically.

Unless you have absolutely sterile materials and are handling them with sterile gloving and using proper sterile techniques, the part of the thread and needle you handle, and which will be drawn through the blister, is an infection risk. The thread left in place, regardless of material used, will, once it is wet, allow the wicking of bacteria into the blister. The fluid in the blister is a perfect medium for allowing bacteria to grow.

When incising or puncturing a blister, only the tips of the scissors or the disposable blade enter the blister, they can be made and kept disinfected because that area of the instrument is never handled while performing the incision or puncturing.

Your subjective experience is good, my experience is the opposite. The mechanism of infection from threading, if objectively examined, clearly demonstrates that there is far more opportunity for bacterial contamination of a roofed blister to occur, than is the case with either simple piercing by a disinfected needle, or a slit made by blade or scissor.

How one chooses to proceed with threading is that individual's choice. However, when Best Practices clearly defines a best course to follow, individual choices and experience are outweighed - as it applies to treatment advocacy - by what can be objectively determined.

The reason this works for me is my use of alcohol to disinfect everything continuously until the the thread is removed. Several times a day I soak the blister and thread with alcohol and I find that the the blister is quite dry and painfree within a day, no sting from the alcohol. I control the condition of the blister from beginning to end by keeping the blister clean, dry, and draining.

I have also used the method of creating a large drain hole on the side of the blister and this works well and requires the same post treatment care as the thread method. Both methods still leave the open wound exposed to a sock and the elements and requires continuous care. Both methods also manage the wound from start to finish.

Having said all of that, I believe success with the pre and post handling of blisters is more attributed to one's personal selection of footwear for walking many days. A different topic

 

[davebugg]

The reason this works for me is my use of alcohol to disinfect everything continuously until the the thread is removed. Several times a day I soak the blister and thread with alcohol and I find that the the blister is quite dry and painfree within a day, no sting from the alcohol. I control the condition of the blister from beginning to end by keeping the blister clean, dry, and draining.

I have also used the method of creating a large drain hole on the side of the blister and this works well and requires the same post treatment care as the thread method. Both methods still leave the open wound exposed to a sock and the elements and requires continuous care. Both methods also manage the wound from start to finish.

Having said all of that, I believe success with the pre and post handling of blisters is more attributed to one's personal selection of footwear for walking many days. A different topic

it is impossible to keep thread in blister disinfected on a continuous basis. Sorry, but it breaks a primary rule of infection control: material that is wet will wick bacteria. Soaking the thread has a short lived effect, it does not provide continuous sepsis control.

Threading and leaving a blister drained by slitting it does NOT have a similar mechanism or the same wound environment. One method leaves a roofed blister with fluid but with a wicking thread inserted and left in situ which can bring bacteria into that body fluid. A blister that is slit to drain fluid does not. The dynamics of draining fluid actually helps to keep bacteria from entering the wound. It is the element of the thread which increases a risk of infection.

Subjective experience is not the same as objective evidence of outcomes. I accept that YOUR experience turned out well for you, but individuals do all sorts of ill advised things and are exceptions to the rules of bad outcomes both in medicine and in social practice. Those who drink and drive do not always get into wrecks and those who do not wear helmets riding a bike do not always suffer traumatic head injuries.

Threading is inadvisable, and should not be part of blister treatment that is publicly recommended. Aside from the fact that it offers no benefit in terms of decreased healing time, it increases the risk of complications.

However, like choosing to not mask or foregoing vaccinations, anyone is free to choose whatever they wish to do.

 

[Crosscheck]

it is impossible to keep thread in blister disinfected on a continuous basis. Sorry, but it breaks a primary rule of infection control: material that is wet will wick bacteria. Soaking the thread has a short lived effect, it does not provide continuous sepsis control.

Threading and leaving a blister drained by slitting it does NOT have a similar mechanism or the same wound environment. One method leaves a roofed blister with fluid but with a wicking thread inserted and left in situ which can bring bacteria into that body fluid. A blister that is slit to drain fluid does not. The dynamics of draining fluid actually helps to keep bacteria from entering the wound. It is the element of the thread which increases a risk of infection.

Subjective experience is not the same as objective evidence of outcomes. I accept that YOUR experience turned out well for you, but individuals do all sorts of ill advised things and are exceptions to the rules of bad outcomes both in medicine and in social practice. Those who drink and drive do not always get into wrecks and those who do not wear helmets riding a bike do not always suffer traumatic head injuries.

Threading is inadvisable, and should not be part of blister treatment that is publicly recommended. Aside from the fact that it offers no benefit in terms of decreased healing time, it increases the risk of complications.

However, like choosing to not mask or foregoing vaccinations, anyone is free to choose whatever they wish to do.

I am not recommending threading to others I am only describing my success with this. Long ago I reluctantly learned this on the trail from others who also have positive results with the practice. Yes, bacteria will enter an opened blister but as I described I treat the wound continuously, with or without a thread. I agree that this technique is not suitable for most people. By the way, I cycle a lot with a helmet, I don't drink and drive, and I have received my two Moderna shots.

 

[jpflavin1]

Wow. Over the top! Good for you. It can also be much easier if you choose the simple route

As an ER physician, I always use this method:
* rupture with clean safety pin and drain
* Leave roof intact
* Wash with soapy water daily. Let dry.
* Apply triple antibiotic ointment
* Cover with protector of your choice [I cut the middles out of a bandaids..cheap] and duct tape. I hiked 3 months on App Trail with this method. No infection. No pain. Simple.

Had to argue with a physician but here is my method.

Alcohol wipe to clean blister area.
Needle with thread attached through blister dome. This allows blister to continually drain.
Clean area again and apply Neosporin and a bandage.
Keep area clean and bandaged until healed.
I have only had 4-5 blisters in 10 Camino's
The best thing to do, imo, is when you start to feel a rub, stop and address it. Blisters do not happen immediately. We feel them coming on. Mine all happened on rainy days and when hiking through snow in ares where I could not stop.

Ultreya,
Joe

 

[jpflavin1]

it is impossible to keep thread in blister disinfected on a continuous basis. Sorry, but it breaks a primary rule of infection control: material that is wet will wick bacteria. Soaking the thread has a short lived effect, it does not provide continuous sepsis control.

Threading and leaving a blister drained by slitting it does NOT have a similar mechanism or the same wound environment. One method leaves a roofed blister with fluid but with a wicking thread inserted and left in situ which can bring bacteria into that body fluid. A blister that is slit to drain fluid does not. The dynamics of draining fluid actually helps to keep bacteria from entering the wound. It is the element of the thread which increases a risk of infection.

Subjective experience is not the same as objective evidence of outcomes. I accept that YOUR experience turned out well for you, but individuals do all sorts of ill advised things and are exceptions to the rules of bad outcomes both in medicine and in social practice. Those who drink and drive do not always get into wrecks and those who do not wear helmets riding a bike do not always suffer traumatic head injuries.

Threading is inadvisable, and should not be part of blister treatment that is publicly recommended. Aside from the fact that it offers no benefit in terms of decreased healing time, it increases the risk of complications.

However, like choosing to not mask or foregoing vaccinations, anyone is free to choose whatever they wish to do.

As you can see from my previous comment, I disagree. This method has worked for me and never had an infection. I would suggest the thread method is no worse than any other choice in a hiking environment.

The best method is to prevent blisters altogether. Pay attention to your feet and respond to hot spots or rub areas immediately.

Ultreya,
Joe

 

[davebugg]

As you can see from my previous comment, I disagree. This method has worked for me and never had an infection. I would suggest the thread method is no worse than any other choice in a hiking environment.

The best method is to prevent blisters altogether. Pay attention to your feet and respond to hot spots or rub areas immediately.

Ultreya,
Joe

And I have treated a lot of soldiers and backpackers who have had infections as a result of threading, so I disagree that threading is no worse.

There is a specific reason why threading was done: to overcome the deficiencies of a needle puncture, which can reseal itself, when used to drain fluid in a roofed blister. Slitting the blister avoids this deficiency obviating the need for the placement of a thread which can introduce bacteria into a close environment.

This thread (no pun intended) was specifically about blister treatment. Avoiding blisters is good advice. If failure to avoid blistering occurs, it is good to have a way of safely and effectively dealing with them.

 

[jpflavin1]

And I have treated a lot of soldiers and backpackers who have had infections as a result of threading, so I disagree that threading is no worse.

There is a specific reason why threading was done: to overcome the deficiencies of a needle puncture, which can reseal itself, when used to drain fluid in a roofed blister. Slitting the blister avoids this deficiency obviating the need for the placement of a thread which can introduce bacteria into a close environment.

This thread (no pun intended) was specifically about blister treatment. Avoiding blisters is good advice. If failure to avoid blistering occurs, it is good to have a way of safely and effectively dealing with them.

I am an ex-soldier. That said, never had a blister in the corps. Many infections are caused by lack of attention to blister once treated. I encountered many soldiers who never kept blister area, once treated, clean or paid attention until a problem. Therefore, I can understand why there might be infections.

I am also not saying any of the methods you recommend are not effective.

All treatments have the possibility of infection, imo. My statements are based on my experiences using the thread treatment, zero infections.

Again, best method is prevention.

Best regards,
Joe

 

[davebugg]

I am not recommending threading to others I am only describing my success with this. Long ago I reluctantly learned this on the trail from others who also have positive results with the practice. Yes, bacteria will enter an opened blister but as I described I treat the wound continuously, with or without a thread. I agree that this technique is not suitable for most people. By the way, I cycle a lot with a helmet, I don't drink and drive, and I have received my two Moderna shots.

I apologize then for addressing your post as advocating for a technique in a thread (no pun intended) devoted on how to safely and effectively treat blisters.

What do you say to folks who would tell you that they have ridden bikes for thousands of miles and have never worn a helmet, so a helmet is not needed? Believe me, from my work in public health with both state and local public health districts, I have heard this said about helmets and other injury prevention issues.

 

[jpflavin1]

I apologize then for addressing your post as advocating for a technique in a thread (no pun intended) devoted on how to safely and effectively treat blisters.

What do you say to folks who would tell you that they have ridden bikes for thousands of miles and have never worn a helmet, so a helmet is not needed? Believe me, from my work in public health with both state and local public health districts, I have heard this said about helmets and other injury prevention issues.

My statements are based on my experiences. This has been an effective treatment for the handful of blisters I have had hiking. I do believe it is a safe and effective way to treat a blister.

I would also not analogize riding a bike without a helmet too treating a blister. Your are comparing a life threatening activity too, at worst, a possible infection.

Dave, if I may address you this way. You have articulated, based on your training and experience, several ways of treating a blister. I have not suggested any of those methods will not work.

My last comment on subject.

Best regards,
Joe

 

[davebugg]

I am an ex-soldier. That said, never had a blister in the corps. Many infections are caused by lack of attention to blister once treated. I encountered many soldiers who never kept blister area, once treated, clean or paid attention until a problem. Therefore, I can understand why there might be infections.

I am also not saying any of the methods you recommend are not effective.

All treatments have the possibility of infection, imo. My statements are based on my experiences using the thread treatment, zero infections.

Again, best method is prevention.

Best regards,
Joe

A Marine calling himself a 'soldier'? Blood has been spilled because members of the Army have mistakenly called a Marine a mere 'soldier'. Heck, I got reamed for referring to a Navy Corpsman, attached to a Marine OP, a 'medic'. I have never made that mistake again.

Yes, untreated or blisters that have been treated and then ignored will have infections occur, but that is a bit of a red herring as this is not the baseline comparative. The comparatives are for the differing rates of infections between threaded and attended vs. unthreaded and attended blister treatments.

I do not dispute your individual outcome. Individual outcomes do not define risks or best practices, however. The do reflect an outcome that occurred despite the risks involved.

I am also not saying any of the methods you recommend are not effective.

As opposed to threading a blister when we are talking about the Best Practices for treatment?

Ignoring the increased infection risk from threading, what is the rationale for using thread inside a blister? To try and overcome a tendency of a blister to refill with fluid because the older technique of draining a blister using a puncture by a needle allows the blister to reseal itself.

What does not occur when using the updated technique of slitting a blister as described in the OP? The blister resealing itself and refilling with fluid.

What is not needed, thereby reducing the increased risk of bacteria infiltrating a closed and moist environment? A thread to keep the blister from resealing itself.

Best Practices no longer uses or needs thread for blister treatment.

 

[C clearly]

C'mon guys. Do we need to declare a winner? Duel at sundown? Military engagement? Popular vote?

 

[davebugg]

C'mon guys. Do we need to declare a winner? Duel at sundown? Military engagement? Popular vote?

You are right. This thread has devolved into argumentative debate.

My intention was to provide a Best Practices model that is scientifically recognized as reducing infection risks, while at the same time allowing continued and normal walking should a blister become too uncomfortable to walk on when it remains filled with fluid.

It is difficult to ignore information that is posted which is objectively and clinically in direct contradiction to medical Best Practices, which to me is quite different than sharing opinions about gear and clothing or blister prevention methods.

When starting this thread, I did not think ahead and consider that it could also have postings attached that are not just contradictory, but also potentially harmful. Is it possible to simply delete the entire thread?

 

[C clearly]

My intention was to provide a Best Practices model

I understand that, but the forum is not a peer-reviewed medical site.

 

[davebugg]

I understand that, but the forum is not a peer-reviewed medical site.

I genuinely agree and understand and will consider that with before posting any guidelines I have put together for things like Plantars Fasciitis and shin splint avoidance, etc. For now, I just did not want a thread which I am responsible for to be associated with potentially harmful advice.

 

[sunwanderer]

My statements are based on my experiences using the thread treatment, zero infections.

People have different microbiomes. Your zero infections may not have anything to do with your treatment methodologies, but rather due to your natural resistance provided by your unique microbiome.

I would suggest the thread method is no worse than any other choice in a hiking environment.

Stating that your treatment is equal to the other treatments mentioned by Dave doesn't make sense. I would like to see any reports and data supporting your statement.

Note that alcohol does kill a broad range of infectants, but its action only lasts for a few seconds. After that, those infectants start closing in again.