So blisters...
(not trolling just interested in an informal polite discussion)
I know the medical sites state friction as a primary cause, but in my experience it's more pressure than friction. Shoes fitting loose but with some movement don't give me blisters at all.
But then the medical sites seem to all agree to not pop blisters when I've overwhelmingly heard the opposite advice from pilgrims. In fact my mother told me to use white thread to pop them. When I asked if blue would do she chuckled and admitted that was just what she was told as a child in Austria.
Thoughts?
Ahh darn it I just noticed the title as boots and backs. My bad. Apologies!
Below are a couple of things I've posted before. Perhaps they will help clarify things a bit
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Blisters are a product of friction.... often referred to as shear force friction. The skin of your foot, and the sock that is in contact with that area of skin, are sliding and rubbing together.
Strategies for the prevention of shear force friction and blisters have changed and matured over recent years.
- A properly fitting shoe. In brief, it needs to be long enough and wide enough to accommodate any insoles, orthotics, metatarsal pads, etc, PLUS the socks that you will be wearing, PLUS the increased pressure on the feet from wearing a loaded pack.
- Light padded Merino wool sock designed for walking or backpacking, or the same type of sock in a good synthetic blend. A heavy pad on a sock allows potentially more movement against the skin, takes longer to air out, and takes longer to dry when washed.
- A sock fit that is snug and form fitting to the foot, but not gangrene-inducing tight. You want the shear force to be between the sock and the interior of the shoe, not the sock and the skin. A snug fitting sock will help to make that happen.
- Allow the shoe to move over the sock a bit. By keeping the shoes a bit looser on the feet, the sock will take the brunt of the shear force. If a shoe is tied snug, then that forces the foot to move more in the sock, which means the sock and skin are absorbing the shear force. An exception occurs on long downhill grades; the shoes need to be tied tight enough to keep your toes from hitting the front of the shoe which can cause injury and trauma to the nail bed and toe joints.
- While there are foot lubricants, from Body Glide and Hiker's Goo to plain old vaseline, they have a fairly short viable working span as the material rubs off of the skin and is absorbed by the socks. For prophylactic protection from shear force friction to blister prone areas on the feet, a long lasting barrier is the better option. The placement of tapes, like Leukotape P, or moleskin-type products, if adhered correctly, will last the whole day.
- To apply tapes and moleskin type products,
- Clean off the area of application with a bit of alcohol to remove grease, dirt, and body oils. A bit of regular hand sanitizer works for this, in addition to hand cleansing.
- Cut a piece of your chosen barrier material to fit the area you want protected; be sure to cut rounded corners rather than square in order to help the material from rolling up away from the skin.
- Apply a thin smear of Tincture of Benzoin to the skin area where the adhesive will stick. This will increase the holding power of the tape or moleskin.
- If the tape or moleskin, etc. is going on top of a blistered area, avoid getting the Benzoin on the roof area of the blister, and add a thin coating of ointment/vaseline onto the blister roof, avoiding the surrounding skin area. This will allow removal of the product without hurting the blister wound.
- Place the barrier on the area, taking care to not handle the adhesive; spend a bit of time rubbing the material to create friction so that the adhesive will heat up and adhere more firmly.
- At the end of the day, remove the barrier and use some alcohol to wipe the area that was covered.
- Since fungus (athletes foot) and pathogens splash around in showers, shower shoes are not necessarily preventative to one's feet being exposed or infected. It is helpful to use an alcohol or astringent product applied to the feet after showering.
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As with most things in life, there are variables to consider when treating blisters. There are two primary choices:
- Do not drain the blister.
- 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:
- That first step is to leave an intact blister intact and 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 walk more comfortably with a blister.
However, it assumes:
- 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.
- If the blister still has it's '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; a disposable scalpel blade or a hobby knife blade as part of a first aid kit.
- 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 creme, 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 adhering to the wound.
Blister Dressing
A primary issue is getting whatever method of dressing 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.
