Blisters – Andrea Arthur Owan

Blister Care on the Camino de Santiago: A Personal Case Study

The pilgrimage was a success, emotionally and spiritually, and, for the most part, physically! I even got comfortable with carrying 23 pounds. By the end of the trip, I didn’t even notice the weight, and neither did my arthritic back!

Unfortunately, though, I injured my right knee and didn’t stay off of it enough. The last day of walking pretty much did me in. It was too far—15 miles—too fast on a bad leg. Then I tramped 7 miles across Paris to ascend the Eiffel Tour. Now, I’m back to very low daily mileage, icing and making sure I put my leg up every afternoon. That usually means a nap accompanies the leg elevation, which isn’t such a bad way to spend a rainy fall afternoon.

But most of the other days were rousing successes physically, actually better than I hoped, including the blister prevention and management. Here’s a quick rundown on that aspect of my journey:

Daily rituals—

The morning prepto start walking usually went like this:

Make sure all strategic body parts (like the sore left ankle) were clean and properly supported with Kinesiotape.
Kinesiotape the ball of my right foot.
Tape (usually with Kinesiotape) the second, third and fourth toes to avoid blisters.
Slather the heals and toes with Foot Glide cream.
Put the light sock liner on.
Sprinkle Gold Bond medicated foot powder (to absorb moisture) in the main sock, squish it around for good coverage, and put the sock over the liner.
Slide gaiters over my ankles before putting shoes on.
Place lambs wool in the right toe box to cut down on toenail bruising from foot sliding forward in the shoe and banging on the toe box. (This worked wonders! I knew my ballet training with toe shoes knowledge would come in handy some day.)
Insert foot in shoe and make sure no seams or bunched up sock areas are annoying or noticeable.
Properly double tie the shoes and attach gaiters to laces and spread them down around the heals and mid-shoe areas.
Make sure my toes were comfortably spread out while walking rather than scrunched up in the shoes.

Post-walk ritual—

After peeling off soaked clothes and taking a shower, dry feet thoroughly and check for blisters and hot spots, and then check toe nails, cuticles and rough skin that needs trimming and filing. (I tried to keep my feet and toes as smooth as possible, without grinding off all of the calluses on my big toes and heals. I used a fairly rough mani/pedicure board for this.)
Walk around the rest of the afternoon and evening in open-toed flip-flops to make sure my feet stay dry. Sometimes my Kinesiotape stayed on in the shower, so I kept it on the body parts it was anchored to the next day.)
Slather feet with lotion and put socks on to sleep in.

Even with this ritual, which I adhered to religiously, my fourth toes sprung leaks with some nasty blisters; the one on the right toe had two blisters with one under the callus that runs down the middle of my toe. The other toe had a pretty sizeable blister, probably because I didn’t correctly place my blister pressure pad on it a couple of days and ended up increasing the shear rather than decreasing it.

The results—

No matter how hard I tried, I couldn’t keep those fourth toes blister-free, which is probably due to the fact that they curve and twist like little commas, due to all of the time I spent with them hooked around a balance beam while growing up. So I had to do some minor surgery on those.

First steps in dealing with the blisters—

This is where the Spenco 2^ndSkin and moleskin strips and cutouts saved my life.

For several days, I provided extra padding over the blister and around the toe to protect the tender, elevated skin and keep it from breaking. A little piece of Second Skin cut to the length of my toe was placed over the blister and then covered with Kinesiotape or moleskin. If it was just a hot spot I was tending to, I applied a generic blister pad.
Then I decided I needed to do some lancing of the one blister because it appeared to be getting larger. So I sterilized my cuticle scissors and made tiny slices at the base of the blister and gently pushed the fluid from the blister. Then I went through the same padding procedure.
But one blister was a toughy. It kept re-sealing itself, so I kept cutting. Several slices on the last go around to make sure it stayed drained. Then I applied the Second Skin and wrapped it across the top and around with moleskin. To alleviate some pressure and attempt to straighten out the toe a bit, I placed a small wedge of lambs wool between the fourth and third toe.
In spite of pretty fire-red blisters and skin, I walked a lot of mileage without blister pain. Now, about 10 days after completing the walk, I’ve snipped off the dead skin layers. And we’re back in business!

Survival kit—

My toes wouldn’t have survived without my blister care arsenal:

Foot Glide
Double-layered socks
Sock liners
Drymax socks (these are now my favorite go=to socks!)
Moleskin
Spenco 2^ndSkin
Kinesiotape
Toe clippers and scissors and cuticle clippers
Told Bond Powder
Kinesiotape

I also used Desitin Maximum Strength cream for its zinc oxide protection and drying, and its medicated healing capabilities. That was applied at night after a thorough cleaning and drying and before putting on my socks.

Toward the end of the journey, I was measuring and pre-cutting my tape and moleskin to reduce the morning prep time. And I actually had to snap Chris’s Kinesiotape from him to enlist on my feet, legs, knees, and ankles. Good thing for me that he didn’t need it!

Other pilgrims’s foot woes—

We ate dinner one night with a gentleman who was walking the Camino for the second time. He recounted his devastating first experience, with such severe blisters that he couldn’t walk. Some of them broke on their own and ended up getting infected after he showered without wearing shower sandals. Then he contracted something like trench foot. Only after he managed to secure some hefty antibiotic did the infections subside and he finished his walk. It sounded ghastly!

In one of the hostels I watched an older French couple sitting in the lounge. She had her feet on his legs, and he was lovingly applying ointment and bandages to her blistered feet and toes. Her oooh, ooh, ooh’s were replaced by grateful sighs when he carefully slid socks on her feet and tenderly massaged them.

Then, on our last official day of walking, Chris and I encountered a pilgrim perched on a large boulder on the side of the path. Her foot was a mess, and she was trying to improve her predicament by taping a large-wound Telfa pad sheet (like the kind you see with the “plastic” side to control fluid draining and infection) on the bottom of her foot. She had it cut (as closely as possible) to the shape of her foot. I suspect she was trying to reduce friction. It didn’t look as though it was going to turn out so well for her.

She looked miserable.

Not to be taken lightly—

Blister problems can be more than annoying and painful. They can be dangerous. And they need to be taken care of immediately. I’m fortunate to know how to care for blisters and be able to take care of them on my own. But even my blister ailments could have gone south very quickly. The one blister got so red I became concerned about infection. I applied triple antibiotic cream to it for a couple of days as a precaution.

I was fortunate.

Planning and preparing for problems—

If you’re planning any long distance hiking, make sure you prepare your feet well by training, wearing the right shoes for your feet, wearing friction-reducing sock liners and attending to your hot spots as soon as they crop up, NOT after you’ve put in your mileage. If you wait until the walk is over, it might be too late to get control over them. Stay vigilant.

Be prepared.

Make sure you’re all set so you can enjoy the walk!

NEXT WEEK we’ll take a quick look at more equipment you don’t want to hike without. Equipment that can reduce the stress on your joints and feet.

Until then, take care of your feet so they can keep you moving!

Blessings,

Andrea

May you prosper in all things and be in health, just as your soul prospers (3 John 2).

Photo of my own toes taken by me!

Basic Blister Care Part 3: Treating a Blister

If you’re the type of athlete that uses shoes for your sport—like tennis, running, hiking, or walking—you’re bound to end up with blisters. New shoes or too tight or loose shoes are often culprits, but there are a variety of factors that play into whether or not you’re more-or less likely to end up hobbling through your event with blisters or curtailing your workout.

I wasn’t a shoe-wearing athlete, but I had plenty of blisters on my hands from heat and shear forces generated from swinging bars day after day after day. Yes, our hands got hot just like a runner’s feet. I had to learn how to take care of them, and managing them meant attending to my hands on a daily basis.

When I became an athletic trainer, I cared for other people’s feet (and hands) and their blisters. Humbling thing, taking care of other people’s feet. And having someone take care of yours. Feet aren’t always the prettiest body parts, but they tend to bear the brunt of athletic activity.

How to Treat a Blister

Look online or in a book for guidelines on blister care, and you’re liable to find a host of suggestions. While the materials available to pad and treat blisters has changed somewhat and improved a little, the goals for blister treatment are still the same.

Goals—

Decide whether or not the blister is causing pain and needs to be broken or just padded with protective padding.
Always work with the goal in mind to NOT make the blister bigger, worse or allow infection to infiltrate it.
Treat it in a way that promotes the fastest healing.
Figure out what caused the blister in the first place and work to avoid further irritation or future blistering.

Immediate care for the basic blister—

There was a general routine we followed when taking care of foot blisters, which often occurred on the back of the heal.

We would assess whether or not we could let the fluid stay in the blister and simply use padding material and tape to create a donut hole around the blister and tape the donut hole (usually of moleskin with sticky backing or a thicker material that was built up just a little higher than the blister).

The problem with this procedure is that if you make the donut hole too large, larger then the blister, you will usually end up with a larger blister! So beware when trying this method.

If the blister was simply too large or too painful for basic padding, then we’d do the following—

Using an alcohol wipe or betadine pad, we’d wipe the blister and surrounding area in order to disinfect it.
Then, using a small scalpel or curved scissors, we made a tiny slice (about the size of a cotton swab) along one edge of the blister, as close to the perimeter of the blister as possible.
Using a gauze pad or sterile swab, we would gently push the fluid out of the blister through the hole. If the blister was on the heal, the hole would be toward the foot. We would continue this process until the blister was emptied and just the blister “pocket” remained.
Sometimes we would then soak another sterile swab with hydrogen peroxide and clean the open hole edge to kill any remaining bacteria that might sneak into the pocket.
Following this, we’d smear zinc oxide onto the swab and pack the blister pocket with the zinc. The zinc has drying properties that absorb any excess fluid and keeps the new skin dry and aids healing.
Then donut hole padding would be designed to fit over the lanced and drained blister and taped on so the athlete could return to activity.
The process usually allowed the blister to heal quickly, the outer dead skin to dry rapidly so it could be cut off.
The blister was care for with antiseptic, zinc and padding until it was completely healed.
We did NOT cut the outer skin off immediately as this skin acts as a protective covering for the new skin forming underneath.
Always make sure the skin is dry before treating it. We usually had the athlete come to us after they had their post-workout shower, or prior to putting on their socks and shoes for practice. If the skin around the blister was dirty, we’d clean it properly prior to treating and padding.

Alternative care—

If you don’t use a scalpel and just use a sterilized needle to poke a hole in the blister, which often occurs is a re-sealing of the outer skin and a re-filling of the fluid. Hence, another puffed up blister. If you don’t have a scalpel and want to use a needle, make sure it is properly sterilized and you poke several holes in the top and bottom of the blister and then gently drain toward one direction.

But always make sure you keep the wound (because a blister is a wound) clean, disinfected and properly covered.

Fancy padding and materials—

When Spenco’s Second Skin came along we thought we’d died and gone to athletic trainer heaven! Just cut out the desired size for the blister (we got the stuff in rolls and sheets), lay it gently over the hot spot or blister, tape it on, and leave it there for several days, even through the shower, if the taping didn’t come off.

Now any searching in your neighborhood pharmacy yields a plethora of blister care material, like Spenco, Dr. Scholl, pharmacy brand name material and others. Little donut hole pads for toes and bigger pads for heals and balls of the feet can be purchased.

Keep it clean, Clean, CLEAN!!

Whatever treatment you opt for, you must make sure you keep the blister clean. If you’re a runner, hiker, or walk, it’s easy to get dirt or grime in the wound. Make sure it’s properly bandaged and always tended to following your exercise.

And I wouldn’t recommend washing your blister with regular hand soap that’s been sitting on your bathroom basin. You would be stunned to find out how many germs congregate and thrive on that soap!

What about blood blisters?

Personally, I would always opt for draining a blood blister. They’re painful. Blood is an irritant, and just draining the blister of that pressure and irritation goes a long way toward regaining some comfort.

But you always need to be on the lookout for an infection with this type of blister, so pay extra careful attention to its healing. Look for signs of pus, discolored fluid, redness and heat around the wound.

What about for blisters that really don’t need to be drained?

For smaller, or tiny blisters that don’t need to be drained, it wasn’t uncommon for us to just tape them down with adhesive tape, directly over the blister. This obviously pulls the skin off when you pull the tape off, but I often us kinesiotape directly over my small toe blisters. The tape stays on several days through showers and moisture and provides a protective, sticky coating.

And keeping it clean is one of the reasons I don’t like plain old Band-Aids. They don’t seal well around the blister and allow dirt and grime to enter the area. And because they don’t seal, they can end up rubbing on the blister, which further irritates it.

One product I love is medical-grade Manuka honey pads. They also provide a great covering that stays on in moisture, protects the wound with padding and promotes healing. But be careful. If you’re allergic to bees or any bee product, you shouldn’t use them.

What about blood blisters under toenails?

Blisters under toenails are especially painful. They need to be drilled and drained. A special tool (or VERY clean nail) is required for this, so don’t head out to your tool chest to get just any old sharp implement.

But what about how to avoid getting these pesky irritants in the first place?

That’s what we’re going to cover NEXT WEEK—steps you can take to avoid having to deal with blisters, so many of them, or such severe ones.

Until then, make sure you have a blister care kit available at home, and whenever you go out walking, hiking or running. You never know when you’re going to have to get off the trail, peel off those socks and shoes and treat a hot spot. If you don’t do it then, prepare to suffer longer than you should have!

Blessings,

Andrea

May you prosper in all things and be in health, just as your soul prospers (3 John 2).

Photo by Andrea A Owan

Blister Basics Part 2

One of the first shocking things I learned as a beginning gymnast was that:

I was going to get a lot of blisters on my hands;
They were going to HURT; and
I needed to learn how to take care of them so they wouldn’t be a problem—for my health or my gymnastics participation.

At the beginning—

My eight-year-old hands were tender, unused to the friction and shear forces I was going to expect them to handle for the next fourteen years of my life. Like it or not, they would come with my sport.

So after the first two or three episodes of having areas on the palms of my hands heat up, get fiery red, hot and swollen, before having the skin peeled off, I had to learn to care for my hands.

Coach would laugh when we told him we “had a rip.” As an ex-military guy, it was all in line with toughening up, and he thought it was funny. “Just chalk up and get back up on those bars!” A palm-full of thick calluses was to be my fate, and the fate of every other gymnast I knew.

That was back in the days when female gymnasts didn’t wear the grips they do now. Guys did; girls suffered. They were cumbersome and difficult to use on our oval-shaped bars; and they were also difficult to use if you had stubby fingers like I do—not enough finger sticking out beyond the grips to grad hold. And they didn’t really make them in girls’ sizes. Surprise.

What is a blister, really?

And what causes it?

I learned more than I wanted to know about the physics of blisters. I learned a lot more when I studied and practiced athletic training. Here are some blister-forming facts:

Blisters can be caused by friction, when a tissue encounters friction when it’s rubbed over or against another surface. Like the up-down motion of your heel against the back of your shoe when you’re wearing thin socks, or no socks at all. Rub, rub, rub. Blister.
Deeper blisters are most often the result of shear forces, when the layers of skin are rubbing back and forth on one another.
When the epidermal layer of skin is irritated or damaged by these forces, fluid collects between the epidermis—top layer—and the deeper dermal layer. The fluid usually comes from plasma escaped from the surrounding damaged cells.
The fluid seeps into the pocket and puffs up the top layer of skin.
The fluid is there to bathe the damaged skin layers, protect it, and start the healing process.
Shear force blisters can cause tremendous pain because it causes damage or irritation to surrounding nerves.
Blisters can form under calluses. (These types of blisters can be hard to manage and require careful treatment.)
Having thickened calluses that aren’t managed (like carefully shaving down or kept soft or pliable) can increase your risk of deep blisters, and a lot of pain!
Sweat and warmth—as what happens when your sweaty feet are stuck in a shoe—increase blister formation likelihood.
Blisters can be filled with a variety of fluids, like serum, plasma, blood or pus (indicating a probable infection).
The crushing or pinching of tissue (like I experienced a lot of as a gymnast, when I was swinging around on the bars) can rupture a blood vessel in the dermal layer, which in turn allows blood to seep into the pocket between the layers. There were times we’d leave blood streaks (or skin sections) on the bars when we had a rip.
The body quickly springs into action when a blister forms.

At six hours post-blister formation, the blister fluid is usually re-absorbed, and the top layer flattens back down onto the underlying tissue and begins to die. But it serves as a protective cover for the wound beneath it.
At 24 hours, new skin layers are already beginning to form.
And at 48 hours, new “soft” baby skin can be seen developing over the wound. If the blister is not properly cared for, this new skin can crack and another wound (now exposed) can appear. Then you can have a blister forming underneath a blister, a very painful condition.

Blisters improperly cared for can lead to infections and slowed healing.
How hydrated you are affects blister formation, and how well it heals. Really.

*On the photo above, you can see the cracked, peeling skin of the blisters that ran along my middle toe. I didn’t do anything to treat those. The body took care of everything, and the old skin is now peeling away. While noticeable, these blisters (which occur in the same spot on both my feet), were not noticeable enough to slow me down, or warrant padding or bandaging. But if I were to go on longer hikes during the day, day-after-day, I would make sure I taped the toes to reduce friction and shear forces. Clearly I am prone to irritation in these areas, probably due to the biomechanics of how my foot hits the ground and pushes off.

NEXT WEEK: Learn how to provide immediate care for your blisters.

Until then, keep those feet dry and as cool as possible! (I know. Difficult on a long walk or hike.) And don’t peel the skin from those blisters!

Blessings,

Andrea

May you prosper in all things and be in health, just as your soul prospers (3 John 2).

Photo by Andrea A Owan

Blister Basics Part I

Ever have a big, fiery red puffed up blister on your foot, toe or heal? Not a lot of fun, is it? It can make shoe wearing and even walking miserable or nearly impossible. And they can take SOOO L-O-N-G to heal.

I saw and treated a lot of blisters in my day as an athletic trainer. There was a special process we’d go through to lance, drain, pack and pad them, so the athlete could bite their lip and return to practice or competition. And I still find myself treating my own today.

But a lot of those blisters could have been avoided. Some of the blister-causing culprits I saw were:

Improperly fitted shoes.
Shoes that had gotten wet and dirty and, consequently, dry and stiff. No pliability left.
Too old or too worn out shoes. (Sometimes athletes just couldn’t relinquish them.)
Wrong shoes for the activity. Tennis for running. Running shoes for tennis.
Old, dirty socks worn, worn and re-worn until they could stand up on their own.
Worn out socks with pills, errant threads floating around, threadbare areas and holes.
Shoes stiffened from sweat.
Socks that didn’t fit.
Wrong sock for the wrong activity.
Dirty feet and toes.
Improperly trimmed toenails.
Untrimmed toenails.
Feet not properly dried following a shower or sweat-inducing exercise.
Grit and dirt in the shoes or socks.
Old insoles that needed to be replaced.
Calluses that hadn’t been cared for properly or filed down sufficiently.
Doing too much too soon on soft, unconditioned feet.

Did I say doing too much too soon on unconditioned feet?

That last one is probably one of the biggest culprits. Feet need to be conditioned to do the work you expect of them. You need to work up to the mileage and pace you want to maintain.

Blister Care—

Some things have changed about blister care since I was treating them daily. Some of the super neat treatment options were arriving on the scene while I was still in school learning how to be an injury-preventing, injury-identifying, and recovering-from-injury athletic trainer. Our understanding of how blisters are caused has evolved, and that understand has allowed developments in better treatment.

But there is no one-type-of-prevention-fits-all to follow.

You can conquer and reduce the number and severity of blisters if you know the basics.

NEXT WEEKI’ll take you through the physics of blister formation. Then we’ll talk about how to reduce their occurrence and treat them if they do arise. Literally.

Until then,

look through your closets and drawers for socks that have seen better days and need to be retired to the laundry room as rags. (Hint: look for thread bare areas, broken down weave, holes, runs, pilling, and stretched out elastic. Thank the socks for their faithful service, and then use them for something else.)

Blessings,

Andrea

May you prosper in all things and be in health, just as your soul prospers (3 John 2).

Photo by Craig Whitehead