BLISTERS – Complete Guide to Prevention and Treatment

Consider your average ripe peach. Press your thumb against the juicy fruit and gently move it back and forth. What happens? The skin moves under your thumb. Now press harder and rub. The skin rips and wrinkles, and peach juice dribbles down your hand.
The same pressure-and-friction principle comes into play when you hike. The outer layers of your foot’s skin can move more than the sensitive inner layers can. Boots and socks apply pressure and friction as you walk, causing these skin layers to separate and fluid to fill the void – a blister.
If you dunk the peach in hot water, and rub it, it peels more easily. Again, it’s the same with your feet: warm, moist skin blisters quicker than cool, dry skin.
Keep your feet dry, cool, and friction-free to avoid blisters.
Within 6 hours of damage, blistered skin begins to recover. Within 48 hours, a granular layer-the stuff that makes skin tough so it doesn’t hurt when you touch it-forms. Complete healing typically occurs within 5 days. 


I walked 1,600kms on the Camino de Santiago from Le Puy, France to Santiago, Spain in 2010. I averaged about 24kms per day for 62 days. This was probably about the average amount walked by most pilgrims and takes a heavy toll on your feet. Along with ankle tendonitis, blisters of every kind and location were common. Few escaped. We felt a need to walk every day. As a medical doctor, I had the opportunity to treat many foot problems and especially blisters. The common wisdom was to drain all blisters using needle and thread. I never saw or heard of problems with this.

1. SIZE AND BUY THE RIGHT HIKING BOOTS
Buy the right boots for you–and get the right fit.
a. Before trying a single boot on, decide how much support, protection, and weatherproofing you need. Rigid soled boots are only necessary for mountaineering and ice climbing. A too-heavy boot can cause fatigue and blisters; a too-light shoe can lead to twisted ankles.
Don’t buy shoes that are too small. It’s easy to do, since a close fit feels good in the store. You need to allow room for normal foot swell–inevitable under a load. Some buy boots one-half size larger than usual. Feel any pressure points, pinching, or an uncomfortable tongue fold? They’ll only get worse.
If off-trail, on snow, scrambling, or alpine climbing, full boots with firm, but non-rigid foot beds, and lug soles offer many advantages. In snow and wet, muddy conditions like the Pacific Northwest, waterproof boots and gaiters are the only viable thing to use.
If walking only on trails, light hikers are often the best choice. Many thru-hikers on the long distance trails have abandoned boots and instead wear light trail runners. Few thru-hikers go the other way switching from light shoes to boots. Try many pairs until you find the ones that fit the best. It isn’t always the most expensive ones. You can’t beat trail runners for their flexibility, breathability, and lightweight. Lower heal and rolling heals will not be a problem because the lever that rolls your heal is shorter. You have to pay attention to where you are putting you foot to protect your shoes from abrasion and ankles from twisting. Whatever you buy, a firm sole is advised as they will give you the most support especially going downhill. Goretex lined light hikers provide reasonable waterproofing but may limit breathability.
b. Shop at the end of the day, when your feet are slightly swollen, like they will be on the trail. Wear the socks (hopefully you will decide to use a double sock system) and any insoles you use while hiking; they greatly affect fit. Purchasing boots 1/2 size larger than your foot size works well for some. Feet swell when hiking.
You always can accommodate for a slightly larger size boot, but that is not possible with a too small boot.
c. Try on a lot of shoes (and different sizes) to get a feeling for variations in fit. Every manufacturer uses a different last, which can have subtle differences in width, volume, and shape. I personally have always used a trekking model of Meindl boots. Made in Germany with two piece uppers, Goretex lining, a rubber wand, and a roomy last, these boots are instantly comfortable, require little breaking in, and are completely waterproof. I have never had a hot spot in them. My model comes in a woman’s version with a narrower fit. Some purists criticize 2 piece uppers but the increased flexibility is worth what one could give up in waterproofness.
d. Supportive insoles. Both custom- made and over-the-counter insoles reduce movement inside a boot, thus limiting friction.
e. Breaking in boots. Wear your new or almost-new boots around the house and town, then venture out on day hikes with a light pack. Slowly progress to longer trips. Use duct tape to smooth rough spots or protruding seams inside the boot. Heavy, stiff boots require a lengthy break-in. If you’re in a hurry, do like some cowboys do: wade in water to soak the leather, then wear the boots until dry. They’ll conform to the curves of each foot. Boot makers frown on this because it dries out leather, but if you regularly condition and clean your hikers, one thorough soaking probably won’t hurt. A bit of mink oil will soften the toughest of tough shoes, but use it sparingly since it can over soften leather.

2. PREVENTION OF BLISTERS
It is always better to prevent a blister than deal with one once it has already occurred.
a. Condition Your Feet.
Colin Fletcher, the author of the first good backpacking guide, “The Complete Backpacker”, always used rubbing alcohol on his feet for a few weeks before trips. He felt it increased the toughness of his skin and worked well to prevent blisters. Start hiking slowly and work up to longer distances. In a study of soldiers, those who jogged regularly were less likely to get blisters on a 10-kilometer (6.5-mile) hike. Cadets who wore their boots for a total of at least 20 hours in the 2 weeks prior to maneuvers had fewer blisters.
Keep your toenails short and file down calluses.

b. Decrease Perspiration.
Sweaty feet, thick socks, and sturdy boots are a recipe for a blister. Learn to keep your feel clean, dry, reduce chafing and odor and be blister free. Inside wool socks and cramped boots, your feet have every right to perspire. And they will–through more than 125,000 sweat glands on the sole of each foot. That’s not a problem if your body has a typical cooling system; just hike all day, air-dry boots and socks at night, and continue the next morning in comfort. But hikers who sweat more than usual or suffer from overactive sweat glands–a condition called plantar hyperhidrosis–can find themselves in trouble on the trail. Excessively sweaty feet can increase the odds of getting blisters and infections, produce terrible foot odor, ruin socks and footwear, and create conditions for cold injuries like frostbite and trench foot. Here’s how to handle the excessive perspiration.
Use extra-strength antiperspirant creams, roll-ons, or powders to reduce sweating and odor. Bromi-Lotion Antiperspirant cream ($12.50; americarx.com) contains aluminum hydroxychloride, an ingredient to block skin pores that’s stronger than what’s found in regular deodorants. Equally effective is Certain Dri Antiperspirant ($5; americarx.com), a fragrant-free roll-on with aluminum chloride that won’t wash off in water, and can be applied to feet several times a week at bedtime. Even better is Drysol (aluminum chloride hexahydrate 20% in anhydrous ethanol, ~$20, Person and Covey Inc.). Apply to dry skin at least once per week or more often as necessary. Covering feet with plastic wrap and socks overnight increases effectiveness.
All effective antiperspirants contain aluminum. Some believe that in addition stopping sweat, they prevent odor and “toxins” from escaping the body.
Trust me (I am an MD), our feet have no role in odor or toxin excretion. Despite fears that aluminum can affect the endocrine and lymphatic systems, be a potential risk factor in breast cancer, or be a cause of dementia, these have all shown to be groundless. They are safe products that can be used for decades safely (I have used Drysol for 25 years with no sequela. The only function of the apocrine sweat glands in your armpits and groins is sexual – they produce a certain kind or sweat containing oils and other compounds that when broken down by the bacteria on your skin, produce body odor. I use it on my underarms, applying it once/week or less to never develop body odor. I kayak and backpack for weeks at a time when it is not possible to wash every day. Drysol is available in pharmacies, is over-the-counter in Canada but prescription in USA.
Consult a doctor for serious cases of plantar hyperhidrosis that don’t respond to over-the-counter remedies. Long-lasting solutions include skin surgery, botox injections, and iontophoresis; the latter is a noninvasive electro-chemical treatment that clogs sweat glands, and can be administered periodically by a dermatologist.
In soldiers, antiperspirant applied to feet reduced sweating, but it didn’t prevent blisters. In some cases, it even increased irritation.
In camp wear sandals or flip flops to let your feet air out and dry.
Aftermarket insoles specifically designed to absorb sweat, like DryZ foam cushions ($16-$21; shoeline.com), which wick foot moisture and store it in the insole’s gel-like core (to evaporate later when you remove your boots).
Women’s clean sanitary napkins in your boots absorb moisture. This has worked for some with hyperhydrosis.

c. Socks.
Adhere to four rules for socks: 
1) Use a double sock system to reduce friction. A thin synthetic sock liner slides against your sock and boot so your skin doesn’t have to, moving the friction from skin-sock to sock-sock. Synthetic liner socks also wick moisture away from your skin moving it into the thick absorbent sock, the second part of the system. Wool has always been the material of choice because of its warmth when wet, cushioning, and absorbency. Merino wool is favored by many. Nylon and other synthetic materials are usually added to the wool to increase durability. The sock-and-liner method works best if the outer sock maintains its loft (and thus its cushion) when saturated. 2) No cotton; cotton holds moisture next to your skin. 3) Wear socks with smooth, flat seams. 4) Wear socks with a snug fit and no wrinkles or baggy spots. Then experiment with different types and thicknesses.
Rub a bar of soap across the friction points on the outer side of liners to make them slide even easier.

d. Duct tape.
Apply over problem areas to prevent blisters. Wrap about 3-4 feet of the duct tape around a pill bottle and keep in your backpack, use to prevent blisters, to cover a “hot” spot, or to add a layer of protection to the skin where a blister has already formed. Duct tape works because the surface is slick and it slides against the sock. A wide foot with narrow heels causes special problems, as they tend to get blisters on their heels if they don’t remember to apply duct tape.

e. Exchange wet socks for a dry pair as often as possible.
Change every break and if there is a steam nearby, rinse them out and let them dry on your backpack (a few safety pins are useful), where they’ll dry out as you hike–even in cold weather. Alternating pairs of socks also affords different pressure points to the foot preventing blisters as the foot is not being pressured at the same area. How many pairs of socks to bring on a trip? – at least a pair of clean wicking socks per day and new thick socks every other day. Dry boots overnight by propping the tongues open with twigs.

f. Foot powders.
Fight fungus and chafing skin with Gold Bond Medicated Foot Powder, Dr Scholls foot powder or Zeasorb, a talc-based absorbent powder (fill up a couple film canisters depending on length of trip). Soldiers using foot powder had a higher incidence of blisters than those not using it. Once saturated, the powder clumps and abrades feet. The key may be to very lightly dust foot and remove as much as possible.

g. Deal with hot spots immediately.
It only takes a few seconds to produce a blister. Stop, take off your shoes, and check for anything in your socks. Apply over the hot spot any of the above preventative things like duct tape, moleskin, or athletic tape. Super glue also works on hot spots, it gives a much less expensive “second skin” so that it wears off before the blister forms. This also works well but only before the blister forms. After–OUCH! Put socks on making sure there are no creases and tie shoes to the proper tension. Some have luck, oddly enough, by keeping their feet soaking wet. When you feel a hot spot, walk in a creek! If you have nothing better, wax paper can be used when hot spots appear – although it’s a bit messy when you pull out your foot.

h. Friction Prevention
Clean and dry feet thoroughly, then coat each blister-prone area with tincture of benzoin (see “Stick-to-it-iveness”). Let feet dry for 3 minutes, spreading apart any toes that were treated. Apply a thin layer of lubricant over all sticky areas. Try Vaseline, Sportslick, Bodyglide, or a silicone cream like Hydropel or Avon’s Silicone Glove. In a pinch, use cooking oil. Wear a sock liner to prevent your wool or synthetic socks from getting slimy. Change your socks and reapply the lubricant every 4 to 6 hours. Be sure to wipe any grit from your feet before applying another coat.
For friction and moisture prevention try Tape Relief, a lotion but it dries to create a barrier on the skin. (http://www.taperelief.com/). For those who get blisters from friction on the upper ankle, it is particularly effective. A product like Glide applied on trouble spots helps to decrease the friction against the skin.

i. Tape.
Any type of tape from athletic tape to hockey tape can be used to cover areas prone to blister. When placing tape over broken skin, create a bandage by placing a smaller piece of tape in the center of a strip-sticky side to sticky side-so a smooth surface lies against the sore.
Leukotape P Sports Tape. Prevents blister.

j. Avoiding Toe Blisters
Wrap a small strip of tape, sticky side down, from the base of the toenail over the tip of your toe and then underneath it. Wrap a second strip around the circumference of the toe, covering the ends of the first strip. Cut the ends of the second strip as close to each other as possible without overlapping them. 
 

Body Glide Liquified Powder Works especially for those who get blisters between the toes ($10 REI).

k. Preventing Ball Blisters
Place a long, wide strip of tape on the floor, adhesive side up, and set the ball of your foot directly atop it. Press down to make your foot as wide as possible. Pull the ends of the tape up around the sides of your foot to meet on the top of your foot.
Trim the tape to conform to the shape of your foot so the tape doesn’t contact your toes.

l. Wear gaiters
I use low gaiters every time I hike to keep boots and socks clean. Going downhill on scree, they keep all the rocks and dirt out of my boot. In snow, your feet remain dry.

TREATMENT OF BLISTERS
Should You Pop?
To pop or not to pop is the big and hotly debated question. Even the experts disagree about when to drain a blister. Buck Tilton, Backpacker contributing editor and director of the Wilderness Medicine Institute (WMI) of the National Outdoor Leadership School, has treated hundreds of backpackers’ blisters. “At WMI, we open and drain almost all blisters (the exceptions are those caused by burns), including the controversial ones: blisters filled with hazy, cloudy fluid and even blood blisters on the heel or ball of the foot. Our philosophy is that a blister in a high-stress area is going to pop if you keep walking on it. We’d rather drain it in a controlled setting than have it burst inside a sweaty, dirty boot and sock.”
It is important to leave the skin intact over the blister.
The best way to drain a blister is to “thread the blister”: Cleanse the skin with soap and water, alcohol, or an antiseptic pad, sterilize a needle by holding over a flame till it is red hot or boil for 2 minutes. Thread the needle with normal sewing thread. Puncture the blister at the bottom and exit through the top. Remove the needle and leave the thread in place, trimming it to a reasonable length so that it is not easily pulled out. This is the best way to not only drain the blister but also keep it drained. Because of concern of infection with the thread, some would recommend puncturing the blister at the bottom so gravity can help drain it. Starting at the top of the blister, massage the fluid toward the opening. Keep the drained area covered and clean.
Opening the blister creates an open wound that is prone to infection. If it does get infected, deroof the blister completely opening the wound, wash with soap and water, apply topical antibiotics, and cover. Systemic antibiotics may be necessary.
Dressing.
Apply antibiotic ointment directly to the blister and a layer of tincture of benzoin around the wound to help the dressing adhere. Cut a circular piece of moleskin, Molefoam, or your covering of choice 1/2-inch bigger than the blister. Cut a hole slightly larger than the blister in the middle of the covering and place the “doughnut” over the blister to create a pressure-free pocket around the sore.
Cover the entire doughnut with moleskin, then secure it with duct tape or athletic tape. Run tape strips along the sides of your foot toward your toes, then secure the ends with a few loops around the instep.
Tincture of benzoin, a balsamic tree resin, has antiseptic, aromatic, and adhesive properties. It can be found in many forms-impregnated in cotton swabs, in small vials as a liquid, and as a spray-at drugstores and medical supply houses. Keep a little benzoin in your first-aid kit and use it to: Augment the stickiness of any blister treatment. Just apply it to your foot, let it dry until tacky (a few minutes), then affix your dressing of choice. When applied to unblistered skin, tincture of benzoin dries to a hardened shield, like a second layer of toughened-up skin. Seal an existing blister as a last resort.
Blister Products
Who better to test blister products than tenderfoots who develop hot spots just pulling on their hiking boots? For 3 months, five brave testers put their feet at the mercy of blister products found at drugstores, supermarkets, and medical supply stores. Products are listed in order of overall performance.
Effectiveness: Did it prevent a hot spot from turning into a blister? If a blister did form, did this material keep it under control? Did it ease the pain?
Durability: How often did you need to replace it? Did it hurt when you removed it?
Final grade: Would you buy and use this product? Note: This rating is not an average of other scores, but a gut-level reaction to overall performance.
Rating Scale 5=Excellent, superior gear, 4=Very good, beats most, 3=Good, decent gear, 2=Fair, okay, but… 1=Poor, miserable

Product Price Effectiveness Durability Final Grade
Band-Aid Blister Block $4.49 for four 21/8 x 11/4-inch sterile cushions 4.5 4 4.5
“Like instantly having new skin on my foot.
Generic athletic tape about $2 per 360-inch roll 3 3 3.5
“If you tape it right-covering 1/4 to 1/2 inch beyond the blistered area-it stays put.
Dr. Scholl’s Cushlin Blister Treatment (gel-filled dressing) $4.75 for 3.5 2.5 3.5
six 2 x 13/4-inch (size large)sterile cushions
“It worked great, but didn’t stay put as well as some other products._
*Body Guard Skin Protection Sheets (flannel-like tape) $3.50 for two 3.5 3.5 3
41/2 x 41/2-inch sheets
“Because it’s stretchy, it’s ideal for odd spots-around toes, on arches._
Dr. Scholl’s Moleskin Plus (flannel-like tape) $3.29 for two 3.5 3 3.5
41/2 x 3-inch sheets
“Great for toe blisters because the soft surface doesn’t chafe neighboring toes._
Dr. Scholl’s Molefoam (padded tape) $3.29 for two 41/2 x 3-inch pads 3 3 3
that are 3/8 inch thick. “A doughnut of Molefoam creates the deepest pocket for a
tricky-to-protect spot._
Silver duct tape $1 to $5 per roll 2.5 3 2.5
“It’s better than nothing, but there are more effective remedies out there._
Spenco 2nd Skin Blister Pads $6.99 for five moist, nonsterile pads; 2.5 2.5 2.5
one large and six small sheets of flannel-like tape; and 11 pressure pads. “It’s a challenge
to apply all the different parts._

Rich – Oct 11, 2008
I completed the 220 mile John Muir Trail in September and had serious blister issues. I tried duct tape, moleskin, Bandaid blister block, Nexcare blister and Spenco 2nd skin. I hiked 15+ miles per day in light trail runner shoes with a 21 pound max pack weight. All of the above treatments would become filthy from trail dust and would be partially hanging off my foot by the end of each day. Good old duct tape and moleskin were the least expensive treatments yet were just effective as expensive Bandaid, Nexcare and Spenco blister treatments. Next time I won’t waste my money on the special blister products! Happy hiking.

FIX BOOTS THAT CAUSE BLISTERS
Don’t throw expensive boots just because they’re giving you a hot spot (best case) or a blister (worse case) when a quick makeover will do the trick. If the problem is a pressure point–rather than fit or break-in–you can work it out just like a cobbler would. This two-step trick also lets you customize your boots for bunions, heel spurs, and other foot problems.
step 1 Remove the laces and pull back the tongue. Apply a dab of mink oil (found at most hardware and shoe stores) to the inner leather at the troublesome spot. Massage until the oil is absorbed to soften the leather. (For non-leather-lined boots, skip the mink oil and go to the next step.)
step 2 Knead the offending area with a hard, smooth, blunt object like the end of a broomstick or a closed pocketknife. Use a circular or back-and-forth motion and a
healthy bit of muscle. The extra space this effort creates should eliminate the problem.

TREATMENT OF HEMATOMAS UNDER TOENAILS (subungual hematoma)
They are caused by repetitively hitting the large toenail against the end of your shoe. Too long nails and downhill travel are the common denominatiors. The trauma causes the nail to separate from the nail bed. Fluid, usually bloody, accumulates under the nail. They cause pressure and can be quite painful. The nail will be lost eventually and a new one will grow back.
Prevent by making sure your boots are large enough and then cut all your nails short just before any trip. Retighten the laces of your boots before going downhill.
If bothering enough to prevent you from walking, then it is necessary to treat. Use pliers to hold a red hot paper clip (better than a nail or needle). With the end of the paper clip over the center of the hematoma under the nail, burn a hole directly through the nail. It may require a second heating if the hole is not completely through. Often a spurt of bloody fluid comes out of the hole and there is immediate relief of the pressure and pain. Apply a thin absorbent dressing held on my tape to absorb all the fluid that can take some to drain completely.

TREATMENT OF ANKLE TENDONITIS
This is due to a repetitive type of injury, again most often from walking long distances many days in a row. Pain in front of the ankle, crepitus over the tendons as they move through their inflamed tendon sheaths, often swelling, and pain especially with dorsiflexion of the ankle. Treatment consists of rest (often many days are required to settle satisfactorily), ice, anti-inflammatories (ibuprofen 400-1000mg 2x/day), and regular stretching especially of the Achilles tendons.

About admin

I would like to think of myself as a full time traveler. I have been retired since 2006 and in that time have traveled every winter for four to seven months. The months that I am "home", are often also spent on the road, hiking or kayaking. I hope to present a website that describes my travel along with my hiking and sea kayaking experiences.
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