Article written by Rebecca Rushton - podiatrist

In the ideal world, managing foot blisters starts and stops with prevention. But sometimes things go wrong. Either prevention fails, or we let things go a bit too far (sometimes a lot too far). Then we end up having to deal with a foot blister while we’re on the track.
To treat a blister on the track, it goes without saying, you’ll need to be carrying some sort of a blister kit. But what should you have in your blister kit? To help you decide, let me explain the principles of blister treatment. And I’ll show you what’s in my blister kit.

The aims of blister treatment are to minimise pain, prevent infection and speed healing. There are five steps to achieving this.

• Step 1: Apply antiseptic

  Betadine is the most popular one. I prefer a liquid because it can soak into all the nooks and crannies rather than just sit on the surface. Single-use swabs are great because they’re light and small. But they’re messy (take gloves or be prepared to wash your hands afterwards). An alternative is a 15 ml bottle with a built-in eye-dropper lid.

• Step 2: Dress your blister

  The dressing you choose for your blister depends on the integrity of the blister roof. Your blister roof will either be:
  * Intact
  * Torn
  * Deroofed

  For intact and torn blisters, don’t stick anything adhesive to the blister itself. Otherwise the roof might tear off completely when you remove the dressing. Use an island dressing, an absorbent non-adhesive pad surrounded by adhesive tape. Most Band-Aids are an example of an island dressing, but you can do better than that! Try something like Primapore dressings: the adhesive is really good and you can buy them from most pharmacies. I like them because they’re sterile too. Alternatively, if you choose to buy a roll of dressing that you can cut to size, make sure you tape both ends to lock out the sweat and dirt that inevitably gets in during the course of a hike. Fixomul tape is good for this.
  

  For deroofed blisters, use a hydrocolloid dressing. Hydrocolloid dressings are rubbery yellow dressings that absorb water to form a gel.

  They provide the best environment for your blister to heal fast. Compeed is an example of a hydrocolloid dressing. Yes, they’re adhesive, but it’s a bit different - because as the raw skin heals, it weeps. And this combines with the hydrocolloid material to provide that ideal healing environment, preventing it from sticking to and disrupting the valuable healed tissue when the time comes to remove the dressing. You leave hydrocolloid dressings on for up to a few days (depending on how weepy your blister is) for best results. Some people don’t like how these dressings make blisters gooey and smelly, but I can tell you this is a good thing for healing. By the way, sometimes hydrocolloids don’t stick well to the surrounding skin. I like to put a bit of Fixomul around each side to make sure it doesn’t peel off. That way, I can see how weepy my blister is to judge when the dressing needs replacing.

• Step 3: Reduce pressure

  Nothing hurts more than walking on a nasty blister under the ball of your foot. Or having to put your boots back on and walk downhill with a blister on the outside of your little toe.
  You need to get the pressure off it. When you get home or to camp, you can leave your boots off, walk a bit funny to take the weight off or keep off your feet as much as you can. But while you’re out on the track you can’t do this, so there are two ways to reduce pressure.

  You can use cushioning. Presumably you’ve already got a bit of cushioning under your foot in the form of an insole, so there might not be any more you can do there. But for toe blisters, silicone gel toe covers are great. They will help blisters on top, underneath, on the tip of and between toes. If you’ve never tried silicone gel toe covers, get a couple and put them in your kit – they might just save the day.

  Even better than cushioning is pressure deflection in the form of felt donut pads. You might know this better as moleskin, but the orthopedic felt that podiatrists use is better because it’s thicker. The idea is you cut a hole in the middle and this is where the blister sits. Felt donut pads really come into their own for blisters under the ball of the foot or over bony prominences, like bunions. Most pharmacies have felt or firm foams.
  
  

• Step 4: Reduce friction levels

  This is the most overlooked part of blister treatment. Without addressing friction levels, the shear that causes blisters continues at the blister base as it’s trying to heal, delaying healing and making it hurt more. Here’s an excerpt from an article I wrote recently that highlights our misconceptions about friction in blister treatment:
  
  There’s something you don’t know about friction. And your feet need you to know this! Think back to your last foot blister. You treated it with a plaster right? You know, to stop that friction. But I bet you think friction is rubbing. It isn’t. Friction is about grip. High friction means two surfaces grip together. Low friction means they don’t… they’re slippery.
  Read the full article here: a-fraction-too-much-friction.

  So how do you reduce friction levels? Firstly, you can try and make your skin drier. I know, that’s a tough ask when you’re out on the track, not to mention when it’s hot or wet. Antiperspirants, powders and changing socks are a small step in the right direction. But you’ll need to do even better than that once you’ve got a blister.
  Greasy lubricants like Vaseline and BodyGlide significantly reduce friction in the short to medium term. They have a few downsides, including a delayed increase in friction. And they can cause your dressing to dislodge or make the next one not stick.
  An even better option is ENGO Blister Patches. These patches stick onto your shoe or insole where your blister is and just stay there day in, day out.

  The best thing is they keep friction levels low no matter how moist your skin gets – that’s a big plus. But they can come loose when waterlogged, so river crossings and heavy precipitation can be a problem.

• Step 5: Monitor regularly for infection

  Once you’ve got a blister, your job isn’t over when you get home. You have to continue to treat it and monitor it for days to a week until your blister has healed. You have to keep it dressed and clean and monitor for signs of infection the whole time. What are the signs of infection?
  - Pus
  - Increased pain, swelling, redness, warmth
  - Red streaks extending from the blister (medical emergency)

• What’s in your blister kit?

  If you’re not sure you’re as prepared as you could be for blisters, ask yourself these questions:
  * Am I covered for infection control?
  * Do I have dressings for all three types of blisters?
  * Have I got something to deal with pressure
  * Have I got something to reduce friction levels?

  Below is a photo of my blister kit. If you want to know more about why each item was included and how to get the most out of each item, you can read this article. So what’s in your blister kit?

  
  

• Should I pop my blister?

  There are times when keeping the blister roof intact is not the best option. When the blister is large and painful and you have to keep going, it can be better to take matters into your own hands and lance it in a controlled and clean environment. But you must realise the increased risk of infection. And you must use a sterile implement! Remember, it is okay to not lance your blood blister. If in doubt, don’t pop it!
  If you want to know more on how to pop and drain a blister safely, please follow this link and read what Rebecca wrote on this topic how-to-drain-a-blister.

Article was written by Rebecca Rushton, a podiatrist with 20 year’s experience. She has a special interest in blister management, is the founder of blisterprevention.com.au, and the author of The Advanced Guide to Blister Prevention and distributor of ENGO Blister Prevention Patches. She lives in Esperance WA and her favourite walk is the rocky limestone track just 200 metres from her back door.