Typical Heel Blister Problems

January 12, 2015 by
Filed under: blister care, Foot Care, Footwear, Footwear Products 

Heel blisters are quite common – although they shouldn’t be.

Feet in the Jungle Marathon

Heels in the Jungle Marathon

Today’s post shows one participant’s feet at the 2014 Amazon Jungle Marathon.

If you look closely at this picture, you’ll see two heel blisters, both on the outside of the runner’s feet. The right foot blister is large but is not blood-filled. The blister on the left heel, however, is very large and filled with a large amount of blood.

It’s easy to think these are normal blisters – but their size makes they abnormal.

In my experience, heel blisters are caused by the constant shear when either 1) the heel is moving up and down inside the shoes’ heel, or 2) by the constant movement at the place where the shoe’s insole touches the inside of the shoe. Over the years, the majority of heel blisters have been the latter. One of the characteristics of this “insole/shoe junction” blister is that they often are flat across the bottom. The blister starts at the point where the insole’s edge at the side of the heel touches the inside of the shoe. That’s what makes the flat line at the bottom. Then the blister forms upward as the fluid forms and it grows. Given enough time and movement, you’ll get blood inside.


These are relatively simple to patch. The skin must be cleaned with alcohol wipes, and then the blister can be lanced and drained. Depending on the size of the blister, you’ll need to apply some type of blister patch. The bottom line is that you need to have something over the blister to protect the skin and prevent the top layer of skin from tearing off. For these, I would use strips of kinesiology tape (my preference is either StrengthTape or RockTape H2O) with antibiotic ointment over the blister to keep the tape from sticking to the skin. The larger the blister, the harder these are to patch but it can be done.


You are better off to prevent these blisters in the first place.

Start with the fit. Make sure your shoes hold your heels in place with just a little movement.

Check your shoes and insoles for rough and/or thick edges at the inside and outside of each heel. Side blisters are much more common than the back of the heel. If the insole has a large thick edge, replace them. If the shoe’s fabric is worn into a hole, you are due for new shoes. Under the fabric is generally a plastic edge of the shoe’s heel counter – the plastic that curves around the heel from side to side.

Engo Blister Prevention Patches are perfect for to help prevent these types of blisters. These patches are super slick. Either the small or large oval can be applied to the inside of the shoe and cover the offending edge of the insole/shoe junction. Clean the inside of the shoe and insole first. I work the patch with my fingers to form a curve to fit with area I need to cover. Then remove the backing and apply the center of the patch first and then push the top and bottom of the patch into place. Rub it a bit to assure adherence.

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4 Comments on Typical Heel Blister Problems

  1. Nancy Shura Dervin on Tue, 13th Jan 2015 5:18 pm
  2. John,

    I find that blisters on the back of the heel can be prevented with taping.

    Blisters on the back/bottom, where the insole meets the shoe, can almost always be prevented by a combination of:

    1) Regular callous prevention; use a rough emery board to regularly file the callouses on the feet until they are smooth. It may take a couple of months to gradually take down the thick callouses and then maintenance filing is needed to keep them from coming back. Best time to do this is after each shower.

    2) Trim off the rounded edge of the heel of the insole so that the heel of the insole is flat versus curved.

    3) Tape the entire heel; bottom to back.

    Hope this helps, NSD

  3. DMB on Tue, 13th Jan 2015 7:20 pm
  4. Just a note about lancing blisters – it’s typically better not to, as exposing what is left of the skin underneath creates an open wound, and leaves one at risk of infection. (An intact blister is a closed wound.)

    Although with blisters as large as your example, getting into alternative footwear while they are in their current state would be tricky, and using careful / as sterile as possible lancing techniques would be the way to go.

  5. John Vonhof on Sun, 18th Jan 2015 10:09 pm
  6. Nancy makes several good suggestions. Thanks. Taping can protect the skin. Also the edge of your insole may be thick and rough, leading to these heel blisters. Either cut them down or replace them.

    Most times, it’s better to lance blisters, especially if they are in a pressure point area. Otherwise they’ll become larger, possible fill with blood, and pop on their own with the chance of tearing the roof off. Key to the decision is whether you are in a race of a day or less, or a multi-day event, where continued dirt and contamination is an issue for infection. With shorter events you can clean the blister later and care for it properly.

  7. Henry Bickerstaff on Wed, 28th Jan 2015 1:22 pm
  8. I have found that using an alternate lacing at the top of the shoe helps tighten the show around my narrow heel. I think you mentioned this in a previous blog.

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