Understanding Shear

This is part II of a series on blister formation and prevention. If you’ve missed the first post, I encourage yo to go back and read it to get a foundation on blisters. Here the link: Blister Formation.

In this part II, we’ll look at shear. For years we didn’t understand the concept of shear and its effect on blister formation. So let’s start with a story.

In Fixing Your Feet I tell the story of a runner at Badwater whose feet I patched. In short, he had run 90 miles of the 135-mile race, on pavement, in extreme heat. He had Elastikon tape on both balls of the feet. His feet were hurting to the point of quitting. I replaced the Elastikon tape with smoother kinesiology tape, which allowed movement between the tape and his sock, greatly reducing the shear movement between the layers of skin and the bones of his feet. I also added a large ENGO Blister Prevention Patch on each insole under the ball of each foot. By reducing the shear level, the runner was able to finish the race with less pain. Try to picture the following: as your foot moves through its foot strike, the bones of the foot move against the layers of underlying skin—then you apply a tape that is not smooth to the skin, pull on a sock, and finally put your foot inside a shoe. The tape sticks to the skin. As you run, the foot naturally moves a bit inside your shoes.

However, the sock cannot move freely against the coarseness of the tape. The sock and tape move as one, which stresses the outer layer of skin against the inner layers. The only movement is the shearing effect between the layers of skin.

That experience was the first time I made the connection to shear, although I didn’t know it by that name. All I knew is the stickiness at the sock–shoe interface, the tape–sock interface, and the tape–skin interface—and one, or all three, had created this major problem for the runner. I never forgot the story. His skin was stuck to the Elastikon tape, the coarse tape didn’t move against his sock, and the sock didn’t move against the shoe’s insole. With the smoother kinesiology tape and the new slipperiness between the tape and the sock, the coefficient of friction was reduced and in turn shear was reduced.

Shear is a new concept for most athletes, especially as it relates to blisters. Shear is defined as a strain in the structure of a substance when its layers are laterally shifted in relation to each other. Applying the definition to the above example, shear happened between the layers of skin as the bones of the foot moved through the foot strike. The internal layers of skin were connected. But those connections can break under the stress of shear and the cavity fills with fluid—and you have a blister.

To understand shear, try this. Place the tip of your index finger against the skin on the back of your hand. Keep it stuck to the same bit of skin while you move it back and forth while. See how your skin stretches? The skin on your hand has moved against the underlying bones. That is shear that causes blisters.

Note that nothing has rubbed against the skin. Your finger did not rub the skin. J. Martin Carlson, the founder of Tamarack Habilitation Technologies, has championed shear as the cause of blisters. Tamarack has a long history of providing innovative orthotic-prosthetic componentry and materials. Their focus on friction management, especially for amputees, has won them many awards and much recognition. This knowledge in turn led to the creation of a new product that can be applied to footwear to reduce high friction levels and, in turn, the shear that leads to blister formation: ENGO Blister Prevention Patches.

Shear in Action

After watching a video on Tamarack’s website, I understood more about shear in action. The video showed a cutaway on the heel area of a shoe, showing the sock and foot inside moving through a foot strike motion. In one video, the cutaway showed a sock and foot on an insole where there were high levels of friction. The sock and foot were distorted as they were held against the insole. It was as if they were stuck together. In another video, the sock and foot were on an insole with an ENGO patch underneath. No distortion occurred as the sock and foot moved easily through the foot strike, over the slippery surface of the ENGO patch.

It’s important to grasp how shear happens. As described above, shear results in distortion occurring between the skin and soft tissues underneath. This shear distortion is what causes blisters. The bones in our feet move back and forth as they move through each foot strike. When the skin at the bottom of the foot is stuck by high friction (stickiness) to the sock and shoe, the middle tissues are distorted. When this is repeated over and over, traumatic levels are reached and a blister forms. This distortion can happen anywhere on the foot: in an up-and down motion in the heel, the sides of the foot, and between toes; in a side-to-side motion at the ball of the foot, under the heels, and at the bottom of the toes; and in rotation as the foot moves through its foot strike. As we walk, run, and pivot in our shoes, the surface of our skin incurs a shearing force.

Certain amounts of shear are normal, and our feet can deal with a lot. However, with repeated traumatic levels of shear, blisters will develop. How much is too much? It varies from person to person, and some people are simply more blister-prone than others.

Part III will look at the five factors of blister formation.

Blister Formation

October 14, 2017 by · Leave a Comment
Filed under: blister care, Foot Care, Footwear Products, Health, Sports 

This is the first in a multi-part series on blister formation and prevention. Subsequent posts will focus on various part of the blister process. Too many people do not understand how blisters form, some even think they are a natural part of the running or hiking experience.

Blisters are the result of shear trauma to the skin. When running, every step is “repetitive loading” as the foot moves through the foot strike. The whole of the body’s weight is put on the skin and inner tissues, onto the bones and joints, up the leg, into the knees and hips, and into the pelvis and spine. For now, let’s focus on the foot. The skin can take a lot of repetitions without a problem, but once skin and tissue damage reaches a painful level, the trauma is escalating rapidly.

Repetitive loading has two components. The first is a vertical loading to the surface of the skin and by itself is relatively harmless. The second is a repetitive friction loading parallel to the surface of the skin. The two combine to create shear stresses within the skin. When these shear stresses exceed a certain level, micro tears begin to form within the third layer of tissue. As more repetition occurs, more micro tears appear and existing tears grow. These tears in the tissue form a cleft parallel to the skin’s surface. The cleft fills with serous fluid and a blister has formed—caused by shear stressors. This typically occurs in the stratum spinosum, the inner fourth layer of the epidermis that is the least resistant to shear.

If the blister is deep or traumatically stressed by continued running or hiking, the serous fluid may contain blood. When the serous fluid lifts the outer layer of epidermis, oxygen and nutrition to this layer is cut off and it becomes dead skin. This outer layer is easily burst. The fluid then drains and the skin loses its natural protective barrier. The underlying skin is raw and sensitive. At this point, the blister is most susceptible to infection.

Rebecca Rushton, an Australian podiatrist and the author of The Blister Prone Athlete’s Guide to Preventing Foot Blisters, has studied extensively about blister formation. She has identified four requirements for shear that cause foot blisters to form:

  1. Skin resilience: The skin on our feet is, by its very nature, susceptible to blister formation. Repeated gradual exposure to shear can improve the skin’s ability to withstand shear stress. Often times the skin is stressed by a sudden increase, or an increase over many days. Examples include increasing one’s mileage too quickly and doing more than normal in a multiday event.
  2. Moving bone: Bones within the foot move throughout the foot strike. The more they move relative to the skin’s surface, the higher the shear stress created, and the more likely you are to develop a blister. An example is the movement of the heel bone underneath the skin as it moves up and down in the shoe’s heel counter.
  3. Repetition: It’s the repetitions throughout the foot strike that increase the odds of a blister forming. An example is studies showing that runners in a multiday event blister more as the race progresses.
  4. Friction and normal force: The levels of friction and pressure determine the amount of shear that impacts the skin.

It’s worth talking about how blisters will deroof—when the stop layer of skin is torn off the top of the blister. Consider a back-of-the-heel blister. A blister has formed because the heel bone has moved up and down while the outer skin has remained fixed inside the sock and shoe. The shear stressors, as described previously, have caused the blister. With repeated levels of movement against the skin on the back of the heel, the skin can be rubbed over and over. This is what causes abrasions. When the forces that cause blisters combine with forces that cause abrasion, the skin is stretched past normal levels and is torn off.

In reality, some people are more blister-prone than others, irrespective of the amount of training and preparation. In spite of having done everything right, the shear strength of their skin is going to be lower than others—no matter what they do. They are simply blister-prone. For others, some of this has to do with the training that they do in preparation for races. It’s quite common at races to see lead runners come through aid stations without any blister problems. They typically have conditioned their feet through extensive training. But as the race progresses, the middle- and back-of-the-pack runners enter aid stations with a lot of blister problems. They typically have put fewer miles on their feet and, in some cases, have made poor choices about footwear and foot care.

This is the first in a multi-part series on blister formation and prevention. The material is extracted from Fixing Your Feet, 6th edition.

Reduce Friction to Reduce Shear

December 21, 2014 by · Leave a Comment
Filed under: blister care, Foot Care, Foot Care Products, Sports 

I have often mentioned the website BlisterPrevention.com.au as a great source of information on blister care. Rebecca Rushton, manages the website and is on top of developments in the prevention and care of blisters. She’s a podiatrist in Australia – and a friend.

Through research and looking at the mechanism of how blisters form, Rebecca has changed some old theories of what causes blisters. Heat, moisture, and friction were always considered the three contributors of blisters. Further consideration has found that shear is a major factor. Shear and friction combine to cause blister formation.

You must reduce friction to  blister-causing shear.

You must reduce friction to blister-causing shear.

I want to quote a blog post by Rebecca about Healing Foot Blisters Faster to help you understand more about friction and shear.

“You know friction is responsible for friction blisters. 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.

“Here’s how friction is responsible for foot blisters … There is high friction in your shoe. There just is. This means your skin grips your sock; and your sock grips your shoe. All three surfaces grip together so your foot doesn’t slide around in your shoe.

But with every step you take, your bones are moving around under the skin. And while the skin is stuck and the bones are moving back and forth. Everything in between is pulled and stretched. This pulling and stretching is what causes blisters.

We call it shear. And it needs high friction to get anywhere near blister-causing.”

With this opening, Rebecca starts to explain the effect of shear and friction on blister formation. She talks about cutting friction levels, especially when a blister develops, and gives examples of six friction reducers. Some of these are better than others.

We have always tried to reduce friction in both preventing blisters and when treating blisters. As Rebecca says, and I support, “Otherwise all that stretching (shear) continues at the blister base while it’s trying to heal. Making it hurt more. And taking longer heal.”

So take a moment and click on the Blister Prevention link and read Rebecca’s full blog post. While you are there, I encourage you to subscribe to her email list.

Patching Heel Counter Wear in Shoes

Holes in Heel Counter

Holes in Heel Counter

Occasionally I see runner’s shoes that have wear holes in the material in the heel counter. This picture from Dan shows his shoes with holes to the outside of center on both heels. I emailed the following suggestion.

ENGO Back of the Heel Patch

ENGO Back of the Heel Patch

I’d try an ENGO Back of Heel Patch. They are made to shape to the curve of the back of the heel counter. Put them in when the shoe is dry. Rub them a bit in a curving motion to help them form to the shape of the shoe. Then peel off the paper backing and apply from the center outwards to the sides. Rub well so they adhere to the shoe’s material. You could also try the large ovals if the hole is small. The blue ENGO patches are very slick and can take a lot of wear. Once the blue wears down to expose white, replace the patch. Sometimes the holes are on the sides of the heel.

Heel Patch in Shoe

Heel Patch in Shoe

Heel Bump

Heel Bump

Last summer at Western States, I had a runner whose shoe was rubbing her heel raw. You can see from the image that she has a prominent heel bump. This, of course, contributed to her problem. This is the kind of problem one needs to plan for before it becomes a major issue – especially at the event the magnitude of Western States.

Cut Shoe Heel

Cut Shoe Heel

We decided to cut a notch out of the outside of her shoe’s heel. This allowed the back of the shoe to spread apart for her large heel bump. Then I applied an ENGO Back of the Heel Patch to the inside of the shoe’s heel counter. This provided some protection to her heel bump.

The large ENGO ovals can also be used when there is a small area to be covered.

I have been a fan of ENGO Blister Prevention Patches since I first discovered them years ago. The ovals are perfect for the common areas at the side of the heel where blisters form at the junction of insole and heel counter. The large rectangles are great to put on insoles underneath the ball of the foot, another common problem area.

Check out the ENGO website for more information. ENGO products are available through Zombierunner. If you are in Australia or New Zealand, ENGO products are available through Rebecca Rushton’s Blister Prevention website.

Disclosure: Tamarack Habilitation Technologies supplies me with ENGO Patches as I need them for races.

ENGO Blister Prevention Patches

September 8, 2013 by · Leave a Comment
Filed under: blister care, Foot Care, Foot Care Products, Footwear, Sports 

In my last post, I talked about four ways to reduce shear and the likelihood of blisters. To recap, they were fit, cushioning, moisture management, and socks. Today’s post will cover a fifth way by using ENGO Blister Prevention Patches.

Tamarack Habilitation Technologies is well known for providing healthcare professionals and clients with innovative, value-added orthotic-prosthetic componentry and materials. Their ShearBan product is similar to the ENGO Blister Prevention Patches reviewed in this article. ShearBan is used in the orthopaedic and prosthetic industry on prostheses at amputation stump sites to reduce the incidence of skin breakdown.

ENGO in Footwear

ENGO in Footwear

Introduced in 2004, ENGO Blister Prevention Patches have radically redefined the way hot spots, blisters and calluses are treated. As a preventative measure, ENGO patches provide peace-of-mind that blisters won’t become a painful, debilitating problem. If a blister has already formed, applying patches to footwear, corresponding to the blistered area eliminates painful irritation and further skin damage, allowing continued activity. Friction forces are reduced by more than 50% when you apply an ENGO Patch to your footwear.

ENGO Applied

ENGO Applied

The patches are made from an ultra-thin Polytetrafluoroethylene (PTFE) film and are 0.015 inches total thickness – a very slippery surface. They are very durable, lasting four to six weeks in most applications. The aggressively sticky patch peels away from the backing and is applied to dry shoes or boots. The PTFE ENGO Patch reduces the ‘stickiness’ between the shoe and sock so they can glide over one another. The foot, inside the sock, glides over the patch shear distortion and friction are reduced, and blisters can be averted, in spite of pressure.

Avid runners, hikers and sports players rely on their feet to reach performance goals; from day hikes to ultra marathons. But quality footwear and socks alone don’t eliminate the skin trauma your feet can experience from repetitive rubbing — building friction forces to levels that cause hot spots, blisters and calluses. While I use these patches in runners’ footwear at races, they can also be used in ordinary every day shoes to reduce calluses.

Similar to Tamarack’s ShearBan material, ENGO patches are applied directly to footwear and equipment, not to the skin. Outcomes of this unique application include ease of use, long-lasting and guaranteed friction relief.

ENGO Patch in Shoe

ENGO Patch in Shoe

ENGO Patches are made in several sizes and types:

  • A large oval – 2 ¾ x 1 ¾
  • A small oval – 2 x 1 ½
  • A rectangle – 3 ¾ x 2 ¾
  • Back of the heel patch – 3 ¾ x 1 ¾
  • A cushion heel wrap – 3 ¾ x 1 ½

When I work a race I always have a bag with different sizes of ENGO patches. I have applied the ovals and rectangles and the back of the heel patches. The patches are applied to the shoes and insoles – not to your skin. This means wherever you are going to apply a patch has to be dry. My advice is to apply patches before your race when your shoes are dry. I have used them inside the shoes in the sides, in the heels, and on the insoles.

ENGO in a Shoe's Heel

ENGO in a Shoe’s Heel

Typical problem areas in footwear are under the heel and forefoot, and at the side of the heel. An oval patch can be applied to overlap the side of the heel counter and the insole as seen is the photo. I often use a rectangle or large oval under the ball of the foot or an oval under the heel – applied directly to the insole. The patches are useful over stitching or seams in footwear that are rubbing the wearer. If necessary, a patch can be cut to shape for where it will be applied.

The patches will reduce shear and friction; provide relief from hot spot and blister pain, and can be used in any type of insole or orthotic and footwear, from sandals to running shoes, and any type of hiking or ski boot.

I like ENGO patches because they work. The patch is thin and does not alter the fit of the shoe. When properly applied to dry footwear, they stick.

Rebecca Rushton, a podiatrist in Australia, strongly recommends ENGO Patches. She discovered the patches after getting blisters herself and now represents ENGO in Australia. She has written several free reports on blister prevention available on her website, Blister Prevention.

If you are unclear about shear and blister formation, here’s a link to my article An Introduction to Shear and Blister Formation.

The Technical Stuff

JM Carlson, in a 2009 report wrote, “The measurement of friction is the ‘coefficient of friction’. The coefficient of friction (COF) is a number that represents this slipperiness or stickiness between two surfaces and is generally below 1.0. Within the shoe, the COF between the foot, socks and insole can range from 0.5 – 0.9. In contrast the COF between a sock and a polished floor is around 0.2.” Tests have shown PTFE patches to reduce the coefficient of friction (COF) in the shoe by up to 80%. The COF is in approximately 0.16, which is significantly lower than all other in-shoe materials. Importantly, the low COF is maintained even in most and wet conditions inside the shoe.

Check out GoEngo.com for more information about ENGO Blister Prevention Patches. They also offer a money-back guarantee.

ENGO Patches can be purchased at the ENGO website, Zombierunner.com, and Rebecca’s Blister Prevention website.

Disclaimers: I support ENGO Patches and am supplied with whatever I need for the events I work. I am an affiliate of Zombierunner and make a bit of any sale made through the link above.

More on Shear and Blister Treatments

August 26, 2013 by · Leave a Comment
Filed under: blister care, Foot Care, Footwear 

Back on June 17 I introduced the concept of shear with a post by podiatrist Rebecca Rushton from Australia who has studied blisters and identified shear as a major factor in blisters.

It’s best to start by refreshing our memories about what was shared on the previous article. Here’s the link in case you want to see the full post: An Introduction to Shear and Blister Formation. Otherwise, here’s a short piece from that post:

Poor blister prevention outcomes are due in no small part to the misunderstanding of the cause of this obstinate injury. The force that causes ‘friction’ blisters is not friction. And it’s not rubbing. It’s shear. But if you ask 100 people the question “what causes blisters”, nobody would answer “shear”. Shear is the sliding of layers across one another – internal layers that are structurally connected. Those connections can break and when fluid fills that cavity, you have a blister! What Does Shear Look Like?  Try this … Step 1: Place the tip of your right index finger on the back of your left hand. Step 2: Wobble it back and forth but keep it stuck to the same bit of skin. Notice how your skin stretches? This is shear and this is what causes blisters. Shear might look like rubbing but it’s not. Notice how your finger tip has not moved relative to the skin of the back of your hand? But your hand skin has moved relative to the underlying bone. This is shear. Your skin doesn’t need anything to rub over it for blisters to form. It just needs shear (this stretching of the internal tissue layers) to be excessive and repetitive.

That’s shear.

Managing shear is key to managing blisters. Let’s look at several ways to reduce shear.

The first way is to make sure your footwear fits. Many people buy shoes that seem comfortable in the store but don’t make sure they feel ok by wearing them around the house for a few days. Make sure they have enough room in the toe box both in height and length. Make sure there is not undue pressure on soft tissues over any bony spots (sides of the forefoot, ball of the foot, sides and back of the heel, over the instep, etc.). Make sure they are not too loose, allowing too much movement leading to skin abrasions, hot spots, and then blisters.

Using a cushioning product is a second way to reduce shear. This might be a gel pad under the ball of the foot or under the heel bone, or a replacement insole meant to pad and cushion.

Applying power during an adventure race

Applying power during an adventure race

A third method is to manage skin moisture. This can include skin-drying strategies and skin lubrication. Studies have shown that you can reduce the incidence of blisters by keeping the skin either very dry or very wet. Drying the skin can be done with powder, benzoin, alcohol wipes, and antiperspirants. Lubricants can include SportSlick, BodyGlide, BlisterShield, and other popular products. Zinc oxide is also effective at controlling moisture. The method of having runners train with wet feet has been successfully used by Shirley Thompson and Vicky Kypta of the Jungle Marathon Amazon. They have found that the feet of their race participants have been better with this suggestion given to runners before the race.

The fourth method of controlling shear is with socks. This may include double layer socks or wearing two pairs of socks – a thin liner and usually, a thicker second sock. This allows movement between the two sock layers. Injinji toe socks are great for those with toe blister problems.

Next time, we’ll talk about  a fifth way to reduce shear – Engo Blister Prevention Patches.

In the mean time, check out ZombieRunner for many products that can help with cushioning, skin-drying and lubricants, and socks.

An Introduction to Shear and Blister Formation

June 17, 2013 by · 2 Comments
Filed under: blister care, Foot Care, Health, Sports 

This is a guest post by podiatrist Rebecca Rushton from Australia. She has looked at blisters, how they are formed, what causes them, and how to prevent them. For years, the common thinking about blister causes has been friction, heat, and moisture. Rebecca’s research has led her to identify shear as a leading cause of blisters. Read the article and then check out her website. Over the next months, Rebecca and I will take an in-depth look into blisters, their formation, and treatments. Her website Blister Prevention has a lot of valuable information on blisters (more on that at the end of this post). Here’s Rebecca’s article.

An Introduction to Shear and Blister Formation

Foot blisters continue to wreak havoc with endurance athletes’ feet in spite of their best preventative efforts.

Poor blister prevention outcomes are due in no small part to the misunderstanding of the cause of this obstinate injury.

The force that causes ‘friction’ blisters is not friction. And it’s not rubbing. It’s shear. But if you ask 100 people the question “what causes blisters”, nobody would answer “shear”.

Shear is the sliding of layers across one another – internal layers that are structurally connected. Those connections can break and when fluid fills that cavity, you have a blister!

What Does Shear Look Like?  Try this …

Step 1: Place the tip of your right index finger on the back of your left hand.

Step 2: Wobble it back and forth but keep it stuck to the same bit of skin. Notice how your skin stretches? This is shear and this is what causes blisters.

Shear might look like rubbing but it’s not. Notice how your finger tip has not moved relative to the skin of the back of your hand? But your hand skin has moved relative to the underlying bone. This is shear. Your skin doesn’t need anything to rub over it for blisters to form. It just needs shear (this stretching of the internal tissue layers) to be excessive and repetitive.

Rubbing Causes Abrasions

Most of us use the term rubbing to mean two surfaces moving across one another – like when you rub your hands together.  The type of skin injury that rubbing causes is abrasions. An abrasion is where the top layers of skin are rubbed off – you end up with a red raw sore. Blisters (from shear) and abrasions (from rubbing) are completely different entities – they have different mechanisms of injury and affect different layers of the skin. Here’s a video on blisters versus abrasions on the feet.

Is the distinction important? Yes it is. The lack of understanding of blister causation is at the heart of why foot blisters continue to plague athletes.

Achieving True Blister Prevention Success

There are 3 factors that influence shear. Impacting on these is how we can minimise shear and prevent blisters.

1) Type of skin

Thinner and more mobile skin (like we saw earlier on the back of the hand) will abrade before it blisters.  In contrast, thicker and less mobile skin (like on the palm of your hand) is the type of skin more likely to form and maintain a blister.  Do the same experiment we did before but with your index finger on your palm – the skin is noticeably thicker and less mobile in comparison. (This is why blisters are most common on the soles and palms)!

Apart from the thickness and mobility characteristics which determine the ability to blister (and which you can’t do an awful lot about), shear is influenced by two other factors: friction and bone movement. You need both, not just one, to create skin shear. The good news is that these things we really can change! Change one or more of these, in one of many ways, and you can successfully prevent foot blisters.

The cause and influencing factors of foot blisters

The cause and influencing factors of foot blisters

2) Friction

Friction is the force that resists the movement of one surface against another. It’s the degree of slip or grip between surfaces. Low friction (slippery) is when two surfaces glide easily against each other. High friction (sticky) is when the two surfaces tend to grip together.

The moist in-shoe environment during exercise causes high friction levels between the shoe, sock and skin. This causes these materials to stick together … yes the shoe sticks to the sock and the sock sticks to the skin … for longer.  They all stick together for longer because of high friction.

3) Bone Movement

Meanwhile, as we run the bones move back and forth. With the skin remaining stationary (for longer) and the bones moving back and forth as far as they can go, the soft tissue in between stretches – that’s what shear is.

This concept of friction and bone movement leading to shear is depicted in the diagram below and in this video demonstrating shear.

Orange = shoe | White = sock | Brown = skin | Purple = section of soft tissue undergoing shear
Orange = shoe | White = sock | Brown = skin | Purple = section of soft tissue undergoing shear

The purple area is a section soft tissue between the skin surface and its underlying bone. Although the heel itself has not lifted within the shoe due to high friction levels, the bone has moved up relative to the skin surface causing shear to the soft tissues in between.

About Rebecca

Rebecca’s website Blister Prevention has a lot of valuable tips and techniques, and information on blisters. Take some time and explore the site, subscribe to updates and receive a copy of her ebook, Blister Prevention for Active People. Rebecca is a podiatrist in Australia.

Next Up? More on Shear and Blister Treatments

Over the next month or two, we will talk more about shear and common blister treatments – including what works and doesn’t work. Make sure you are a subscriber to this blog to receive each post. You can do that at the box at the upper right side of this page.

Blister Treatment or Prevention?

June 3, 2013 by · 6 Comments
Filed under: blister care, Foot Care, Footwear, Health, Sports, toenails 

Which is more important, blister prevention or blister treatment?

For more than 17 years, I’ve taught foot care techniques to anyone who will listen. I have taught classes at running stores, REI stores, events, and more. In addition, I have worked medical at many races, helping provide foot care to participants. These races have been in Death Valley, Chile, Costa Rica, BC Canada, Colorado and Washington, and many in California. This year I will be at Western States 100, Badwater, the Gold Rush Adventure Race, the Jungle Marathon in the Amazon, and hopefully at races in Colorado and Namibia.

I have never counted the feet I have worked on but I would put the number well over 3000. I remember one race in Colorado in 2010 when I saw the same lady 10 times. It was a six-day stage race and she’d come in every evening and morning! I’d patch her feet in the evening and she’d take it off when she went to bed in her tent. She had foot wear issues that gave her blisters on top of blisters. She was never into prevention mode – only treatments.

In this picture, taken from the cover of the 5th edition of Fixing Your Feet, we see treatment taking place. I love the picture. I even know whose foot it is. What I can’t tell you is what he did for prevention. I wish I knew.

FYF Cover Image

FYF Cover Image

My question in this blog post is what should we spend more time on, blister prevention or blister treatment?

Prevention can take many forms: good choices in footwear, the right socks, lubricants and powders, toenail care, skin care, taping, Engo patches, correct lacing, the right insoles, and training and conditioning.

Treatments likewise offers many options: blister draining, many different types of patches, taping, ointments and salves, a multitude of tapes, wraps and straps, silicone pads, Engo patches, toe caps, and lubricants and powders.

So here are a few questions:

  • Does prevention last only until the race starts?
  • What are your best prevention options?
  • How much do you count on aid station personnel to manage treatments?
  • Do you know how to treat your feet?
  • Do you carry materials to treat your feet?
  • What are your best treatment options?
  • How well do you understand blister formation and prevention?

For 17 years, athletes have had Fixing Your Feet as a resource to learn important information about foot care. As I patch feet at races, I try to educate the athletes about what I am doing and why, and what could have helped in their feet. If crews come to me for advice, I try to help them too. I have watched athletes and crews work on feet with materials and using techniques I have long preached.

In general, foot care has advanced over the years. Shoes, socks and insoles have become light years better. Lubricants, powders, blister patches, and our tools are better. People interested in foot care are trying new blister patching techniques.

All this is good because every day there are new athletes coming into running, adventure racing, hiking and thru-hiking, walking, and other feet stressing sports. Let’s make sure they understand the importance of prevention before treatment.

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