Blister Prevention – The Long Version

January 13, 2013 by · 1 Comment
Filed under: blister care, Foot Care, Health 

Today’s post is long, but illustrates a valuable point. The Facebook post below started a long chain of responses – all suggestions on what the poster could do to eliminate her blister problem. There were a total of 64 responses. Let’s get right to what was initially posted.

Original Facebook Post

So some of you may remember the nasty blood blister I got during Boston in 2011. I am very unhappy to say I have another one as a result of yesterday. Today I will be doing a GREAT amount of reading on not only how to treat but prevent this from happening again. My next long run is 20 miles. I think that moleskin is going to become my new best friend for EVERY long run.

Side of the foot blister

Side of the foot blister

Fifty-four Responses

I use Sportslick and only wear Wright socks (thin, double layer) for long runs. For my last Ironman I put anti-perspirant on my feet everyday for a week before the race. I got no blisters. Good luck!

Soldiers have been known to wear panty hose footies during marches. And tape every hot spot.

Going to look up mole skin because since I lost 90+, my sneakers were huge on me and I didn’t realize it so after the bursitis incident I walked a few miles and had horrible blood blisters that were UBER painful. I applied Band-Aids the next day and kept hustling… moleskin eh? Thank you and healing love to your blisters. They hurt!

May be time to re-evaluate your shoes. I got a whopper this summer after a 20 miler. My inserts in that particular pair of shoes were causing me to run a little odd.

Moleskin! I used it with any shoe that pinches or rubs, especially heels. I found cleaning my skin with alcohol first helps it adhere the best and stays even after taking showers!

If you have sweaty feet be warned moleskin can be sweated off. It is probably the best out there though to prevent blister. If it gets rolled or folded it can make the problem worse.

I use Sportslick and wear Wright socks as well. No blisters as of yet. It got me through my first marathon with no blisters and it rained that day and my feet were soaked. It didn’t do much for my bruised toe nails though lately I have been using Monkey Butt” anti-chafing powder when training for triathlons. Have had great results with this product with my bike shorts. But for feet, I would recommend Sportslick as it is a thick petroleum based ointment. Best of luck! And remember, one foot in front of the other. It doesn’t have to get any more complicated than that!

New shoes may also be the answer. I switched from running in Nike Air Pegasus years ago to Mizuno Wave Riders with little to no blistering. Turns out I needed a narrower toe box and the Nike Pegasus toe boxes would stretch a great deal over time.

Research socks and use a Bodyglide type product
.

I have hyper mobility in my feet. I was using Sauconys. Horrible foot pain. Got some Mizuno. Best shoes ever! I can run without pain!

I use anti-perspirant and change my socks every 5 miles
.

Try Balega dry fit socks. I NEVER get blisters anymore and I’ve completed two marathons and two Ironmans in them. Used to get blisters all of the time before I switched!

Mizunos + Bodyglide + a great fitting pair of socks = No blisters… ever again!

I get the cheap Monistat anti-chafing cream and put that on my blister prone areas, and it works perfect!

My latest blood blister peeled off the end of my toe just this week! I had a little party!

Have you ever tried Smartwool socks? They are pricey, but worth it. I haven’t had a blister since I started wearing them on my runs
.

We always wore two thinner pairs of socks in high school if we had history of blisters… one pair inside and it worked like a charm.

Inside out [socks].

Here’s my 2 cents! I keep my toenails as short as I can handle- short! Smear on some Vaseline between my toes wear the same brand of sox and so far so good.

Moleskin is amazing, and glide works well too. I have heard if you’re in a pinch use deodorant where there is any friction.

In the years I have done marathons/half marathons, I find that having the right shoes, using wicking socks (I too use the Wright socks), and use talc/baby powder in between my toes I do not get blisters.

I gave up on running because of constant and ongoing blisters, I tried several shoes etc nothing helped, I loved running but those blisters were so painful, what is moleskin?

Totally agree with Smartwool socks. They rock.

Try Nuskin. I have a friend who is a marathon runner and this company is her sponsor. Supposedly very good!

Love moleskin! I get wicked blisters without it and none with it. The stuff rocks! Superb for healing blisters too!

Military uses just basic slip on panty hose/dress socks especially with long hauls when carrying 80+lbs in the desert – it works and it is cheap.

Mole Skin and my hiking boots = Love.

Panty hose and then socks over?

I swear by these don’t know if you have used/seen them – Nike Elite Anti-Blister Low-Cut Tab Running Socks.

I spray my feet with Trislide if I start getting any rubbing in my shoes. I can run barefoot and not get a blister no matter how long I go.

SUPER HELPFUL! OKAY NOW FOR TREATMENT FOR MY EXISTING BLISTER? IDEAS? I HAVE RUNS THIS WEEK.

There are lacing techniques that you can try to that help prevent this – as with some of the other comments; you may need a different shoe or sock. I’m sorry, that’s such a pain! I recently switched from Saucony to Mizuno’s & have had a really great experience so far.

Try the book Fixing Your Feet by John Vonhof. We ultra runners swear by this book.

Yeah I do believe my Saucony Kinvaras are out for this very reason. Both times I wore them – in Boston and again yesterday it happened.

The best stuff for blister is Compeed. It is now sold by Band-Aid as Blister Band-Aid and still says Compeed on the box. You can put over the blister and still run without feeling anything. I always carry with me on races. Just in case!

To heal the latest blisters I had to pop them as they were so big I couldn’t put shoes on. Then I cut the size of the blister out of the center of the moleskin and place it over/around the blister. Kept blister clean and voila, perfectly fine that night!

Yes – pantyhose and then socks over – they glide and no friction in between skin and toes.

I play hockey and some girls get the worst blisters from skates. It was actually a doctor on our team that recommended using duct tape! It does work better than moleskin and with good socks. This is at the stage where you are getting irritated in a certain spot, not of course after the blister has formed!

I second the double sock and panty hose method. I actually found ones you wear for ballet flats very helpful. Not sure how they would do on long hauls as I was a short and medium distance sprinter. Cheap and easy.

I have ran a ton of marathons and have stopped getting blisters when I purchased a good pair of socks and bought my shoes a size and a half bigger. So one good sock and big shoes = happy feet.

What you are describing sounds like poorly fitted shoes to me. Make sure you get fitted a good running shoe store, and tell them up front that you have a problem area. A good running shoe fitter should be able to fix the problem.

Knee high pantyhose along with powder maybe but the pantyhose should protect your feet from the friction.

You need to check out Incrediwear.com – they have the best socks for runners. My husband does marathons and I’ve recently started running myself. There is no question our feet don’t hurt and they wick away the sweat. They are made with bamboo charcoal and they increase blood circulation.

Wright socks!! I get them sometimes. But I wear Vibram FiveFinger shoes. And any other running shoes I have are minimalist shoes. So not socks… But if you do wear socks. Get some 2-layer Wright” socks! They are awesome. Or an old army trick. Wear nylons/knee highs under socks.

You are not supposed to pop blisters ever. If they pop on their own fine. But I would cover it up with something like the moleskin or a blister Band-Aid and wear good socks and shoes. I like the knee-high panty hose idea. Good luck & feel better!

Duct tape.

I hate to hear that girl…I run in Asics, and those socks I told you about and have never had a blister…sorry feel better girl!

I remember that blister because I had an awful one at the same time! I finally stopped getting them when I went to a actual running store, they fitted me with a pair of Sauconys with a wide toe box and laced them just from the middle of the shoe and up. In all the miles I ran after that never got another blister and my black toenails grew out and had no more problems with that either! It’s the wide toe box that saved my feet.

If the blister is open, use vitamin E oil on it at night. Air it out as much as possible. If the blisters are so large you can’t wear shoes, take a cleaned (alcohol) safety pin and drain. Don’t tear skin off. It is best not to pop but sometimes it’s needed. Motrin for the pain may seem extreme but if you r in so much pain and start altering your stride you’ll get even more blisters.

Try Second Skin. It works very good for soldiers. In two days your feet will be like new!

I never got blisters-and i used to run 65 miles a week. My trick was either Thorlo socks, or wearing two pairs of snug socks. And wearing shoes that were a full size larger. My favorites are Kswiss performance. When running distance, your feet swell so much, you need the space to be able to accommodate it.

Vibrams! They literally took away all my feet problems, including blisters. I love them.

Essential oils are helpful for treating the actual blister. Lavender and tea tree (also called Melaleuca) will help it heal. Apply 2-3 drops of each every couple hours – or when you think of it really. I hope it feels better… they are nasty.

I grease my toes and footpad down with simple cocoa butter Vaseline before any run or distance walk! Haven’t had a blister since! Took a couple times to get used to the immediate feel, but now a year later with no blisters, I hardly notice I’m doing it any more! It’s cheap & simple! And, foot fitting socks! I have my favorite kind that I own multiple pairs of, got them at the local Fred Meyer!

I do the same for long runs. And sometimes baby powder to. Helps with the moisture.

After all 54 responses, I had to weigh in. Here’s what I wrote:  

As the author of Fixing Your Feet, I’ll comment that some of what has been suggested here is good but some is not what I would recommend. There is no “one right” answer to the ago-old blister problem. There are many causes and many answers. Try some and find what works for your feet. What’s important is fit, socks, trimmed and filed nails, reducing calluses, and a high-quality lube if needed to reduce friction.

Later, I emailed Jenny and based on what she described and the picture of the blister, here is my response to her.

Let’s talk treatment first. Because it’s a blood blister, I’d try to keep the roof intact. If it opens, your circulatory system is open to possible infection.  I lance them, but I am used to doing that, and give the athlete a lecture on infection. Generally if you soak your foot in warm/hot water with Epson Slats, several times a day, the blood and fluid will be reabsorbed – and the blister will harden. Over time, after that, the top layer of skin may slough off but by then, the possibility of infection is over. Start there. If the blister ruptures, make sure you use an antibiotic ointment and keep it covered. Signs of infection are redness, heat, swelling, pus, pain, and streaks moving up the foot. That becomes serious. Make sure your Tetanus shot is up to date (usually about every 8-10 years).

As far a prevention goes, here are a few thoughts:

  1. I think I see the edge of callus at the forward edge of the blister. I don’t like calluses. Try and reduce any you might have.
  2. Do you have bunions? If so, that changes a few of my ideas.
  3. I’d guess that you have a shoe issue (meaning fit). If you have wide feet, or the shoes you wear are too narrow, you’ll have these problems. I read you wore the same shoes both time this happened. That’s a good sign you don’t have a good fit. A better fitting shoes could solve your problem.  Can you get fitted at a good running store?
  4. Something else I see is that the bottom edge of the blister is right at the edge of where the insole hits the side of the shoe. This again gets to the issue of fit. There is pressure there, creating friction, that cayses the blister, that builds from this bottom edge upward.
  5. One option is to protect the area with a strip of tape. Duct tape isn’t the best, but would work. Don’t use white athletic tape. It won’t stick. I prefer Leukotape.
  6. You could cut a horizontal slit in the side of the shoe over the pressure point.
  7. I hate moleskin and never use it. It does not stick well, does not conform to the shape of the area, and is too thick. Stick to tape. The ONLY kind I would recommend is Profoot Velvetex Moleskin (available on Amazon).
  8. Only wear moisture wicking socks.

Something to understand, that I preach all the time, is that what works for one person will not necessarily work for another. That goes for socks, shoes, lubricants, powders, etc. We each are an experiment of one and need to determine what our feet need. Keep me posted.

Spartathlon Feet

October 6, 2012 by · 1 Comment
Filed under: blister care, Foot Care, Health 

Several years ago I met Gregg at Badwater in Death Valley. We were in line to check in at Furnace Creek and I heard the last name. It was the same as an aunt of mine. Turns out we are related.

At Badwater he ran well and finished near the top. Later that year, he and his wife moved to Asia and I had not heard from him – until the other day. He sent an email about running the Spartathlon in Greece. It’s a 246-kilometer (153 mile) race between Athens and Sparta. The Spartathlon aims to trace the footsteps of Pheidippides, an Athenian messenger sent to Sparta in 490 BC to seek help against the Persians in the Battle of Marathon. Here’s his email:

I just finished running Spartathlon. It was nearly as hot as Badwater (100.4), ok maybe not as hot as Badwater, but it was far to hot for this race, considering it is normally 86. The race by the way is fantastic; I would highly recommend that you make a trip out there if you get the chance.

So, I took a photo of my feet after the race and thought you might like the photo, being that you are the foot guy. Might make for a good example. The blister appeared to start from underneath the pad of my foot by my big toe. The pressure built up so much that it formed the blister on top of my foot as well – as you can see from the photo. Pretty cool if you ask me. I probably ran with it for 50 miles, since I didn’t change my shoes and didn’t feel like taking them off. They lanced it when I finished… as I was receiving two bags of IV fluid. Haven’t had any problems with it since, although it has taken a few days for the pressure under my foot to slowly recede.

Spartathlon Feet

Spartathlon Feet

As you can see in the photo, there is blood in the blister. Here’s where you have to be careful and take precautions to prevent infection. I don’t encourage people to lance these on their own, but in aid stations with the right equipment and knowledge, it can be done. When I do it, I always give the athlete the warning signs of infection: redness, warm to the touch, pain, fever, pus, and swelling. If you have a blood blister, be careful.

Really though, Gregg’s feet look pretty good for just having run 153 miles. Don’t you agree?

Blood Blisters

July 22, 2012 by · 1 Comment
Filed under: blister care, Foot Care 

In reality, most blisters don’t have blood in them. Repeated heavy pressure (friction) or simply long periods of pressure can turn an ordinary blister into a blood blister.

The fluid will go from clear to light pink, and with continued pressure, to blood red.

The general rule of thumb is not to lance and drain any blood blister. You may have to pad the area to take the pressure off the blood-filled skin. You need to now how to manage a ruptured blood blister.

Here’s why. The problem with blood blisters is that by draining them, the athlete’s circulatory system is opened to possible infection. In a sterile environment or at your home, this may not be an issue. However out on a trail, or somewhere where the athlete may be unable to keep his feet clean, it’s a different story. Where the blister is on the foot can present more problems. A blood blister on the side of the heel is not as problematic as one on the bottom of the foot. The opened blister is exposed to dirt, grime and any bacteria on whatever is touching the skin. Blood blister must be treated as wounds.

Another issue is whether the athlete has he right supplies in his foot care kit to patch the blister. Opening it up and not applying antibiotic ointment and a covering it is a huge mistake.

I tell athletes that normally blood blisters are not lanced because that is the wise thing to say. If everyone thinks they can simply lance them, without fully understanding how to care for them, we’ll have a lot of people with infected feet.

At Badwater last year we had a runner with a very large heel blood blister. She was from Brazil and would be flying home – but she was also a diabetic. Because of her diabetic status, we declined to lance the blister. It would not have been safe.

Arch of the foot blood blister

Arch of the foot blood blister

The photo here is from last week’s Badwater Ultramarathon in Death Valley. The runner had completed the 135-mile race. I talked to him at the finish line and told him the pitfalls of lancing a blood blister. I told him to shower and be careful of popping it and to come see us in the medical room if it did pop. It popped when he was in the shower, the best of all places.

I cleaned the area with alcohol wipes and lanced the blister with a #11 scalpel. I made three cuts so any more fluid would be forced out as he walked. I expelled the blood and applied a generous layer of antibiotic ointment. A gauze 4×4 was placed over the top and then the foot was wrapped with Coban, a wrap material that sticks only to itself. I gave the runner a Zip-Lock bag with a small tube of ointment, several more 4x4s, a Popsicle stick to apply the ointment. I told him he could unwrap the Coban and reuse it multiple times. Then I asked him if his Tetanus was up to date after which I gave him the usual infection speech.

Recheck the blister three times a day for signs of the infection. Each time you check, apply a new coating of antibiotic ointment and change the dressing. Early treatment can keep the infection from becoming more serious.

An infected blister may be both seen and felt. An infection will be indicated by any of the following: redness, swelling, red streaks up the limb, pain, fever, and pus. Treat the blister as a wound. Clean it frequently and apply an antibiotic ointment. Frequent warm water or Epsom salt soaks can also help the healing process. Stay off the foot as much as possible and elevate it above the level of your heart. If the infection does not seem to subside over 24 to 48 hours, see a doctor.

It’s wise to keep a tube of antibiotic ointment in your foot care kit. You may never get a blood blister, but then again, you might. And if you get one, it may not rupture, but then again, it might.

It’s better to be prepared by knowing how to care for blood blisters.

 

Ball of the Foot Blisters

December 29, 2011 by · 1 Comment
Filed under: blister care, Foot Care 
A large blister on the ball of the foot

Here's a big blister on the ball of the foot

Ball of the foot blisters are quite common. Often they are more common when runners change to walking. Let take a look at these blisters.

Challenges with Ball of the Foot Blisters

There are three problems with ball of the foot blisters that make them more problematic than blisters elsewhere on the foot. Look at the image and you’ll see the large amount of area it covers. And yes, there’s blood in the blister section between the big and first toe.

  • They often extend up into the skin between one of more toes
  • They can spread out to cover a large area side-to-side and further down to the mid-foot
  • They can easily tear at the front most area at the base of the toes

Preventing Ball of the Foot Blisters

I have learned several things about preventing ball of the foot blisters

  • Keep your feet as dry as possible.
  • Pre-tape if you are prone to these blisters
  • Check your insoles for rough surfaces and change to a smoother insole
  • Make sure your shoes fit and you don’t have a lot of movement of the forefoot inside the shoe

Patching Ball of the Foot Blisters

  • Drain any blister, with a slit cut where ongoing foot pressure during the foot strike will expel extra fluid out
  • Patch the blister with your favorite product and tape
  • Apply tape from up one side of the foot to up the other side – not too high but over the edge
  • Use one or more strips to cover the problem area
  • Cut a figure 8 out of a piece of tape and apply it first to the forward edge of the tape between two of the toes, and pull it between the toes, securing it on the top of the foot.

The larger these blisters, the harder they are to patch. Try to patch them before they grow into monster blisters.

Here’s a link to a page on FixingYourFeet.com about Taping for Blisters.

These photos are courtesy of Ron Jones and were taken as I patched a runner’s feet at Badwater.