Susan Alcorn’s Backpacking & Hiking Tales & Tips is a monthly email newsletter from her website at Backpack45.com. Susan and her husband Ralph have done hikes on the Pacific Crest Trail, the John Muir Trail, the Camino de Santiago, and more. Every month I review her newsletter for tips and information that I can share with my readers. I encourage you to check out her website and subscribe to her newsletter.
Only once before in the 15 plus years of publishing an email newsletter and this blog have I shared information that has the potential to save a life. Please read on and take this information to heart.
In the December newsletter, Susan shared a story they experienced while hiking the John Muir Trail. They met a hiker with a sobering tale he shared with them. He and his wife had reached Palisades Lake when she was suddenly hit with nausea, fever, and weakness. Initially he thought it was exhaustion, but the next morning his wife was worse so they did a layover day. She was even worse the following day so they decided to exit at Bishop.
His wife became so weak that she could no longer walk – even without her pack and with help. She collapsed on the attempt to descend the Golden Staircase. Her vitals were a temperature of 105, blood pressure of 90/50, a resting pulse 135 – and she was unaware of her surroundings. He and two others tried to carry her out, but found it impossible because of the narrow trail. A helicopter was brought in and she was airlifted out in a basket to Deer Meadow, where she was put inside the helicopter and taken to the hospital.
The Alcorn’s met the husband as they were leaving the John Muir Trail over Bishop Pass. He was going out on the east side and then going to find a way over to the hospital in Fresno. We wondered for days how this had played out and were happy when they heard a subsequent report. After four days in the hospital on antibiotics, the lady was ready to be flown home – not entirely well, but no longer in danger. The hospital did not do tests to determine the cause, but only treated symptoms, so the cause of the problem was up for speculation. Her husband thought that an infection had probably entered her blood through blisters in her feet – most likely the source was open blisters and their soak in hot springs.
Susan says, This is a reminder of the importance of avoiding infection in any open sore – especially under trail conditions.
I agree. In 2007 I wrote an article about another hiker on the Pacific Crest Trail who had to be evacuated out and spend a long time recuperating from a serious infection. Her infection was also caused by an infection through an open blister. This first photo shows her infected foot after she reached the hospital.
Bacteria causing the infection can come from your skin, from the environment, or from anything that gets inside the blister. The web spaces between the toes have more skin bacteria and open blisters here present an increased risk of infection. The second photo shows the redness common to an infection.
The take-away here is that we need to understand how to properly clean and care for blisters, have the right materials to patch them, and know the signs of infection.
All open blisters should be watched for redness, streaks up the leg, pus, heat to the touch, pain and/or swelling around the area, and fever. When any of these are present, prompt medical care should be obtained.
In my 2007 Fixing Your Feet newsletter I wrote, I think this is the most serious and important issue yet. It has in-depth focus on infections as a result of blisters. First read my editorial, Blisters Can Lead to Serious Infection, and then the feature article, My Infected Blister – Almost My Life! where Cari Tucker “Sandals” tells her story. I think you’ll agree with Denise Jones, the Badwater Blister Queen, who told me, ‘This is indeed sobering and shocking (literally). I think people need to see this because I do not think they take blisters very seriously!’ I urge you to fully digest the articles, then read the articles on Blood Blisters and Infections, Staph Facts and Cellulitis Facts.
Here’s the link to the July 2007 Fixing Your Feet newsletter with the articles.
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.
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!
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:
- 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.
- Do you have bunions? If so, that changes a few of my ideas.
- 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?
- 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.
- 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.
- You could cut a horizontal slit in the side of the shoe over the pressure point.
- 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).
- 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.
In August I worked the Gold Rush Adventure Race in the California Sierras. Throughout the race I worked at three checkpoints. As racers needed foot care, I carried my lounge chair and foot care box to where their team was set up and did what I could.
Most racers had hot spots, blisters and sore feet. A lot of times, athletes tell me that have blisters and yet, after cleaning their feet, none are visible. They may have a very sore spot or a hot spot, but there is no blister. Sometimes I can tape over the area or place a Spenco patch to provide a bit of cushioning. I often add an Engo Blister Prevention Patch to their insole underneath the tender area on their foot.
A lot of the racers needed blister care and taping. My whole aim when patching feet is to get the racers back in the race. I do what I can to drain and patch blisters on any part of the foot.
One of the racers came into checkpoint where they were transitioning from bikes to foot. At this point, they had been on their feet for almost two days. They started with a long paddle, followed with a long bushwack up a canyon, and then a really long bike section. The team was near the end of pack. The four members sat and discussed their options and whether to continue. The next section was a long trek of about 36 miles.
The racer needing foot care took off his shoes. As he sat back in my lounge chair, I removed his socks. His heels were fine, however he had major problems with blisters at the ball of the foot where the toes started. Both feet were the same. I cleaned his feet and did an evaluation.
I wish I had taken a few pictures of his feet but I was too involved in getting his feet patched so the team could continue. At the base of each toe were blisters. Many extended to several toes. Some of the blisters extended up between the toes. The majority had blood in the fluid. There were blisters at the base of the toes from one side of the foot to the other side – on both feet. His feet were swollen so the blistered skin was stretched tight from the fluid. In addition, several of the toes had blisters on the bottoms or sides, several with blood inside.
The blood in the blisters was my major concern and that there were so many of them. I usually drain blood blisters and with clean skin and a dab of antibiotic ointment – in a 24-hour race, I’m comfortable doing that. I always ask the person if they are up to date with their Tetanus shots and give them instructions about infections.
I talked to the racer and gave him my honest opinion – that he not continue in the race. We talked and I gave him my reasons. The next section was about 36 hard miles of cross-country trekking. His feet would get wet, and this would soften the skin and lead to further skin breakdown. The blisters were in a hard area to patch and it would especially be one long patch at the base of all his toes. The swollen condition of his feet was not going to get any better. And most important, the blood in so many blisters, even with the blisters lanced and patch, would increase the chances of an infection. Plus, if his feet took a beating during the trek, the blisters would become a huge open unpatchable mess (for lack of a better term). And of course, his feet would hurt badly.
He took my advice and I wrapped his feet as shown in the photo.
I think I can count on my fingers how many times I have advised racers to stop because of foot problems. Sometimes your feet simply quit. They have had enough.
Could this have been prevented? Based on my experience, I have to say, probably. Changing socks, treating hot spots, earlier blister care, better socks, moisture controlling lubricants, airing feet at checkpoints, and better shoe fit. In a team event, such as adventure races, every member of the team must help the other members with foot care. Every team member must be honest with their teammates about the condition of their feet. In solo races where athletes are racing alone, they need to be constantly aware of their feet. And where there are crews, these important people must ask questions about the condition of the athlete’s feet.
There are no guarantees in a race of any length. Our feet propel us forward, but every so often, out feet quit.
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.
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.
Blood blisters are something every athlete should know how to treat. Whether on the heel, forefoot, or under a toenail, these ornery blisters require special attention.
There are two schools of thought about blood blisters.
The Conservative Treatment
The conservative treatment is to not drain a blister when it is blood-filled. Doing so creates the risk of a serious infection as bacteria is easily introduced into the dermis layer of skin and into the blood system. Pad around the blister with moleskin or adhesive felt. As the blister heals, the blood will turn from bright red to a reddish-brown.
When to Drain A Blood Blister
There are times when it is appropriate or necessary to drain a blood blister. Here are a few occasions:
- If it is in a pressure point where it is likely to pop on its own.
- If it will likely pop on its own if you continue on in a race.
- If you can have it attended to by a medical team.
In these instances, clean around the blister with an alcohol wipe and lance the blister with a sterilized pin, scissors, or scalpel. After expelling the blood, apply a layer of antibiotic ointment, and then cover with tape or a blister patch.
Watch for Infection
Recheck all blisters daily for signs of infection. 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.
Studies have shown that StaphAseptic (www.staphaseptic.com) kills over 99.9% of staph and MRSA germs, preventing an infection without antibiotics. This new pain-relieving wound treatment should be used as part of a complete staph prevention program to provide protection from skin infections. An alternative ointment is Bacitracin. A prescription ointment is Bactroban.
Cloudy or Hazy Blisters
Do not drain the blister if the fluid inside appears to be either cloudy or hazy. Normal blister fluid is clear and the change indicates that an infection has set in. If clear, the fluid can be drained, an antibiotic ointment applied, and a protective covering applied. 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.
Once a blister is open, using soap and water, and an antibiotic ointment or Betadine is important for avoiding infection. Though you may not use these on an open blister during a run or in the middle of the day while backpacking, at the end of the event or day, take the necessary time to properly treat the open skin. Applying an antibacterial topical ointment will help the open blister heal up to 40% faster. Check your local drugstore for a broad-spectrum antibiotic ointment like Neosporin or Polysporin that provides protection against both gram-positive and gram-negative pathogens. Brave Soldier Antiseptic Healing Ointment is an excellent all-purpose salve to have on hand for blister care.
This was a good week. Badwater in Death Valley always is. Fit runners, great crews, fantastic scenery through the harsh reality of Death Valley – and for me, lots of feet needing care.
For the most part, things were pretty normal. Blisters and more blisters. A great case of severe capillaritis (heat rash) on one runner’s ankles. Ugly toenails. Stinky feet. And more. Lots to like for someone who does foot care.
At the closing ceremony, I noticed Monica, a runner from Brazil, was favoring her right heel. I had met her several years earlier at a previous Badwater when I patched her feet at the 40-mile mark. This year, she finished her 2nd Badwater and that was important. However, she had not come in for help.
She should have.
After the awards ceremony, Denise Jones came and told me I had to see this blister. She talked as if it was really a great find. Denise, as the Badwater Blister Queen, has seen everything and it takes quite a bit to faze her. This blister did. And yes, it was good.
What started as a small blister, one that could have been treated to prevent it from getting bigger, was now an enormous blood blister. The image shows you the size.
There were several issues we had to consider. First and foremost, Monica is a diabetic. This makes foot care a huge issue because any foot infection suddenly becomes a huge health issue. Secondly, the size of this blister, filled with blood, would make it difficult to patch. As always, blood-filled blisters must be managed with care.
We debated the issues and gave Monica advice on how to take care of the blister for her trip home. We advised frequent soaks in warm/hot water with Epson salts and sticking to sandals or other open heel footwear.
What I want to emphasize here is that this never should have reached the size it was and worse yet, filled with blood. For those wondering, a blood blister is bad because, once opened or torn, it can introduce infection into the circularity system if not kept clean.
I wish Monica had taken care of this earlier. She may have never mentioned it to her crew. At any rate, what could have been easily treated now became a huge issue.
It’s a good lesson on not allowing small problems to become large problems. In other words, “Don’t do this to your feet.”