Infections from Blisters – A Serious Condition

December 3, 2013 by · 2 Comments
Filed under: blister care, Foot Care, Health, Sports 

Susan Alcorn’s Backpacking & Hiking Tales & Tips is a monthly email newsletter from her website at 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.

Cari's Blister Infected Foot

Cari’s Blister Infected Foot

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.

An Infected Blister

An Infected Blister

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.


A Wart Story – Part II

September 3, 2012 by · 3 Comments
Filed under: Foot Care, Health 

Part I of this story on August 22 was The Wart Story.  It tells what Brad did to get rid of a stubborn wart on the bottom of his heel. He tried a lot of treatments and ended up having it excised through surgery. After I posted the story, Brad emailed with a follow-up. I’ll let Brad tell Part II. (If you scroll down, you’ll get to Part I).

It’s now been 4-1/2 years since the surgery described in your Aug 22, 2012 posting.  The wart in that area was completely removed, however, there is a fair amount of scar tissue.  I normally don’t notice it unless I rub the area, or very rarely when walking barefoot.  During my pre-op visit, I was told to expect this common side effect.  It has the feeling of a large callous.

Now flash forward about three years:  I’ve been wearing thongs in public showers, but I live in my Tevas sandles, I can’t give up beach volleyball, and occasionally go outside barefoot to bring the garbage cans in.  And unfortunately ended up with another wart.  My doctor and I decided to try the blistering agent again.  (He said the compound was derived from beetles, so I’m guessing it might have been antharidin.) 

Wart after compound applied

Wart after compound applied

It’s a simple liquid that is applied with a Q-tip directly onto the affected area and surrounding tissue, and within several hours it produces a large fluid-filled blister.  The pressure of the fluid in the blister causes a fair amount of pain, so after 24 hours, I was instructed to lance the blister to relieve the pressure. (Thanks, John, for providing useful and safe lancing techniques! 🙂 )

The idea behind this treatment is that the blistering agent essentially kills the underlying tissue including the diseased sections, and then the blister sloughs off normally.  During the previous attempts, by the time the tissue sloughed off, the remaining bits of the wart had gone deeper and we were never able to completely remove it, thus the surgery.

For the latest wart, I had the idea to simply remove the roof of the blister (hopefully along with the diseased tissue), and repeat as soon as possible until the wart was gone.  I discussed it with my doctor and we decided to proceed.  This technique worked quite well.  I went through three rounds of treatments, about 9 days apart, and was wart-free in just under a month.

Each treatment was similar.  The solution was applied at the doctor’s office.  The blister formed in about 4 hours. 

After removal of blistered skin

After removal of blistered skin

I lanced and drained the blister, then cut around the borders of the tissue to remove the roof. Then I just treated the area as a regular blister without its roof: Neosporin and a large bandage.  I changed the bandage regularly until it was no longer oozing.  By this point, I could see how much of the wart remained, and then made another appointment.  Of course, I watched very carefully for any signs of infection.  As an orienteer (cross-country running/navigation), I’ve had many blisters rub off during competitions, so this was nothing new for me.

It’s been one year since the treatments, and there is no visible or tactile reminder.  Comparing the surgery to this approach, it’s a no-brainer which I would prefer.  For surgery, I was under general anesthesia and then on Tylenol/codeine for several days, it took about two months to heal the excised depression, I had to get a temporary Disabled Parking Placard, and I still have scar tissue.  For the blistering agent, I had about 6 days (2 days x 3 treatments) of a raw open wound, but it usually didn’t hurt after that, and no scars.

I’ve attached two pictures for comparison.

My comment: In each picture you can see the wart in the center. It’s important to understand what Brad says about how the two treatments differ. If you have had warts and tried over the counter treatments, without success, Brad’s story can help you.


A Wart Story

August 22, 2012 by · Leave a Comment
Filed under: Foot Care, Health 

I’d bet most of us think we are immune to warts. Or we simply never think about them.

But we can pick them up in communal showers at the gym, the local pool, or anywhere where people go barefoot.I found an email where the sender told the story of his wart – and included a picture. Here is Brad’s story.

Excised depression after a large wart on the bottom of the heel

Excised depression after a large wart on the bottom of the heel

I used to be that guy who didn’t wear shoes.  I played volleyball barefoot.  Went around the house/yard barefoot.  Took showers at the gym barefoot.  I’m not sure where it happened, but somewhere I picked up a wart.  Not just any wart, but the wart that wouldn’t respond to any treatment kind.

Did the salicylic drops.  Moved to salicylic acid patches.  Then to the podiatrist:  three rounds of blistering agents, four rounds of bleomycin injections.  While waiting for surgery, did the duct tape method. Needless to say, nothing worked, and the wart just kept growing and shooting off satellites.  Finally, after an incision of about 3 cms wide by several mms deep, and 7 weeks of recovery later, I think I’m finally wart free. 

Needless to say, at least in the gym showers and other questionable patches of real estate, I’m keeping my thongs (zorries) on, thank you very much… 

So there you have it. It could happen to you if you are not careful. Wear clogs, flip-flops, or sandals in common areas. Check your feet after showering for any signs of a wart beginning. Then take care of them before they become too large for localized over the counter treatments.

If you think about how this would affect your training and running/hiking/walking, you’ll be careful in communal areas.

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