Blister Repair – Your Way or Their Way?

March 7, 2015 by · 1 Comment
Filed under: blister care, Foot Care, Health, Sports 

One of my goals is to educate athletes about good foot care techniques. You may recall blog posts where I stress the importance of knowing how to do foot care and importantly, to know what’s best for your feet.

I recently received an email from Rob, asking for some advice. Here’s Rob’s email:

“I have been running a modest 30 miles a week for a few years. Last weekend we attended a tennis camp and during the first night of drills during ball pick up (not during a drill or competitive play) another player smacked a ball in to the arch of my foot from a shot distance away causing severe pain. I played through the pain and the next morning I asked the trainer to tape up my bruised arch, which she did. I played all day and at the end of the day there was a blister in the center of my foot between the taped and un-taped area.

“I went back to the trainer in the morning and she created a donut shaped pad about a 1/4-inch thick and taped it to my foot. I took out my shoe arch supports and played for another 1/2 day in a bit of pain. When I took off the shoe, sock, and bandage and pad I found that the blister had filled with liquid to the size of the donut hole – now a huge blister about the size of a silver dollar and 1/4-inch thick. The camp staff took pictures of the biggest tennis-related blister they had seen.

“I went back to the trainer at the college and she drained about half of the liquid out of the blister and we decided I was done playing tennis for the rest of the camp. I’m not sure going to the trainer really helped and I probably should have had your book along as reference and taped myself up. Now I am back home and have a huge blister on the bottom of my foot.”

This is a case where the trainer patched Rob’s blister the best way she knew how. It was an “old-school” patch job. A piece of moleskin cut in a donut shape with a hole in the middle for the blister. There may have been Vaseline on the center, and then tape or gauze over the top.

The problem with this old-school method is that it adds bulk to the foot – that can easily alter the person’s gait. This gait change can lead to further problems. At the same time, the patch can cause irritation, expanding the original blister or leading to new blisters.

Rob’s experience shows there is a long ways to go to get everyone up to speed about good blister care. I’d bet that if Rob had been prepared, he could have done a better job then the trained did. It’s hard to go everywhere with a blister patch kit in hand, but here’s my recommendation. Make up several simple kits and put them in Zip-Lock bags and stash one in your car and another in your gear bag. Fill the kits with your choices of blister tapes and patches. Then of course, make sure you know the best way to patch any blisters that may develop.

This post is from July 2102, but is important for athletes to understand.

Blister Repair – Your Way or Their Way?

July 29, 2012 by · Leave a Comment
Filed under: Uncategorized 

One of my goals is to educate athletes about good foot care techniques. You may recall blog posts where I stress the importance of knowing how to do foot care and importantly, to know what’s best for your feet.

I recently received an email from Rob, asking for some advice. Here’s Rob’s email:

I have been running a modest 30 miles a week for a few years. Last weekend we attended a tennis camp and during the first night of drills during ball pick up (not during a drill or competitive play) another player smacked a ball in to the arch of my foot from a shot distance away causing severe pain. I played through the pain and the next morning I asked the trainer to tape up my bruised arch, which she did. I played all day and at the end of the day there was a blister in the center of my foot between the taped and un-taped area. I went back to the trainer in the morning and she created a donut shaped pad about a 1/4-inch thick and taped it to my foot. I took out my shoe arch supports and played for another 1/2 day in a bit of pain. When I took off the shoe, sock, and bandage and pad I found that the blister had filled with liquid to the size of donut hole – now a huge blister about the size of a silver dollar and 1/4-inches thick. The camp staff took picture as the biggest tennis-related blister they had seen. I went back to the trainer at the college and she drained about half of the liquid out of the blister and we decided I was done playing tennis for the rest of the camp. I’m not sure going to the trainer really helped and I probably should have had your book along as reference and taped myself up. Now I am back home and have a huge blister on the bottom of my foot. 

This is a case where the trainer patched Rob’s blister the best way she knew how. It was an “old-school” patch job. A piece of moleskin cut in a donut shape with a hole in the middle for the blister. There may have been Vaseline on the center, and then tape or gauze over the top.

The problem with this old-school method is that it adds bulk to the foot – that can easily alter the person’s gait. This gait change can lead to further problems. At the same time, the patch can cause irritation, expanding the original blister or leading to new blisters.

Rob’s experience shows there is a long ways to go to get everyone up to speed about good blister care. I’d bet that if Rob had been prepared, he could have done a better job then the trained did. It’s hard to go everywhere with a blister patch kit in hand, but here’s my recommendation. Make up several simple kits and put them in Zip-Lock bags and stash one in your car and another in your gear bag. Fill the kits with your choices of blister tapes and patches. Then of course, make sure you know the best way to patch any blisters that may develop.

Here’s where to start – pages 228 to 256 in the 5th edition of Fixing Your Feet. If you don’t have a copy, or have an old edition, my suggestion is to get the new one. My home page has a link to Amazon if you need one. I was amazed at Badwater in Death Valley a few weeks ago. One of the runners had me autograph a copy of the 2nd edition. So much changes from edition to edition that it’s a small price to pay to help your feet.

Heel Blisters at the Gore-Tex TransRockies – Part II

December 26, 2010 by · Leave a Comment
Filed under: blister care, Foot Care 

Last week I wrote a post about the horrific heel blisters I had seen at the 2010 six-day  Gore-Tex TransRockies Race. If you have not read that post, or want to read it before going on to this Part II, here is the link.

To refresh your memory, here’s a brief description: The heel blisters covered the whole bottom of the heel side-to-side, and were 1 ½ to 2 ½ inches in length, towards the mid-foot. In most runners, the forward most edge of a blister had torn and opened up across the whole bottom of the foot. The blister’s roof is thick, at least four layers of skin. Most runners with these blisters had them on both feet.

This post will describe how I patched these deep and torn heel blisters.

As usual the first steps are to clean the blister and surrounding skin with alcohol wipes. Then drain the blister. Normally, needles holes will seal back up on themselves, so make sure you move the needle side-to-side to make a larger hole. If you use a scissors or clippers, make a V cut in the edge. Make several cuts. I would make one on each side at the forward edge and back edge. Expel as much of the fluid as possible.

In most blister patching jobs, I would then apply a dab of zinc oxide to the blister and then tape over this. The zinc oxide works to dry out the skin – just as when it used on a baby’s bottom. These deep heel blisters required more care.

Injecting zinc oxide

# 1 - Injecting zinc oxide

I filled a 5cc syringe with zinc oxide and attached an 18-gauge needle. Using the holes made to drain the blister, or the torn skin, I inserted the needle as much as possible into the center of the blister, and squeezed the zinc oxide into the blister cavity. This is shown in the first photo. Then I used my fingers to massage the zinc oxide around to fill any open space in the blister cavity. Any excess zinc oxide can be pushed out the openings. All you need is a thin layer of zinc oxide inside the blister.

After injecting the blister with zinc oxide, and pushing out any extra, I cleaned the skin with another alcohol wipe, applied a coating of Compound Tincture of Benzoin, and applied tape. I used two-inch Kinesio Tex tape.

The first strip of tape

# 2 - The first strip of tape

The first strip went around the back of the heel, side-to-side (the second photo).

The second strip of tape

# 3 - The second strip of tape

The second strip went under the foot, side-to-side, to anchor the blister’s roof to the foot (the third photo).

The last strip of tape

# 4 - The last strip of tape

I used two strips under the foot. Whether using one strip or more, the strips should be applied starting towards the mid foot, then work backwards so the last strip covers the edge of the strip going around the back of the heel (the fourth photo). Apply a slight stretch to the tape as it is applied. Round all corners of tape. Squeeze any overlaps sections of tape and use scissors to cut them flush. Kinesio Tex tape should be rubbed gently for 30 to 45 seconds to warm the tape so the adhesive bonds to the skin. At the TransRockies, I patched many runners’ feet with these heel blisters. Because they were running for six days, often times the runners came back the next day for a repatching.

I used the zinc oxide in side of the heel blisters too. I saw one runner, a lady from Germany, five of the six days. She had terrible side of the heel blisters. Her insoles were really thick in the heel and the edge rubbed her foot in the same spot every day, creating new blisters daily. These often were blood filled. After the third day, I started injecting zinc oxide into the blisters. I was amazed at how it would flow into all parts of the blister. Several times, because of the zinc oxide going into the blister, I could see blister under blister.

The zinc oxide worked well to dry the inside of the blister. It also eliminated much of the pain associated with blisters.

Blunt needles

Blunt needles

While I used an 18-gauge sharp needle, I would not recommend that for others. Typical needles, as you might imagine, have a point. Unless you are very careful, you can easily cause the point to penetrate into raw, new skin and tissue. You can purchase blunt needles that are much safer – and are easier to dispose of. Regular needles must be put into special “sharps containers” that most of us do not have access to. If you want to buy blunt needles, Amazon sells them, as well as syringes (the fifth photo). I would recommend a 16 gauge blunt needle. Because zinc oxide is like a thick substance, a large bore needle is needed to push it through. Several times I set the syringe in the sun to warm the zinc oxide so it would push easier. At night, I achieve the same results by rolling the syringe between my hands to generate warmth. If the zinc oxide is too thick (cold), no matter how hard you push on the syringe, it will not come out the needle.

There are several possible options to this extreme blister patching method. One can use Instant Krazy Glue or Gorilla Glue, or Compound Tincture of Benzoin. Be aware that these will sting as they are injected – but they seal the blister’s roof to the base.

Patching blisters using one of these options is best reserved for events where you have to run again the same day or the next day. Also, not everyone will have the syringes and needles necessary to inject blisters. If you are building a foot care kit for extreme events, these tools can help you care for the worst-case blisters.

And as usual, know and heed the signs of infection: redness, swelling, red streaks up the foot and leg, pus, fever, and pain. If any of these happen, seek medical attention.

Spenco 2nd Skin for Blisters

November 8, 2009 by · 1 Comment
Filed under: blister care, Foot Care, Foot Care Products 
2nd Skin

2nd Skin

Most athletes today have heard of Spenco 2nd  Skin. It comes in one-inch squares and three-inch circles. Two pieces of thin film cover a soft gel substance – similar to a skin substitute. To use it, peel off the blue film from one side and apply that side over your hot spot or blister. Whether you remove the film from the other side is your choice. For years, 2nd Skin has been the product of choice for patching blisters. Similar competitive products are available – and what I say here applies to all these gel-like blister patches.

Two well-respected foot care experts gave me their thoughts on 2nd Skin:

  • Denise Jones, commented, “As for 2nd Skin – well, I still use it if the area is very sore and there are many miles to go in a race like Badwater where the cut-offs are generous. It all depends on the circumstances of the time I can take and how painful the area is. I have mostly gone to your method of putting zinc oxide over the roof of the blister then taping over it to try to keep the roof of the blister in tact after draining the fluid out and putting antibiotic ointment on it.”
  • Maddalena Acconci, a fellow foot care specialist from Vancouver, Canada, wrote, “I haven’t had a negative experience with 2nd Skin. As a matter of fact, every time a racer has said to me ‘you saved my race’, I had used it.”

In my opinion, 2nd Skin has its place in foot care, IF one is aware of the downside. First, the positive. 2nd Skin provides protection, cushioning, and a cooling effect to the area. Whether over a hot spot or blister, the patch cushions and protects. Spenco 2nd Skin requires a tape covering to hold it in place. That’s not the problem. If the patch will remain in place for only several hours, I have no objection to 2nd Skin.

There is one problem with 2nd Skin. Anything over a few hours and the skin swells from the moisture in the patch, the water component, of 2nd Skin. It makes the skin damp, often cold to the touch, and leads to maceration. On a long event, 12 hours or longer, especially a multi-day event, when the skin is cool and damp skin from the patch, it is very difficult to apply another patch. It is hard to get anything to adhere to the skin where the 2nd Skin was.

I think 2nd Skin is a good product and it deserves a spot in most runners’ foot care kits. I will use it on occasion – especially for short events up to 50 miles. For longer events or multi-day events, I will use other patching methods. Zombierunner.com offers Spenco 2nd Skin and GlacierGel, both good blister products.

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