Typical Heel Blister Problems

January 12, 2015 by · 4 Comments
Filed under: blister care, Foot Care, Footwear, Footwear Products 

Heel blisters are quite common – although they shouldn’t be.

Feet in the Jungle Marathon

Heels in the Jungle Marathon

Today’s post shows one participant’s feet at the 2014 Amazon Jungle Marathon.

If you look closely at this picture, you’ll see two heel blisters, both on the outside of the runner’s feet. The right foot blister is large but is not blood-filled. The blister on the left heel, however, is very large and filled with a large amount of blood.

It’s easy to think these are normal blisters – but their size makes they abnormal.

In my experience, heel blisters are caused by the constant shear when either 1) the heel is moving up and down inside the shoes’ heel, or 2) by the constant movement at the place where the shoe’s insole touches the inside of the shoe. Over the years, the majority of heel blisters have been the latter. One of the characteristics of this “insole/shoe junction” blister is that they often are flat across the bottom. The blister starts at the point where the insole’s edge at the side of the heel touches the inside of the shoe. That’s what makes the flat line at the bottom. Then the blister forms upward as the fluid forms and it grows. Given enough time and movement, you’ll get blood inside.

Patching

These are relatively simple to patch. The skin must be cleaned with alcohol wipes, and then the blister can be lanced and drained. Depending on the size of the blister, you’ll need to apply some type of blister patch. The bottom line is that you need to have something over the blister to protect the skin and prevent the top layer of skin from tearing off. For these, I would use strips of kinesiology tape (my preference is either StrengthTape or RockTape H2O) with antibiotic ointment over the blister to keep the tape from sticking to the skin. The larger the blister, the harder these are to patch but it can be done.

Prevention

You are better off to prevent these blisters in the first place.

Start with the fit. Make sure your shoes hold your heels in place with just a little movement.

Check your shoes and insoles for rough and/or thick edges at the inside and outside of each heel. Side blisters are much more common than the back of the heel. If the insole has a large thick edge, replace them. If the shoe’s fabric is worn into a hole, you are due for new shoes. Under the fabric is generally a plastic edge of the shoe’s heel counter – the plastic that curves around the heel from side to side.

Engo Blister Prevention Patches are perfect for to help prevent these types of blisters. These patches are super slick. Either the small or large oval can be applied to the inside of the shoe and cover the offending edge of the insole/shoe junction. Clean the inside of the shoe and insole first. I work the patch with my fingers to form a curve to fit with area I need to cover. Then remove the backing and apply the center of the patch first and then push the top and bottom of the patch into place. Rub it a bit to assure adherence.

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.

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