Recently, both the physio and podiatry team at pivotal motion participated as volunteers for the Oxfam 100km trail walk. We were stationed at checkpoint 6, where we saw walkers at the 87km mark. The majority of walkers were tired, sore, but in surprisingly good spirits considering the effort required to get them to that point. The physio’s saw a large percentage of patients with iliotibial band trouble, and provided massage therapy to the walkers’ weary legs. The number one complaint for podiatrists? Blisters!

In day to day practice, it is not overly common for patients to seek treatments for blisters. As a result, it was interesting to note the variety of approaches different podiatrists had for dealing with them. This prompted the creation of a blog devoted to best treatment and prevention of blistering.

For an event like the Oxfam, the main goal is to keep the lesion site as pain free and clean from possible infection as possible. The first consideration required is the location of the blister. If it is at all possible, it is best to keep the blister intact. This gives the best chance to fight against infection as there is not true rupture to the skin. This is often not possible, however as blisters form at locations of high friction. As a result, those friction forces will usually eventually cause the blister to rupture.

In this case, first clean the area with an alcohol swab or saline wash to make the area as clean as possible. Very carefully pierce the blister with a sterile needle head or scalpel at its lowest point to allow it to drain. Always keep the roof of the blister intact as this will provide a barrier from any irritation to the sensitive dermis beneath, as well as provide a physical barrier against infection. After the blister is drained, swab the area with an antiseptic like betadine. Dress the area with padding and tape, to provide both cushioning for the area as well as a barrier to prevent further friction.

If the roof of the blister has been lifted off, try to carefully replace it. If this isn’t possible, a ‘second skin’ dressing is ideal before dressing. If unavailable, dress it as you would a normal wound with antiseptic and a dressing that completely covers the blister to ensure best protection from contamination and infection.

What about prevention techniques? There are mountains of ideas that people have to prevent blisters, all, it seems, with varied levels of success. In theory, the main strategy is to minimise the friction between the feet, the toes, and the shoes. It is important to keep the feet as dry and clean as possible, as any excess moisture will add to friction. Wearing two pairs of socks, changing socks regularly with an alcohol wipe in between changing, or strapping the feet are some strategies that may be used. Injinji socks have special hiking socks with designated toe pockets that may help minimise rubbing between the toes. A number of studies have found that 100% cotton socks are worse for holding in excess moisture than polyester or polyester blend socks. Finally, some patients will also rub a layer of petroleum jelly over their feet to produce less friction.

If you are prone to callus build up, it is recommended that you have the callus paired back by a podiatrist prior to undertaking any significant walk, as it can contribute to pressure in an already over used area.

For any further queries, contact Pivotal Motion Podiatry on (07) 3352 5116.