Blister Prevention and Care

author : AMSSM

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Learn how blisters are formed and some tips on how to prevent blisters and what to do if you get a blister.

By Marjorie Delo MD

Member AMSSM

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Although they are a common injury, blisters have a significant potential to sideline athletes, especially those in endurance activities such as marathons or triathlons. They are the most common complaint of marathon runners, with one study at the Chicago Marathon reporting an incidence rate up to 44% on race day.

How Blisters are Formed

Moisture on the skin increases adhesion of the top layer of skin to the sock or shoe, increasing friction and shear forces between skin layers. This mechanical stress causes separation of the skin layers, which then leads to fluid or blood accumulation between the layers. This accumulation manifests as a blister.

Risk Factors Include:

• Poorly fitting shoes

• Sock or shoe seams

• Heat

• Foot irregularities such as hammer toes or bunions

• Laces that are too tight or too loose

• Debris in footwear

• Excessive/unusual levels of activity for the athlete

Blister Prevention

To prevent blisters, start with a pair of correctly fitted shoes that don’t cause any pressure points. Any minimally aggravating areas can be softened with Vaseline. Be sure to alternate a new pair of shoes with older pairs during the break-in period. The next step is selecting proper socks. Many socks are specifically designed for blister prevention. Key features are a moisture-wicking knit with synthetic fibers, anatomically placed padding to increase cushioning, and two separate layers of fabric to decrease friction next to the skin.

DryMax or CoolMax socks are intended to transport moisture away from the foot. Certain models of DryMax incorporate Profilen, which is a low-friction fiber. Other common materials used are acrylic, nylon, polypropylene, and merino wool. Choose socks manufactured with a flat knit toe seam and a Y-heel or vector heel pocket design. As heat can be a contributing factor to blister formation, many socks are thinner over the instep and under the arch. Some also have ventilation panels under the arch or base of the toes to dissipate heat during athletic activity.

Keep Your Skin Healthy

Healthy, well-hydrated skin can tolerate more stress, so stay well-hydrated and take proper care of your feet. During long training runs or races, drying powder or antiperspirants can be used to minimize moisture and Vaseline or adhesive pads (i.e. ENGO blister prevention patches) can be used over blister prone areas to reduce the incidence of blistering. Blister pads prevent blisters by acting as a barrier between the skin and the shoe. Hair gel is used by some athletes during marathons when they run out of Vaseline, and this works well also (especially as it dries and stays in the area that it is placed without being slippery).

Blister Treatment

Once a blister has formed, the most expedient way to treat it is to cleanse the area, then use a sterile needle to drain the fluid. Because of the risk of infection, the overlying skin layer should be left in place, and antibacterial ointment should be applied under a bandage. If an athlete needs to continue activity, occasionally lidocaine (a numbing agent) will be injected back into the pouch. Some over-the-counter antibacterial ointments now contain an anesthetic agent in them.

A donut-type adhesive dressing can be used to relieve direct pressure on the blister, and athletic tape can be utilized to secure the donut. At the first sign of blistering, aggravating sources should be removed and adhesive tape or blister padding should be applied. The key to competing or training with blisters is to off-load them as much as possible with a combination of all of the above measures. Occasionally, however, large or multiple blisters may lead to an obligatory few days off.

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date: December 3, 2008