Jan 29, 2015Banishing Blisters
By Stan Reents
Blisters occur commonly and they can occur anywhere. Here, contributor Stan Reents shares tips for blister treatment and prevention.
The foot is the most common location. But tennis players can get them on their hands, and I know a triathlete who got saddle sores from her bike. Blisters can bring your activity to a complete halt. Worse, it may be days before your foot, hand, etc. can tolerate performing the same activity again.
WHY DO BLISTERS FORM?
A blister–or, to use the more medical term, “friction blister”–is a visible expression of the body’s physiologic response to repetitive chafing. Although blisters are something that we don’t want, the body doesn’t know that. Blisters are simply another example of the “general adaptation response”, a process first described by Hans Selye, MD, when he was a medical student back in the 1930s.
Just like your muscles enlarge in response to weight training, or your VO2 max improves in response to regular aerobic training, your skin responds to certain new stimuli by forming blisters. It’s the first step in creating a callus. A callus, in turn, is the body’s attempt to create a protective barrier within the skin. PREVENTION
It’s 100 times better to prevent a blister from ever developing than to try and treat one. Here are some prevention tips:
• Wear high quality, thick socks. When blisters occur on the foot, the cause of the chafing is your shoe. Thick socks will generally do a decent job of protecting your skin. Some athletes wear two pairs of socks at the same time. Avoid cheap cotton tube socks. Look for socks by Thermolite, Thorlo, and WigWam. Once your socks get saturated with sweat, change them. Damp skin becomes macerated, making blisters more likely. • Make sure your shoes fit properly. Don’t underestimate how important it is to get properly fitting shoes. Just doing this may prevent blisters from forming.
• Don’t wear brand new shoes just prior to beginning an important event. Even though you have those new shoes that fit perfectly, don’t wait until a big race or the tournament to wear them. Break them in first! Here’s my story:
Several years ago, I made plans to hike the north rim of the Grand Canyon. I went to this terrific outdoor gear store in Orlando, Fla., for a shoe fitting. After two hours of measurements and trying on shoes, I was certain I had some hiking shoes (and socks!) that would guarantee I wouldn’t have any problems with my feet. I was wrong. By the end of the first day of hiking, I had blisters on the inside edge of both heels. The hike back up the next day was miserable. So, what happened? Even though I wore thick socks, these shoes hadn’t been broken in….it was the first time I had worn them. • Use a protective barrier. If thick socks don’t help, try using a topical product like Dr. Scholl’s Moleskin Plus Pads. This OTC product has an adhesive on one side. You can cut it to the size and shape you need, then place it directly over the area you want to protect. Now, if your shoe rubs, it will rub against this pad and not your skin. Band-Aid (www.Band-Aid.com) also has a product called “Tough Strips®” which the company claims is waterproof. • Apply a lubricant. Although somewhat embarrassing, many distance runners and triathletes sometimes suffer from chafed nipples. Think about it: even though the fabric of their jersey is lightweight, it is rubbing across that area continuously for three to four hours. Many of these athletes use a product called Body-Glide. You can also use plain old Vaseline. You can use lubricants on your feet, too. The Walking Site recommends something you can make yourself: A&D ointment + Vaseline + vitamin E cream + aloe vera cream. Obviously, this strategy won’t work for tennis players and rowers who get blisters on their hands. • Trim your toenails. A sharp edge on a toenail rubbing against the toe next to it can create a blister or sore spot in less than 30 minutes.
TREATMENT
So what do you do if a blister has already formed? Here are some tips:
• Moleskin pads: Try using Dr. Scholl’s Moleskin Pads. Cut a hole in the center of the pad and place the Moleskin around the blister. If you stick Moleskin directly on top of a formed blister, you may tear it open when you remove the pad. Not only is this painful, but it can increase the risk of infection.
• Antibiotics: According to a review from Sports Medicine, there is no evidence that topical antibiotics speed healing (Knapik J.J., et al. 1995).
FREQUENTLY ASKED QUESTIONS
Does it make any difference whether I wear cotton socks or socks made from acrylic fabrics? In 1990, the California College of Podiatric Medicine conducted a study of 35 distance runners. They found that socks made from 100 percent acrylic fibers resulted in fewer and smaller blisters compared to socks made from natural cotton (Herring K.M., et al. 1990). Several years later, a literature review published in the journal Sports Medicine stated that “a thin polyester sock, combined with a thick wool or polypropylene sock that maintains its bulk when exposed to sweat and compression, reduced blister incidence in Marine recruits.” (Knapik J.J., et al. 1995). I’m certain that socks have changed a lot in the last 15 to 20 years, but it does seem like synthetic fabrics are better choices than cotton.
Should the fluid inside a fresh blister be drained? If this can be done carefully under antiseptic conditions, it appears the answer is “yes.” A review from Sports Medicine states: “clinical experience suggests draining intact blisters and maintaining the blister roof results in the least discomfort and may reduce the possibility of infection.” (Knapik J.J., et al. 1995).
FOR MORE INFORMATION
A Web site with good information on foot care for hikers is The Walking Site .
For information on simple first aid products for blisters, check out the Web sites for Band-Aid® and Spenco. REFERENCES
Brennan, F.H. “Managing Blisters in Competitive Athletes.” Current Sports Medicine Reports 1 (2002): 319-322.
Herring, K.M. and D.H. Richie. “Friction Blisters and Sock Fiber Composition: A Double-Blind Study.” Journal of the American Podiatric Medical Association 80 (1990): 63-71.
Knapik, J.J., K.L. Reynolds, et al. “Friction Blisters: Pathophysiology, Prevention, and Treatment.” Sports Medicine 20 (1995): 136-147.
Stan Reents, PharmD, is a former healthcare professional. He holds Personal Trainer and Fitness Counselor certifications from the American Council on Exercise. He has been certified as a tennis coach by the USTA. He is the author of Sport and Exercise Pharmacology (published by Human Kinetics). He can be reached at: [email protected].
