HOW TO PREVENT AND TREAT FOOT BLISTERS IN WILDERNESS
Foot Blisters are the common medical problems in wilderness and can make someone’s experience very awful. Before discussing how to prevent and treat Foot Blisters in wilderness, let us understand what are blisters.
Blisters (Source : Wikipedia)
BLISTERS : They are small pockets of fluid within the upper layers of skin caused by rubbing under the skin ( not rubbing on the skin).
IT SIMPLY MEANS BLISTERS ARE NOT ACTUALLY CAUSED BY RUBBING BUT DUE TO SKIN SHEAR (RUBBING UNDER THE SKIN).
The other causes for causing blisters are extreme temperature changes ( either Burning or freezing) and Chemical Exposure.
Above Diagram illustrating the cause of blisters is Skin Shear i.e Rubbing under the skin
( Source : www.blisterprevention.com.au)
HOW TO PREVENT AND TREAT THEM :
Treat Hot-Spots : Hot-Spot(reddened skin and the sensation of heat) is a pre-blister state.It gives you a sensory warning that blister is on its way to form and gives the person a tiny window of opportunity to treat the Hot-Spot. The person may or may not get this sensory warning of Hot-spot. Treat them early as they are not a warning of a problem, they are already a problem. Managing Hot-Spot is just like Blister Prevention explained below.
Moleskin Dough-nut Method of securing the Blister
(Image Source : www.walmartimages.com) (Source: www.myhealth.alberta.ca)
Have the right Shoe-Fit and Lacing System :
A proper shoe fit and lacing system are the first and foremost important strategies to avoid Blisters.
A good fit (snug everywhere,tight nowhere and with enough room to wiggle your toes ) will keep you getting bruised toenails or heel blisters. Following fit tests can be done to check whether your shoe is a good fit or not :
- Walk down an incline : Stomp and scuff your feet while descend and if your toes can already touch the front of the shoes when the shoes are new assuming you have laced the shoes snugly , try on a different pair.
- Walk uphill on stairs : Check for the heel lift by walking up a few flights of stairs, two stairs at a time and if your heels are consistently lifting off the insoles more than 1/8th of an inch, the heel blisters are bound to happen in those shoes.
- Lacing System technique is another important strategy to prevent Blisters. The below video about “How to Lace a Hiking Boot for Better fit” would better explain the method of lacing your shoes.
Avoid wearing Cotton Socks and prefer wearing liner Socks :
Always avoid wearing cotton socks on long wilderness trips because they absorb sweat, saturate quickly and dry slowly, which makes it perfect recipe for forming blisters. Wearing Liner socks under regular socks doesn’t prevent blisters but on the other hand wearing it with polyester socks (athletic socks) is an advantage for week long backpacking trips as liner socks dry much faster than thicker polyester socks and saves the space in your backpack.
Wearing Double Socks ( Liner socks + athletic socks ) depends upon in which climate you are doing the hiking. The only benefit of wearing Double socks is that it ensures the proper fit of your foot
Consider Wearing Gel Material Insoles :
Cushioning your bone is one of the best method to prevent foot blisters as it reduces peak pressure by spreading the load over a larger area. Gel insoles are considered to be the best insoles compared to all other insoles because gel material doesn’t simply compress, it is displaced outwards, the gel “cups” the bone resulting in a larger contact area and further reducing the peak pressure.
Above Diagram showing variation in peak pressure with cushioning
(Source : www.blisterprevention.com.au)
Adaptation of your skin :
Blisters can be prevented by adapting your skin to have a pre-activity training in your shoes, socks and other gear, and on the terrain and hence providing a protective function. It does not ensure protection from blisters but it will be a step in the right direction and should not be neglected.
Use of Lubricants/Powders :
It is actually a Myth that Lubricants always prevent forming blisters, on the other hand it makes you more prone of forming Blisters.
Application of all lubricants, powders such as Vaseline provides large initial friction reduction but after a certain time period they
- Initial Lack of Traction
- Friction levels actually increases
- It weakens the skin
- Attracts grit and it messy
Application of Lubricants won’t be a problem with short duration walks or exercise but for longer weeklong trekking in Himalayas, you need to reapply the lubricant which is very difficult to maintain after every few hours. So it is always better practice to avoid applying lubricants for longer duration.
Taping and Dressings:
Taping and dressings protect blisters from de-roofing(red raw sore) and prevents it from spreading infections. Some tapes and dressings reduces friction, some don’t. As the skin sweats and we continue to do our activity , it becomes a challenge for the adhesive products still stuck to the skin and its not uncommon to get blisters inspite of Taping. Taping and Dressings requires a lot of skills. For thorough understanding of Taping and Dressings, read this
HOW TO TREAT BLISTERS IN WILDERNESS :
The exact course of action to treat blisters depends upon the integrity of Blisters roof. Most common blisters in wilderness are with Blister roof intact. Following should be our aims when treating any blister :
- Apply Antiseptic (Betadine)
- Dressing of Blister (Island dressing is preferred in treating any blister as it doesn’t stick to the blister and prevent the blister roof from tearing while un-dressing)
- Reduce Pressure
- Reduce Friction
- Monitor regularly the blister for any infections.
Here is a short video how to repair Blister with a “Tincture of Benzoin”
Treating Blister may sometimes require lancing/popping up your blister. To learn how to pop a Blister with a scalpel see the below video
Several Questions which come in minds of everyone in Wilderness :
Q) Should you pop up a Blister or not ?
A) In wilderness hikers usually have this question in mind whether we should pop up a blister or not . There is not an easy answer to it but your decision making can be improved if you better ask yourself “Should i pop this blister in these circumstances “. Because it depends entirely on your blister (size,location,your foot). The same blister having different scenarios would have different answers to treat it.
To help you understand take these 3 scenarios in Hiking :
Scene1 : You’re a few hours into a hike. Your mate has a pocket knife and you have some tape.
A) No way! You have no idea what germs are on that pocket knife. You have no antiseptic and no island dressing.
Scene 2 : You’re a few hours into a hike and you’ve bought your blister kit that has sterile dressings, antiseptic and a sterile scalpel blade to lance it.
A) Yeah sure. You're all set up to do what needs to be done.
Scene 3: Your hike takes you through river-crossings, the terrain is muddy and a bit swampy in some parts.
A) No, Water-logging of your dressing means your dressing is no longer forming a barrier against bacterial movement into your blister.
Q) Should we apply the Band-aid directly over the blister ?
- No, it can easily tear the blister roof.
Q) I have a safety- pin or needle with myself in wilderness. Can i pop a blister with it ?
A) Scalpel blades are best recommended to pop a blister in wilderness as it gives you a decent-sized hole in the blister roof to reduce the likelihood of it closing and filling up again. On the other hand they are already sterilised.
The only thing you need to take care of them are that these are single-use time and needs appropriate disposal.
If you don’t have scalpel blades in wilderness, make sure while popping a blister with needle or safety pin to sterilise either with blue-flame only not using a candle(or a match) because its flame is dominated by yellow colour only.
Remember : Treating any blister is very complicated but preventing the blister is very easy.
There is not a definite solution for preventing and treating blisters. Different things work for different people and you need something that is effective for you.