Prevent and Treat Blisters

How To Prevent Blisters

Prevent and Treat Blisters

You've had blisters before. They really suck. You don't want them, and avoiding them should be top priority during an emergency.

They can also be extremely dangerous if left untreated, especially in life or death situations.

The area around the blister can get infected with cellulitis, and that infection can spread into the body as sepsis. If you don't know, sepsis can kill you.

And it isn't uncommon. From Wikipedia:

The risk of death from sepsis is as high as 30%, from severe sepsis as high as 50%, and from septic shock as high as 80%.

Estimates suggest sepsis affects millions of people a year. In the developed world approximately 0.2 to 3 people per 1000 are affected by sepsis yearly, resulting in about a million cases per year in the United States. Rates of disease have been increasing. Sepsis is more common among males than females.

You can almost count on blisters appearing during an emergency or evacuation. Lot's of unexpected walking, likely wet situations, not being properly prepared: all of these things will show up.

So let me state this clearly: blister prevention should be on the top of your list of preparedness items. Right up there with clothing, shelter and medications.

Now that you are taking this seriously, lets talk about how blisters are formed, how to avoid them, and how to treat them properly when they do appear (and they will.)


Why Blisters Form

Blisters like 3 things: friction, pressure and moisture. Under these conditions the cells can separate under the skin, and an abscess is created which fills with fluid or blood.

There are numerous causes of friction, including:

  • Incorrectly fitted shoes or boots (too small, big, or seams in bad locations)
  • Cheap or poorly made socks (see our Darn Tough Sock Review)
  • Dirt inside shoes or boots
  • Frequent changes in terrain
  • New, unbroken-in shoes, boots, or insoles
  • Unconditioned feet
  • Too lose or too tight shoelaces

Feet aren't the only area that can get blisters. Your hands are susceptible as well during activities like cutting wood, bike riding, using a shovel or tools.

All things likely to be experienced during a natural disaster, or other large-scale society disrupting event, right?

Their main takeaway is this: increased exercise and the resulting sweat output and increased skin temperature will increase the likely-hood of blister formation(1).

Walking around in the rain and muck are great ways to get blisters.


How to Prevent Blisters

Best thing to do is avoid them all-together, right? (Say yes.)

So there are a few simple things we can do to prevent friction blisters. Let's look at the feet first.

  1. The first, most obvious thing: keep your feet as clean and dry as possible. If your socks get wet, try to change them or dry them. Don't dump water on your head and let it drip down your legs into your socks (you see marathon runners making this mistake quite often.)
  2. Second, if you feel a hot spot on your foot (the irritation preceding a blister forming) stop walking asap. Take off your shoes and socks and give everything a chance to breathe if you can. Apply the preventative measures discussed below.
  3. Minimize Friction and Pressure: this is the most important preventative step, and it requires a bit of explanation so we are going to give it it's own section.

Friction and Pressure Mitigation

One common misconception about blisters is that rubbing alone creates them. 

It isn't just simply rubbing that causes the damage, but the high sheer stresses caused by friction prior to the foot sliding around inside the shoe and sock. The amount of stress determines how fast the damage to the skin occurs.

Said another way: it is the initial pressure on the skin prior to any friction happening which determines the amount of damage the friction will cause.

So we need to reduce that pressure. There is no real way to completely avoid friction, since we are talking about moving parts (feet, socks, shoes.)

There are a couple of ways to do this, some intuitive, others not so much.

Get the Correct Shoes and Socks

This is probably the most obvious way to prevent blisters, get the right shoes and socks.

Most people get the shoe part right more or less, and understand about breaking them in before using them for a long trip. Yes, even modern day boots and shoes should be broken in, not just leather ones.

The one part a lot of people get wrong is socks. You cannot use cotton socks, they are the worst. Problem is they are everywhere, and they are cheap.

Problem is cotton absorbs water like nobodies business, and bunches up, creating friction points. Friction + water = bad, remember?

Merino wool is a much better material. Acrylic fibers and polyester fibers such as CoolMax also do a very good job of wicking moisture from the surface of the foot.

Look no further than Darn Tough brand socks. They offer a lot of different options, all of them superior to the socks you will find anywhere else. We don't trust our feet to any other company.

Another option is Injinji Socks, which have little toes on them. These are helpful as most blisters occur on the toes.

They make a variety of sizes and styles based on the activity you are doing.

Apply Paper Tape to Feet

A recent study published in the Clinical Journal of Sports Medicine concluded that Paper tape was found to prevent both the incidence and frequency of foot blisters in multistage ultra-marathon runners.

These are folks who were running 155 miles over 6 stages. The tape reduced blister occurrence by over 40% where used.

If it worked that good for those folks, imagine what it can do for us.

The doctors used 1" 3M Micropore Paper Tape in the study because it is inexpensive and easy to find. It also works very well, even when the feet get wet.

The adhesive also isn't so strong that it will pull the skin off of a blister if applied on top of one.

Re-application is required from time to time, it will depend on your level of activity. You can get a roll of 30 feet about $1.50 each so it's worth throwing a roll in each emergency kit.


Example of a pretaped foot.

This image gives you an idea where to place the tape. The toes and heel should also be taped where needed.

If you are wearing Injinji socks, you can probably skip the toe taping.

Read the whole study if you have the time, it's pretty interesting.

Use Sock Liners

You can wear thin socks inside your thicker hiking socks to reduce friction and moisture.

Typically made from nylon or polyester, many now are made with CoolMax which is an amazing material for wicking moisture, as we mentioned.

They work in both warm and cold environments and have been used by the military for troop blister prevention.

Some folks use pantyhose to get the same effect. Whatever works for you.

Add Friction Reducing Patches

There is a product called ShearBan which is made by Tamarack Habilitation Technologies which reduces friction pressure via an ultra-thin PTFE sticker which you apply to your shoes/boots.

What this slick does is allow the foot to slide around easier, and reduce skin bunching and pressure points.

Here is a great video that explains how the idea and how it all works.

ShearBan can be a little hard to find, but luckily Tamarack also makes the Engo brand of friction reducing patches which are available on Amazon. 

They cost about $15 or less, and come in a couple of different sizes.

They aren't expensive, and they can last for several months or more.

You put the patches into your footwear in the places where you get blisters, if you happen to already know, otherwise pre-treat shoes by putting patches on: the heel, on the sole, and along the sides.


Some examples of high friction areas

Consider Wearing Insoles

You can replace the insoles of your shoes for ones that are specifically designed to reduce friction and blisters which are made from neoprene (a wet suit type material.)

Spenco makes insoles with a top lining material called Silpure, which is specifically designed to reduce friction (and odor, for my Stink-Footers out there.)

The Spenco Polysorb Cross Trainers ($20) and the Spenco RX Comfort Thin ($10) models have Silpure. Amazon has them both.

Poron insoles and Plastazote insoles also offer low-friction solutions.

There are probably better insoles out there if you are looking for arch support or cushioning. The ones recommended above are useful for blister prevention.

Insoles can be a pretty subjective thing, pick any particular brand or model and some people will love them and others will hate them. Do your own homework and test out a few types to see what works best for you.


Prevention that Doesn't Work*

* Some might work for you ¯\_(ツ)_/¯

We're about to run off a list of items that have been used over the years by many folks to varying degrees of success.

However there are no good clinical studies proving these methods, and in some cases studies have actually proven them to do more harm than good.

Antiperspirants

Studies have shown that using antiperspirants on feet to prevent blisters does not consistently work. In many cases no detectable improvements have been found at all. (2) (3)

There might have been some reductions in sweating, but this did not result in measurable decreases in blister formation, while causing skin irritation for nearly half of the test group. (4)

Drying and Talcum Powder

Drying powders have been tested extensively by the British military, and many of the studies showed no benefits, and in some cases increased blister creation. (5)

Talcum powder does reduce friction as long as it stays dry, but can turn into a gooey mess once wet.

Creams and Lubricants

There are a multitude of gels and creams that lubricate the skin in the hope to reduce blister formation, and many people use them and swear by them.

Studies have shown however that they only last for a short time, typically and hour or two, and after that actually increase the likely-hood of blisters being formed.

If you decide to use lubricating creams or gels, make sure you are reapplying every few hours if possible.


Blister Treatment

So despite all your best efforts, you wound up with a few blisters. What do you do? Here are a couple of proven methods:

Lance and Drain

For the best pain relief you should lance the blister in several locations with a sterilized needle along the periphery of the blister (where it starts to protrude) and allow the liquid to drain. Make the holes small, and make sure to keep the roof of the blister intact.

You might need to do this multiple times a day. Apply a compressive dressing of dry gauze with an elastic cohesive bandage.

(Have you ever given blood? Same bandaging as that.)

Never remove the roof of the blister, even if it has popped itself. Fold it back on top of the open sore and bandage the area.

2nd Skin

This stuff is great. It provides immediate relief to blisters, chafing and cuts.

Just peel and apply to the area where you need to reinforce the tissue. Keep in place with a band aid or tape if needed.

Better than the liquid skins, although these patches are made mostly out of water anyway. 

They don't last forever, but can get you through a few hours worth of effort before you need to reapply.

Hydrocolloid Patches

If you don't have time to lance and drain, then put a Hydrocolloid patch on the blister.

There are several kinds on the market, and they are easily available. It is a good idea to have a pack with you as a backup or a quick fix.

Hydrocolloid patches hydrate the skin and provide pain relief, but can't be used more than 8 hours or they will remove the roof of the blister, which we don't want to happen.

Use them as a temporary solution, until gauze and an elastic bandage can be applied.

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