Blisters are a common problem and neglecting foot-care can turn a great hike into a painful experience. We have probably all suffered from blisters at some point, and even if these are small, they have the potential to ruin a day out on the hill. In this article I hope to give you some advice that you can pass onto clients on future trips or use when looking after your own feet.
As with all potential medical issues, prevention is better than cure. If you have the ability to send a kit-list to participants in advance of a hill day, it is helpful to specify the type of footwear they will need for the intended terrain. Signposting them to reputable outdoor retailers, so that they can get their feet measured and try on a wide range of boots and/or approach shoes can be beneficial, and also means that they can try out various insoles and sock combinations as well.
Advising participants to keep a spare pair of socks in a dry bag inside their packs can be a huge morale booster, particularly if you are running a multi-day trek or are wild camping. Adding talc to the kit list can be valuable, especially if you are going to be hiking in damp conditions, as this can reduce the chances of participant’s feet becoming wet and macerated. Medicated talc, which contains an antifungal, is an effective strategy to reduce the likelihood of developing athlete’s foot or other fungal infections.
Ensuring feet remain as dry as possible will also reduce the chances of developing immersion foot (also known as trench foot) which is a type of non-freezing cold injury. Although cold-related injuries are outside the scope of this particular article, it is important to be mindful of the risk of frost-nip and frost bite, which can occur even in the UK.
Blisters
Blisters typically occur when there is excessive rubbing between your foot and your shoe, and your body tries to prevent further damage occurring by creating fluid-filled protective cushions. Prevention is key, and individuals with a tendency to develop hot spots or blisters, should be advised to tape their feet prophylactically at the start of the day.
What tape should I use?
Zinc oxide tape is a really good hard-wearing adhesive tape that is great to put on blister-prone areas, over hot spots and onto small blisters. Similarly, Elastoplast® (tape rather than an individual plaster) can be used for this.
Compeed® and similar “second skin” blister plasters are a bit like Marmite- you either love or hate them. They have their place, and are a potential option for managing hot spots, however they can come unstuck, stick to the inside of the sock and lead to a sticky mess and a sock that is out of action. They are incredibly adhesive and can be hard to get off afterwards. If part of the plaster is attached to broken skin or the blister itself, this can unnecessarily de-roof the blister, causing pain and delayed healing.
Help- I have a blister!
Despite preventive measures, blisters can still occur. Different people may have existing treatment strategies for their feet, however the advice below is what I tend to follow when working on ultramarathons and endurance events both in the UK and overseas.
When working on events I tend to use the above collection of items to repair runner’s feet and help them get to the next checkpoint and hopefully onward to the finish line. (Contents: gloves, scissors, gauze, rock tape, needles, sharps bin). The kit is in a washing-up bowl just to make it more portable- not to wash the runners’ feet!
Smaller blisters, where the skin is still intact, can usually be taped over. A gauze or fleeciweb layer can be added to provide cushioning and additional comfort. The taping should be done with either Elastoplast® or a physio tape such as K-tape® or Rocktape®. There are some important points to consider when applying tape:
- It should not have any corners as these are more likely to peel and create an additional friction point. Cutting tape into oval shaped pieces is a must when patching up sore feet!
- The whereabouts of the free end of the tape needs to be considered as this can also peel off when the participant starts walking again.
- Taping toes- it is useful to firstly “anchor” the tape on the foot and then extend it longitudinally along the toe. This can then be overlapped by taping around the toe, encasing it in the tape and creating a barrier against further friction.
To pop or not to pop?
This is always a balancing act, as blisters fundamentally have a protective function. I tend to leave them alone if they are fairly flat with minimal swelling, however if they look like they will rupture spontaneously within someone’s sock, resulting in a bloody mess and worsening pain and discomfort, it is better to sort this prophylactically.
The best way to drain a blister is by making two small holes in it’s inferior aspect using a clean needle. It is important to keeping the overlying skin intact so that it can continue to provide a barrier against friction and reduce the risk of infection. The fluid can then by “milked” downwards to empty the blister. The deflated blister should then be dressed with either gauze or fleeciweb, and then covered with tape or plaster as described above.
As the saying goes- take care of your feet and they will take care of you. This couldn’t be more relevant when taking groups out on the hill, and hopefully this short article has given you some helpful tips to pass on to clients or to use yourself when trekking.
As with all the articles in this series, it is only possible to give a snapshot overview of footcare. If you want to find out more, please look at the weblinks below or consider purchasing the Oxford Handbook of Expedition and Wilderness Medicine 3rd Edition.
Disclaimer
This article does not constitute medical advice and should not be treated as such. You must not rely on the information published here as an alternative to medical advice from your doctor or other professional healthcare provider. You should never delay seeking medical advice, disregard medical advice or discontinue medical treatment because of information published in this article. If in doubt, please advise all participants to see their doctor for a comprehensive assessment and management plan.