Whether you are just getting started in expedition and event medicine, or you are an old hand, one of the things you can’t get away from are feet. You will also get lots of questions about blisters, how to prevent them, how to dress them, whether to pop them and much more. This latest blog will look at foot care and some useful tips and tricks.
Matt sorting his feet in the Yukon
As with all potential medical issues, prevention is better than cure. Ensuring that participants have appropriate footwear, that they have already worn on fairly long treks prior to joining a trip is really important. It is not the time to try some shiny new Gore-Tex boots that are fresh out of the box, as this can be like playing “Russian roulette” with your feet, and indeed your expedition, as bad blisters can ruin a trip.
Depending on the type of terrain, approach shoes or walking boots may be advised and the latter are especially important if ankle protection is required. Having a good quality sole (e.g. Vibram) can be really beneficial, and can reduce the risk of slips and trips. It is also important to check that the sole is not too worn out from prolonged use and to preferably discover this before the start of a trip!
Waterproofing is also a key factor to consider, as wet feet are much more prone to skin breakdown and blistering. It is also a huge morale boost to have dry feet whenever possible! Good quality leather boots, or boots with a membrane-based waterproof lining, are a must when joining an event or expedition in wet or potentially wet conditions.
Having footwear with a waterproof membrane, can in fact be detrimental in some environments, as whilst it keeps water out, it will also trap water within a shoe or boot, in the same way that waterproof socks can. This prolonged exposure to moisture can cause “Warm Water Immersion Foot” (WWIF) or Tropical Immersion Foot (TIF), which can lead to pain, burning, gross oedema and difficulty weight-bearing. Unsurprisingly these two conditions can end someone’s expedition. Prevention by having jungle boots (with holes to drain water), ensuring thorough drying and encouraging the liberal use of talcum powder is prudent, and looking out for the warning signs of white, painful wrinkled feet is vital.
Warm Water Immersion Foot; Image Credit: www.medicalnewstoday.com
We have all had blisters at some point in time and you will recall that they can really hurt! Identifying “hot-spots,” (sore or erythematous areas) at the earliest opportunity, and taping these, should be encouraged at any expedition or event briefing session. Having good footwear that will stay dry is the best method to reduce the likelihood of blister formation, but eventually feet get wet. The repetitive rubbing of wet fabric on pressure points, and the resulting friction on wet skin, will ultimately lead to blister formation as the body tries to prevent further damage from occurring by creating fluid filled cushions.
When working on mass participation events, the queue for blister treatment can stretch out of the medical tent, and encouraging self-care is really valuable. 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 a plaster) can be useful but personally I would use zinc oxide tape in preference.
Race to the Stones 2021
Compeed and similar “second skin” blister plasters are a bit like Marmite in that you either love them or hate them. They have their place, however often they can come unstuck inside of a sock and stick to the inside of the sock, leading to a sticky mess and a sock that is out of action. They are incredibly adhesive and can be hard to get off afterwards which is ok, so long as part of the plaster is not attached to broken skin or the blister itself, in which case this can be really painful and may unnecessarily de-roof the blister.
My bowl full of blister kit!
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, but do make sure that they do this themselves before you see them if possible!
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 obviously better to sort this prophylactically.
A large blister that needs popping!
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.
I hope this has given you some helpful tips on how to sort out feet in the field when out on your next expedition or event. Check out my other blogs and podcasts for more expedition and wilderness medicine tips by clicking here