Blisters
Blisters
20 Hints to Stop the Hurt
Blisters are your body's way of saying it's had enough. Be it too much friction or too much ambition, a blister—much like a muscle cramp or side stitch—is designed to slow you down and make you better prepared for physical activity.
In some cases, blisters result from the painful rigor of breaking in a new pair of badly fit shoes or spending too much time with the garden rake.
But blisters can also be viewed as a badge of initiation, a sign of someone trying something new that's hopefully worth the added effort and pain. Blisters initiate the new walker, the new racquetball player, the new cyclist. Different sports create blisters on different parts of the body, though the foot remains the site of greatest abuse.
Though the following remedies concentrate on blisters of the feet, many of these recommendations can be applied to treating friction blisters on the hands or on any other part of the anatomy where your body has said slow down.
TREATING THEM
Here's how experts recommend you deal with the discomfort of blisters you already have.
Decide whether to prick or not to prick. Once you have a blister, you have to decide what's best to do with it. That is, should you protect it and leave it alone, or should you prick it and drain the fluid?
"I think it depends on the size of the blister," says Suzanne Tanner, M.D., a private practitioner in Denver, Colorado, who specializes in sports medicine. "A purist will probably tell you not to prick it, because then you don't run any risk of infection. But I think for most people that's just not very practical."
While purists do indeed exist, our experts say you should prick large blisters that are painful, while leaving intact smaller blisters that cause no discomfort. "When you have a big blister that's in a weightbearing area, you almost have to drain it," says Clare Starrett, D.P.M., a professor at the Foot and Ankle Institute of the Pennsylvania College of Podiatric Medicine. "They can get so full they get like a balloon."
Also, blisters that are likely to break on their own should be drained by you, our experts say. That way, you can control when and how the blister is opened, instead of leaving it to chance.
Make a moleskin doughnut. One way to protect a tender blister without draining it is to cut a moleskin pad into a doughnut shape and place it over the blister. "Leave the central area open where the blister is," says Dr. Tanner. The surrounding moleskin will absorb most of the shock and friction of everyday activity. As long as the skin is clean and dry, the moleskin will adhere by itself.
Be wise and sterilize. For those who wish to drain a blister, the first thing to do is clean the blister and surrounding skin, and sterilize your "instrument," whether it's a pin (needle) or a razor blade (we'll get to that subject in a minute). "I recommend alcohol to clean both," says Nancy Lu Conrad, D.P.M., a private practitioner in Circleville, Ohio.
Other doctors advise sterilizing your instrument by flame instead of alcohol; that is, simply heat the pin or razor blade with a match until it glows red (let it cool before touching the skin, however). Either method seems equally able to kill germs, and both come equally recommended.
Stick it. "If a blister gives me pain," says Joseph Ellis, D.P.M., a private practitioner in La Jolla, California, and a consultant for the University of California, San Diego, "then I just go ahead and pop it." Use a sterilized needle and stick it in the side of the blister, Dr. Ellis says. "Just make sure the hole's big enough that you can squeeze out all the fluid."
Or slice it. "We use a sterile scalpel to drain blisters at our office," says Dr. Starrett. Not surprisingly, she recommends using a sterilized razor blade for doing the same at home. "Just make a straight incision," she says, "a little slice that's big enough to let the fluid come out."
Keep the roof on. "I think the biggest mistake most people make when treating their own blisters is that after they drain it they pull off the roof—the skin that goes over the top of the blister—and this is a terrible mistake," says Richard Cowin, D.P.M., director of Cowin's Foot Clinic in Libertyville, Illinois. Always leave that roof on, our experts advise. Think of it as nature's Band-Aid.
MEDICAL ALERT
Watch Out for Infection "A good rule of thumb is that most wounds, no matter what they are, should get better each day," says Clare Starrett, D.P.M. That rule holds for blisters as well, she says, noting that the classical signs of infection are redness, swelling, heat, and increased pain. "A blister is definitely infected when the fluid coming from it is not clear like water, or when it has some odor to it," she says. "That's the time to seek professional help." Nancy Lu Conrad, D.P.M., agrees. "You can end up going too far with bathroom surgery," she warns. "Head to the doctor at the first sign of infection." |
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"If you remove it, you're going to end up with a very red, raw, sore area," says Dr. Cowin. "But if you leave it on, it'll eventually harden up and fall off by itself, significantly reducing your recovery time."
Try a triple whammy for germs. Recent research has shown that triple antibiotics (such as Neosporin, to name one) can eliminate bacterial contamination from blisters after only two treatments, whereas old standbys such as iodine and camphor-phenol actually delay healing. Triple antibiotics are the choice of our experts, while iodine and camphor-phenol "are so good at killing germs that when used in high concentrations they can even kill the cells you are trying to heal," says Dr. Starrett.
Keep the dressing simple. After you've treated the blister, you'll need to keep it covered and protected while it heals. Though gauze pads and special bandages may be the first thing you'd expect a podiatrist to reach for, our experts suggest a much simpler approach.
"My first choice is a flexible fabric adhesive strip," says Dr. Cowin. Ditto for Dr. Ellis. "People will tell you to put a sterile dressing on it," he says, "but they forget that Band-Aids are sterile inside the wrapper, so you're actually putting on a piece of sterile gauze that has the adhesive already in place. It's a great dressing and very convenient."
Gauze pads, however, are recommended for blisters that are just too big for a Band-Aid to cover. Keep it in place with waterproof adhesive tape.
Use Second Skin for a second wind. If you've treated and covered your blister and find you just can't wait for it to completely heal before returning to an active lifestyle, then you'll need to know about Spenco's Second Skin dressing, a spongy material that absorbs pressure and reduces friction against blisters and surrounding skin.
"That's a good product," says Dr. Conrad, noting that a number of athletes (weekend and otherwise) apply petroleum jelly to the blister before covering it with Second Skin and taping it in place.
Give it some air. Most doctors suggest that you remove your blister dressing nightly and let it get some air. "Air and water are very good for healing," says Dr. Cowin, "so soaking it in water and keeping it open to the air at night are helpful."
Change wet dressings. Though some physicians say you can leave a dressing on for two days without worry, all agree that if a dressing becomes wet for any reason "you can consider it contaminated and it should be changed." That means you may need to change it quite often if your feet perspire heavily or you engage in activities that will lead to sweating and damp dressings.
PREVENTING THEM
Prevention is always the best option, so here's what experts recommend to keep blisters from developing in the first place.
Try a heel lift. Blisters that appear on the back of the foot usually result from the shoe's heel counter hitting the back of the heel in the wrong area, says Dr. Cowin. The fix? "All you usually have to do is put in a heel lift at the back of the show," he says.
Keep your socks on. "One of the fashions we're seeing again is people going without socks," Dr. Cowin says. "The people who do this suffer blisters on the back of their heels all the time." He recommends that those who want to flash some ankle without suffering the consequences invest in "footie type socks that only go around the foot area." These are available for both men and women nowadays, and they are much better than going sockless.
Powder daily. "Powder should be everybody's friend," says Dr. Conrad. "Make powdering your feet part of a daily routine."
"When people come in with shoes that fit but that still give them blisters," says Dr. Cowin, "I simply tell them to start off by applying baby powder to their feet before putting on their socks. This helps the sock to glide over the foot a little more and prevent blisters."
Coat to protect. If you're planning a long walk, run, tennis match, or whatever, one way to guard against blistered feet in new shoes is to coat blister-prone areas with petroleum jelly. "That will cut down on friction," says Dr. Conrad.
Dr. Ellis says A&D Ointment (typically used for diaper rash) is actually thicker than petroleum jelly, "and the thicker the better," he says. For walkers or runners who insist on going without socks, greasing up blister-prone areas is highly recommended.
Try new socks for new shoes. "If you've got a new pair of shoes that are rubbing up blisters, the first thing I'd do is change to different socks," says Dr. Ellis. "I recommend acrylic socks (available in sporting goods stores) because they're made in layers that are designed to absorb friction so your foot doesn't."
Cotton Up to Acrylic Socks There's a major debate raging in the sock world that could have far-reaching consequences for millions of blister-footed Americans—weekend walkers and Olympic marathoners alike. The cause of the current "friction" among foot care specialists is a study showing that acrylic socks may actually be better at preventing blisters than socks made of cotton or other natural fibers. For years, natural fibers and natural materials (think cotton socks and leather shoes) have been the main recommendation of most podiatrists. The recent findings about man-made acrylic offering superior protection fly in the face of conventional wisdom and go firmly against the advice of most coaches, sports physicians, and athletes alike. But research now shows that cotton socks produce twice as many blisters in runners as acrylic socks, and that the blisters formed by cotton socks are usually three times as big as those produced by their acrylic counterparts. "As a veteran ling-distance runner and someone who treats runners for blisters every day," says Seal Beach, California, sports podiatrist and study author Douglas Richie, Jr., D.P.M., "the results don't surprise me in the least. I'm well aware that cotton fiber becomes abrasive with repeated use, and that it also loses its shape when wet. The shape of a sock is critical when it's inside a shoe. "Many people equate acrylic with a silky, nylonlike fiber," says Dr. Richie, "yet spun acrylic feels exactly like cotton and maintains its soft, bouncy feeling even when wet." Dr. Richie says the nonblistering property of acrylic socks holds true for any type of sporting activity, be it walking, running, tennis, etc. It could be worth a try. |
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Treat your feet to treated insoles. Our experts agree that many of the products made by Spenco are excellent for preventing blisters. One of the best is a chemically treated insole "that's bubbled-in nitrogen," explains Dr. Cowin. "What that does is add some cushioning to the bottom of the foot and help it glide over the bottom of the shoe better, instead of sticking in places and causing a blister."
Toughen with tannic acid. Studies have shown that applying 10 percent tannic acid to vulnerable areas of the skin twice daily for two to three weeks makes the skin tough and less prone to blisters. "If you're a hard-core athlete or distance runner, you can use something like that," says Dr. Conrad. "But weekend athletes and beginners really don't have any business using tannic acid unless it's been suggested by a physician."
Beware the terrible tube. While tube socks, those unformed heelless wonders you can slip into without thinking, are very popular, our experts advise against them. "I personally don't believe in tube socks," says Dr. Cowin. "I don't think they ever fit properly. You need a regular, fitted sock to help prevent blisters."
PANEL OF ADVISERS
Nancy Lu Conrad, D.P.M., is a private practitioner in Circleville, Ohio. She specializes in footwear for children, as well as in sports medicine and orthopedics.
Richard Cowin, D.P.M., is director of Cowin's Foot Clinic in Libertyville, Illinois, where he specializes in the practice of minimal incision and laser foot surgery. He is a diplomate of the American Board of Podiatric Surgery and the American Board of Ambulatory Foot Surgery.
Joseph Ellis, D.P.M., is a private practitioner in La Jolla, California. He is a consultant for the University of California, San Diego, and is the sports medicine consultant for the Asics-Tiger running shoe company. He also writes for Runner's World magazine.
Douglas Richie, Jr., D.P.M., is a sports podiatrist in Seal Beach, California, where he studies the function of socks and their effect on sporting activities. He is also a clinical instructor of podiatry at the Los Angeles County/University of Southern California Medical Center in Los Angeles.
Clare Starrett, D.P.M., is a professor at the Foot and Ankle Institute of the Pennsylvania College of Podiatric Medicine in Philadelphia.
Suzanne Tanner, M.D., is a private practitioner in Denver, Colorado, who specializes in sports medicine.
