Blisters Pinwork and Prevention

Pinwork and Prevention

It's a sure sign that something is rubbing your child the wrong way: She has a puffy, water-filled sac just under the top layer of skin. To her it's a curiosity--something to poke and prod. To you, that blister is a signal that there's been too much friction between your child's foot and shoe--or hand and tennis racket.

Your biggest dilemma with a blister is whether to leave it be or drain it. If it's small and not likely to burst on its own, most doctors advise only cushioning it with moleskin, a soft adhesive-backed product you can find at most drugstores.

But if the blister is large or painful and the child can't avoid putting pressure on it, it's better to drain it, as long as the child is not frightened by the idea. Some studies have shown that blisters heal faster when drained, and it's preferable to drain the blister under sterile conditions rather than let it burst on its own. That's because burst blisters can become infected, cautions Suzanne Levine, D.P.M., a podiatric surgeon, clinical assistant professor at the New York College of Podiatric Medicine in New York City and author of My Feet Are Killing Me. (Never, however, puncture a blister caused by a burn.)

Here's how to proceed, for blisters large or small.

Treatment

Protect them with moleskin. Cut the moleskin into a circle about ¾ inch bigger in all dimensions than the blister itself, says Morris Mellion, M.D., clinical associate professor of family practice and orthopedic surgery (sports medicine) at the University of Nebraska Medical Center and medical director of the Sports Medicine Center, both in Omaha. ''Just leave it on for about two days, until the fluid has been reabsorbed into the skin,'' says Dr. Mellion. Be gentle when you remove it, so the adhesive backing doesn't disturb the tender skin underneath.

Explain the draining process. If your child has a large blister you believe should be drained, first explain calmly why it's a good idea to puncture the blister--and that it won't hurt. ''A child old enough to get a blister will probably be able to understand that the process will be painless because the skin is dead--just as there is no feeling when you cut your hair or nails,'' says Douglas Richie, D.P.M., a practicing podiatrist in Seal Beach, California, and clinical professor at the California College of Podiatric Medicine, southern campus, at Los Angeles County--USC Medical Center. If your child is afraid, however, don't proceed--just pad the blister with moleskin instead.

Don't waste time. If your child is agreeable to having the blister drained, do it now. ''A blister will heal faster if you drain it during the first 24 hours after it has formed,'' says Dr. Richie.

Clean the scene. Before you puncture the blister, paint it with an iodine solution such as Betadine Solution, says Dr. Mellion. After you've disinfected the area with iodine, wait at least 90 seconds before you proceed, he advises. ( iodine stings on an open wound.)

Sterilize the needle. While waiting, sterilize the needle or pin with isopropyl alcohol or Betadine Solution. Holding it over a flame also sterilizes it, but it's also likely to frighten the child and isn't necessary, says Dr. Richie.

Prick with care. Press the fluid in the blister to one side and then gently insert the needle sideways (not straight up and down) into the fluid-filled part of the blister, advises Dr. Richie. Some of the fluid will come out at once.

Press it out. Gently press out the rest of the fluid with a sterile gauze pad. ''Most important is to leave the roof of the blister intact,'' says Dr. Levine. That flap of dead skin acts as protection for the raw skin underneath. ''Think of it as nature's bandage,'' adds Dr. Richie. If the blister fills up again after 24 hours or so, carefully drain it again.

Battle infection. After the blister has been drained, apply an antibiotic ointment or cream such as Neosporin Ointment or an ointment containing bacitracin, and put a Band-Aid over the area. Better yet, cover the blister with a product called 2nd Skin, which is 96 percent water and looks like jelly, says Dr. Richie. You can find it at most drugstores: It comes in large sheets and can be cut to fit. Whatever covering you use, change it twice a day.

Cover torn blisters. If the blister has already burst and the protective layer of skin is torn, you need a ''replacement skin.'' First clean the exposed wound and apply an antibiotic, says Dr. Richie. Then use the over-the-counter 2nd Skin product to protect the exposed area.

''The 2nd Skin creates a moist environment for healing, covers open nerve endings, provides a cushion and protects the area from dirt,'' he says. He recommends changing the dressing twice every 24 hours. A dressing should be used until the wound starts to heal on its own and your child says it feels better.

Make removal a snap. Before you change the 2nd Skin dressing, moisten it if it has dried out. ''That way, you'll save your child's newly healed skin from damage and prevent some unnecessary pain,'' says Dr. Levine.

Preventive Care

Shop for shoes that fit. One of the best ways to avoid heel, toe and arch blisters in the first place is to buy your child shoes that fit well, says Dr. Levine. Take your child shoe shopping when he's rested-not after he's been walking around the mall all day, when his feet are tired and he's irritable, says Robin Scanlon, owner and manager of Scanlon Stride Rite Bootery in Whitehall, Pennsylvania.

Scanlon recommends allowing no more than ½ inch of growing room at the toe of slip-on shoes, and no more than an inch for lace-up shoes. Check the heels to make sure they don't slip up and down easily. But if the shoes seem a bit snug, try another pair. ''Never depend on a tight shoe stretching,'' Scanlon says. ''It should be comfortable when first worn.''

Get special footwear for the athlete. Although it can be tough on your pocketbook, you may want to invest in specific shoes for certain sports, to help avoid blisters. You don't want your child to play tennis or racquetball in running shoes, for example, because the foot twists inside the shoe during the quick stop-and-go action--and that twisting motion can cause blisters, says Dr. Mellion.

Go acrylic. If your child has blister-prone feet, choose acrylic socks rather than cotton, says Dr. Richie. His research shows that acrylic fiber socks are half as likely to cause blisters as cotton socks.

''Cotton stays wetter and it doesn't wick moisture off the foot and allow it to evaporate through the shoe,'' he explains. ''Instead, it traps moisture against the foot, and moisture increases friction and rubbing and hence blisters.''

Also, cotton can become rough and abrasive after many washings, while acrylic socks do not. '' Wool is better than cotton but not as good as man-made fibers for protection against blisters,'' says Dr. Richie.

Ban the tubes. Tube socks, which don't have a fitted heel, can contribute to blisters, says Dr. Richie. ''These can creep down into the shoe, balling up at the toes, creating wrinkles and lumps that become a source of irritation,'' he says. For the same reason, don't buy socks that are too large.

Double up on socks. '' When extra friction is bound to occur, as in a sport activity, wearing two layers of socks can prevent blisters,'' says Dr. Mellion.

''The inner pair should be made of a wicking material, such as acrylic fibers, while the outer pair can be cotton.''

Soothe with a sprinkle. ''For kids whose feet sweat a lot, you can sprinkle talcum powder or cornstarch between the toes and all around the foot to reduce the friction that causes blisters,'' says Dr. Levine.

Or grease those piggies. ''Rub a bit of petroleum jelly onto any red or irritated spots on your child's feet before putting socks on,'' says Dr. Levine. ''That will help reduce any mild friction that may be occurring.'' That soothing lubricant may be especially helpful for those times when your child is participating in a sport where overuse can create a blister, she says.

Battle sweat. Sweaty feet can contribute to blisters. For this reason your child is always better off wearing socks, says Dr. Levine.

''If your child insists on going sockless, sprinkle talcum powder inside her shoes and on her feet,'' she suggests. And make sure your child has an extra pair of well-fitting shoes that she can wear on alternate days. That way, each pair can dry out completely between wearings.