ADVANCED BLISTER PREVENTION AND CARE
Shane Krogen
Site Admin
Joined: 15 Sep 2003
Posts: 197
Location: Fresno, Ca
Posted: Mon Oct 18, 2004 9:05 pm
Post subject: ADVANCED BLISTER PREVENTION AND CARE
ADVANCED BLISTER PREVENTION AND CARE
Ken Murray, M.D.
==============================
Dealing with the issue of blisters is simply something that
all hikers must cope with, whether personally or others on a
trip. It is astonishing how poorly prepared some people are,
but that is largely a function of education. The purpose of
this paper is to review the newest information incorporating
the latest advances in care and prevention..
PREVENTION
Of course, the best treatment for blisters is not to have any!
This begins with good fitting boots, appropriate for the type
of trip anticipated. For example, if one is doing a simple day
hike of a few miles, or a backpack using the new ultralight
techniques, athletic shoes are fine. Heavy, full leather shoes
are of no value, and add a lot of work. Likewise, a heavy pack
weight of more than 30 lbs, or serious cross-country travel
require more protection of the feet and ankles than
lightweight boots will provide. Most people find that when
they are doing multi-day hard hikes that their feet swell, and
they do better with boots a little larger than the normal size
of shoe they would wear. When I buy boots, I wear them in the
store for an hour, to make sure they fit well, preferably
carrying weight. If you inspect the footbeds of any boot, you
will be astonished at the poor quality of the supplied ones.
The first thing anyone should do who buys a boot is to buy a
properly supported insole. The best on the market are the
custom insoles produced by "Superfeet", which are custom
molded to the foot in the store. They are pricey, and there
are less expensive non-custom types available. These make an
incredible difference in reducing foot problems.
Most experienced people these days wear a two-sock system: an
inner "sock liner", designed to wick moisture away from the
foot, and a heavy wool/synthetic/combo, designed to pad and
absorb shock. Some people find thin dress socks work well for
the liners.
Moisture is an enemy of feet. If you are having foot problems
after several hours, switching to dry socks often helps a lot.
Likewise, if you walk through a stream; your wet feet/socks/boots are an
invitation for blisters. Some folks like to shoot some powder
into the boots at the beginning of the day. If you do so, be
sure to use talcum powder, not cornstarch, which can promote
foot fungus. Look at bottle contents.
If you have an area which is prone to trouble, there are a
couple of things that can be done. First, duct tape over the
area creates a low-friction surface to be rubbed, other than
the skin. Sometimes, simple Vaseline applied to a trouble area
makes a big difference. This is particularly true of the toes.
There are various "skin lubricants" sold for the purpose, but
I've not found them better than Vaseline. In bad cases, one
can use padding (moleskin), with a hole cut in the center, to
relieve pressure.
Some people find that when they take their hourly rest break,
it helps to unlace the boots, and relieve the pressure. Some
take off their boots, some even take off their socks, allowing
them to dry a bit. Inasmuch as most laces stretch a bit, and
loosen as one walks, repeated re-tightening makes sense. As
the hours pile up, some find their feet "swimming" in the boot
loosened by use.
If a person has a continuing problem, then they should
probably seek the care of a medical expert on foot problems.
In the Fresno area, the
Expert is Allen Clyde, DPM. In the LA area, Gersten Stein,
DPM.
TREATMENT
A critical point to make is to treat early......as early as
possible.
In the beginning, a mild irritation is easy to treat. Once
you've got
Broken blisters, it becomes much more difficult, and pain is
part of the picture.
People try to tough through early pain, probably because they
don't
Want to slow their partners down. It will only get worse, and
many days have been spent in camp, because a person couldn't
walk!
Blisters are a heat injury, basically a second-degree burn. As
with
All burns, the first priority is to stop the burn source. Stop
walking! Fix the problem! If a stream/lake is available, a
soak can work wonders. Make sure the feet are dry before
redressing.
There is a "pyramid" for treating blisters, based on severity.
There are many variations, this is one.
Skin Protectant: There are several products which have two
virtues:
They form a protective barrier for the skin, and they create a
VERY sticky surface for things, such as tape, to stick to.
These products are used under casts and in the emergency room
for bandaging. They make a HUGE difference in tape/moleskin
sticking to sweaty skin! By FAR the most common and cheapest
product is Compound Tinture of Benzoin (sometimes with the
words arranged in a different order)
CRITICAL: NOT THE SAME as "Tinture of Benzoin". MUST be
"compound" to be sticky. Comes in bottles and swab sticks. Apply to skin
until dry, tape over.
Duct tape is used as a skin protectant, as well as providing a
"sliding surface" OTHER than the skin. When applying duct
tape, it is best to avoid folds by cutting in the center of
where the fold would be, then overlapping the two sides.
Moleskin (and Molefoam, a slightly thicker version), provides
padding, and is cut to fit. There are "pre-formed" pads, but I
prefer the
Versatility of the Moleskin "artificial skins" These represent
a major step forward in the consumer market. These products
have been used in hospitals with great success. They are a
layer that provides a barrier, designed to replace broken
skin, and stay in place for several days. They GREATLY speed
the healing rate, greatly reduce pain, and simplify treatment.
There are several products on the market, in several sizes. My
current favorite is made by "Band-Aid" brand: Advanced Healing
Gel Strips, large size. It doesn't matter if they are a little
large, but are of no use if too small. There are smaller ones
made for toe treatment.
Vaseline refers to any brand of petroleum jelly. Antibiotic
ointment
(Neosporin-type) also works.
"HOT SPOTS" This is the first thing that a person feels in the
boot.
It never gets better without treatment, if one continues to
walk. Duct tape, Vaseline are options. Some will use moleskin at this
point.
SIMPLE FLAT BLISTERS Apply moleskin, cover with duct tape. If
you break the blister, you introduce the possibility of
infection, so avoid this if you can. If continued pain, use
the "hole" method, below.
TENSE, ELEVATED BLISTERS generally, these have to be punctured
to drain enough so that boot will go on, and there is not an
elevated pressure point. Use a sterilized knife or needle at
the base of the blister, side towards the ground. Cut a hole
in moleskin about the size of the blister, and apply. You may
need two pieces to gain height. This takes the pressure off
the blister, and onto the surrounding moleskin.
Apply a dab of Neosporin-type ointment directly on the
blister; apply duct tape over it all.
BROKEN BLISTERS if it is difficult to tell exactly where it is
broken, that is, the skin is largely covering the blister and
is flat; I'd leave it, and treat as above. If the skin is
significantly disturbed (turned under or over, or creased),
remove the damaged skin with scissors, as the folded surface
can create another pressure point. Apply an "artificial skin"
to the damaged, open skin, apply cut-out moleskin, and apply
duct tape.
You may need to change the moleskin and/or duct tape, but
leave the "skin" on for a week, if you can.
_________________
Shane Krogen
Director of Trail Crew