Blister's are not caused by friction

As part of our bite sized medical series, treating aliments in the backcountry can be tricky. The best treatment? Prevention! Blisters plague almost everyone who hikes, runs, wears new shoes but become an expert and hike blister free!

WHY DO WE GET THEM?

Many people will state its the friction, or rubbing, between the shoe/sock/skin combination. That's a really simple way to put it however it is much more complex and is really cause by the shearing forces between the different layers of skin, body tissue, muscles, bone and how the outside world impacts this (socks/shoes).

Understanding Shearing Forces

PREVENTION

- Properly fitting shoes/boots and don't forget to try on with hiking socks

- Switch from ridged boots to lightweight boots or trail runners that have a softer sole

- Break them in before hitting the trail

- Account for swelling by sizing up slightly if needed (ultra marathoners do this)

- Address hot spots SOON AS THEY FORM, more on this below

HOT SPOTS

These are irritation spots before the fluid filled blister forms. Many people describe these as a warm spot in their boot.Treating these can prevent further development of a blister. Apply your choice of blister treatment at this stage or adjust problematic rubbing areas. Consider swapping out your socks if they are moist!

BLISTER TREATMENT

You've made it to camp and have an unsightly and painful intact blister. What should you do?

1. Wash your foot with soap and water or use a wet wipe

2. Using 1-2 alcohol pads, gentle clean the blister and surrounding area, allow to dry. The area is now sterile, do not touch

3. Clean a safety pin with alcohol pad then pierce the blister at 4 and 8 o'clock to facilitate drainage. Place the alcohol pad over the blister and gently push to help move the fluid out, you don't need to get it all the way out, gravity will do that

4. Apply treatment product of choice, making note that area should be examined daily for signs of infection

TOOL KIT & PRODUCTS

To each their own on this, the jury is out on a "gold stand" product so find something you like and works for you. Here are a number of great options. Recommend having a prophylactic aid and a treatment aid with you!

- Kinesology Tape or Leukotape (BEST): clean area with alcohol wipe and allow to dry. Cut tape to size and round the edges. Apply tape on a VERTICAL axis (shearing forces are typically vertical axis) and lay the tape over. DO NOT STRETCH as you could make the blister worse or create a new one. Rub for 30 seconds to activate the adhesive for better fit. You can add Tincture of Benzoin to skin before tape to help increase the adhesive.

- Patches: these are typically marketed as blister specific band aids and have a cushioned center to pad the blister and facilitate healing. Defiantly want to use tincture of benzoin to increase the effectiveness of the adhesive otherwise they have a tendency to rub off in the next mile or two.

- Mole Skin: is a commonly marketed blister treatment. I don't like it and would recommend other products over this. Many people just cut and stick over a blister however this isn't the intended way to use it. You actually create a donut around the blister to assist with padding.

- Engo: an excellent prevention tool that you place right into your shoe in hotspot prone areas. This super slippery surface helps decrease the amount of shearing forces dramatically. Check out this cross section shoe with and without eno! It really drives home the shearing forces idea too.