Are you getting rubbed the wrong way?

As we head into summer, we start to get involved with more physical activity such as marathons, triathlons, trail runs and a wide assortment of fun runs.

With all this running, hiking and walking comes the dreaded foot blister. These nasty guys can happen out of nowhere and turn a fun weekend into pure pain and suffering that can last for days. So what’s up with foot blisters? I have had people say their favorite shoes they have worn for months suddenly gave them blisters. I have had people close to me wear fashionable but extremely ridiculous high heels wrecking their feet for weeks with blisters. Then there are those foolish, but well meaning, folks who buy new running shoes and break them in on their first half marathon.

How do we manage the madness around shoes, feet and blisters? Blisters are also known as vesicles. They’re caused when the top layer of skin pulls away from lower layers and then fills with fluid. The fluid inside a blister is sterile and made up of water with some protein, plus traces of cellular material. The fluid creates a good healing environment for the breaks in your dermis layers, so popping a blister is not always a great idea. By lancing your blisters with a sharp pin or needle, you can introduce bacteria, leading to an infection.

The most common cause of blistering happens when friction between your skin and poorly fitting shoes separates the layers of your foot’s epidermis and/or dermis. Once friction and movement stretches the skin around toes, the top, sides or bottom of your feet too far, over time the layers of your skin cells part and break. These tears between skin layers is how and where blisters form. The more area affected, the larger the blister and when fluid fills the injured area and then the uncomfortable feeling of a blister starts to sink in.

How quickly a blister will form is dependent on the person and a few other environmental factors like moisture, temperature and activity levels. Over the years, there have been many tried and some believe true ways to avoid blisters. These include wearing thick socks, moisture wicking sock liners, foot powder, mole-skin tape and even lubricants, all in an effort to avoid blisters. What is really interesting is all these great ideas for prevention still fall short of consistently delivering a blister-free environment for your feet.

There is one aspect of how blisters develop that surprises many people and that is around skin shear. Shear happens internally when skin shear is excessive due to repetitive motion. An example of this is in the way our heel bone moves inside the foot. In some cases, people’s skin stretches up and down or side to side creating shear which fatigues the cells of the dermis and epidermis layers leading to blisters. Blood blisters found on your heel can be an indication of skin shear. The issue with skin shear is your shoes and socks may not be the direct problem. Many times standard blister prevention will not help with this type of blistering.

Let’s take a look at a few key factors to consider in your search for the perfect way to avoid blisters.

Shoes

Shoes are tricky to get fitted correctly. Various shoes have different arch measurements that do not fit your foot properly. If you wear a size 8, but your arch is high or short the shoes arch position could be longer with a bigger insole size making the shoe not fit the shape of your foot. In the case of dress shoes like high heels, the pressure on the front of your foot is extreme, making blisters very common. For running shoes, if fitted correctly, are good right out of the box. Running shoes need a little more room for your foot strike, stride and cadence. Most people buy inexpensive running shoes from stores that have no idea about foot strike, pronation, sublimation and stride so two things happen. You run in a poorly designed shoe that is not the correct size of running. Guess what happens: next comes blisters and injury to your feet and/or ankles.

Socks

A few folks out there don’t wear socks and that increases the chances for blisters in a big way. Wearing a thick sock in an effort to avoid blisters is another great way to create friction. Thick socks can make your feet sweat more and they retain moisture very well. Sweating and moisture retention create a wonderful environment of slip and friction, leading to blisters. The best approach to blister control and socks is to buy quality running socks. They have ultra-thin mesh for ventilation and wrap firmly around your arch which keeps slip and movement in check. A lot of fitness folks learned this a long time ago and wear running socks in both running shoes and their street shoes for this very reason.

Lubricants

Lubricants are a bit messy so not always a good option for street shoes, but for distance runners or folks who hike long distances, these options can be a real benefit. For example, many triathlon athletes use gels, glides and friction blockers. There is a large number of these products on the market and the science behind these formulas have become very effective.

Taping

Taping is, in my opinion, a last option. For some people no matter how well your shoes fit or how great your socks are, they still manage to get blisters on their heels or around their toes. Taping with the proper tape can keep blisters in check. I have seen people use duct tape which is a bad idea, but one that seems to make sense since it is super sticky. There are a number of blister tape varieties on the market. Mole-skin and Leukotape are two that are pretty effective. The problem with tape is if it gets too moist or moves, it creates a bigger problem. The other aspect of tape is it seems from studies that certain areas on the foot benefit from certain types of tape better than other areas. Tapes come in all sizes and thickness, which in itself can present problems since size and thickness or thinness can either move then fold or just not provide enough protection against shear and friction.

Finally, if you have blisters, puncturing it or not is a choice, but you must be careful of infection. The best treatment I have found is using blister bandages and they work very well. These bandages have a raised gel center with a forming adhesive that attaches to your foot like glue. Often these bandages will stay attached for days and keep out moisture, dirt and germs, allowing the blister to heal without any pain. If you have a large number of big blisters, soaking them in Epsom salts periodically and staying off your feet for a couple days may be a good course of action. For large blood blisters or blisters that form under your toe nails, I would recommend seeing your physician for treatment and healing guidelines.

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Judd Jones is a director for The Hagadone Corporation in Coeur d’Alene.