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Every Blister Prevention Strategy Works In 1 of 5 Ways

Every Blister Prevention Strategy Works In One Of Five Ways

Every Blister Prevention Strategy Works In 1 of 5 Ways

Preventing blisters can seem hit and miss at times. It shouldn’t be. Every blister prevention strategy works in one (or more) of five ways. To demonstrate, I’m going to use a question that came in from Colin from the UK, who asks:

Hi, what products/process is best used to protect the ball of the foot during wet and muddy ultra races that will stand up to 24 hours of abuse??

The easy way to answer Colin’s question would be to direct him straight to this blog post about ball-of-foot blisters. But let’s get into the nitty gritty.

How does your favourite blister prevention strategy work?

Here’s how I think about preventing every single blister:

  1. How will I reduce FRICTION LEVELS
  2. How will I SPREAD SHEAR LOAD
  3. How will I ABSORB SKIN SHEAR
  4. How will I reduce PRESSURE
  5. How will I MINIMISE HOW MUCH THE BONES ARE MOVING AROUND

These are all the ways you have an opportunity to stop blisters from forming, no matter where they are on your foot. So let me show you what I’d use for a wet and muddy 24hour ultra race, for the ball of the foot.

1. FRICTION LEVELS

I’d use an Engo patch, rectangle or oval depending on how big your blisters normally get. Make sure it’s well and truly stuck on before the race and it will almost certainly last the 24 hours, in spite of the wet conditions. It’s adhesive, and the adhesive can be affected by waterlogging. The alternative is ArmaSkin socks. Powders and lubes just won’t last the distance. They could be an option if you have regular access to your powder/lube supplies and you’re happy to stop for reapplication. If you’ve got any questions about, take a look at this article about blister lubricants.

2. SPREAD SHEAR LOAD

Tape the area with a rigid tape. Rigid tapes will perform better at spreading shear load than flexible tapes. Stretchy tapes like Fixomull Stretch, Rocktape, Kinesio Tape, Elasticon and Fleecyweb make it easier to apply smoothly and avoid creases. This is especially helpful around the toes. However, rigid tapes probably perform a bit better at spreading the blister-causing shear forces. Brands like Leuko and BSN all make rigid tapes. They are often referred to as “zinc oxide” tapes due to the type of adhesive they use. Other rigid tapes you may know are the good old paper tape, and moleskin (some moleskins). And of course, duct tape is a rigid tape. It shouldn’t be applied to the skin, however, as its adhesive is not medical grade. If you want to learn more about taping, read this article.

types of blister tapes - rigid and flexible
Different types of tapes used for blisters – flexible and rigid

3. ABSORB SKIN SHEAR

A nice cushiony insole is the best you’ll get for this part of the foot. In other words, ensure it’s not too worn or compressed. If it is, and this includes your orthotic cover (if you’re wearing orthotics), your podiatrist can provide a Spenco insole / orthotic cover. This is the best material, as far as we know (ie: research shows) for shear absorption. Here’s the research.

4. PRESSURE

Your Spenco/cushiony insole will reduce pressure a little. Of course, the ball of your foot is a major weightbearing area and is subject to really high pressure at the best of times. But some structural and functional issues can cause even higher pressure in certain areas. Longer/shorter metatarsals, prominent joints, tight calves… I don’t really want to go into all of these right now, but just know that your podiatrist can help you identify these and do certain things to reduce focal high pressure areas.

5. BONE MOVEMENT

Similarly, it can take a podiatrist to understand if the bones under the ball of the foot (or anywhere) are moving around excessively. Ligamentous laxity comes to mind. Tight calf muscles can exacerbate it. There are others.

The common (and completely inadequate) answer

Just before we come off Colin’s 24 hour ultra question, a lot of people would have answered his question, simply with “taping”. But as a blister prevention strategy, how does taping work?

Don’t get me wrong, a lot of people remain blister-free simply by taping their blister-susceptible areas. If you want to know some variations on ball-of-foot taping techniques, here’s my best video on that topic. But compared with many other blister prevention strategies, taping makes a SMALL difference on its own – at least smaller that you probably expect and smaller than the combination of the 5 strategies I mention in the blisters under the ball of your foot article.

Some of us who are a little more blister-prone still get blisters in spite of taping, and we don’t have to run anything like a 24 hour ultra for it to happen. Here’s why taping doesn’t work for everyone:

a) Some medical tapes are made from cotton

Some medical tapes are made from cotton. Cotton is well known to be a material to avoid because it is hydrophilic, meaning it attracts moisture. I’m sure you’ve heard moisture increases friction levels – a no-no when it comes to preventing blisters.

b) Not a “wear’ injury

Contrary to popular belief, blisters are not a “wear” injury. It’s not like your skin is rubbed and rubbed and this wears right through your skin, from superficial to deeper layers. If it was, tapes would fix the problem because you’d have to wear through the tape first. Also, blisters are not a burn. It’s not like your skin gets rubbed so much that it heats up enough to cause a second degree burn (second degree burns are the burns that cause blisters to form).

In fact, blisters start as a tear under the skin surface, caused by it being stretched back and forth, over and over again as you walk – until it fatigues. Here’s a video that shows how it happens. When the damaged area fills with fluid, the skin bubbles up (that’s the blister roof) and you have what you’ll be familiar with as a blister. This is what you need to have in the back of your mind when you implement a blister prevention strategy, every time.

Wrapping up

Every blister prevention product, method or technique works by doing one or more of these things.

  1. How will I reduce FRICTION LEVELS
  2. How will I SPREAD SHEAR LOAD
  3. How will I ABSORB SKIN SHEAR
  4. How will I reduce PRESSURE
  5. How will I MINIMISE HOW MUCH THE BONES ARE MOVING AROUND

The next time you’re thinking “how will I stop this blister from coming back”, think about these things.

PS: There is one more blister prevention strategy and that is to reduce the repetitions of shear load. This basically means stop walking or running so much. Yes, it works. Because the number of repetitions influences the likelyihood of mechanical failure of the skin cell connections. But pulling out of the race, not training for a few days, or not carrying on to the next checkpoint with your hiking team is not one most people want to hear about, nor is it practical in many active situations.

References

  1. Spence WR and Shields MN. 1968. Prevention of blisters, callosities and ulcers by absorption of shear forces. Journal of the American Podiatric Medical Association. 58: 428-34
  2. Carlson, JM. 2006. CPO Functional Limitations From Pain Caused by Repetitive Loading on the Skin: A Review and Discussion for Practitioners, With New Data for Limiting Friction Loads, JPO Journal of Prosthetics and Orthotics: October – Volume 18 – Issue 4 – p 93-103
  3. Rushton, RJ. 2019. Tape Use to Prevent Blisters: Does It Really Do What We Think It Does? Lower Extremity Review. March.
  4. Rushton, RJ. 2020. Exploring the Mechanism for Blister Prevention Using Moleskin. Current Sports Medicine Reports: Volume 19, Issue 11, p 451-453

Rebecca Rushton

Podiatrist, blister prone ex-hockey player, foot blister thought-leader, author and educator. Can’t cook. Loves test cricket.

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