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Here we bring you expert advice on how to prevent and treat blisters:
Everyone I have ever met has had their own tried and tested cures/solutions to the problem of sore spots on the feet and most of them have sworn by their own unique answers to this age-old problem. Everyone is different and what works for one person might not work for another so if you have always gotten by just fine by peeing in your boots to soften the leather, not wearing socks, rubbing the soles of the feet with surgical spirit for several weeks before a long walk to toughen them up, or using fresh newspaper every day for insoles (these are all real techniques I have heard advocated), then keep on doing whatever works best for you. But if you still get occasional grief from blisters then please read on and you may find something that works.
Better that treating blisters is to prevent them – this can be done by binding the feet with zinc oxide tape. However, even better is to find a shoe/boot and sock combination that doesn’t give you any blisters at all. The choice of foot-wear should be dictated by the requirements and the situation that it will be used in. The right boot for fell walking in the UK or northern Europe will not be suitable for jungle or desert, so when choosing your footwear get the advice of the sales assistants where you purchase it and tell them what environment you will be walking in. Another variable is the duration and distance that you will be walking, your feet will actually expand if your walk is over several consecutive days, so a size larger would be recommended, feet will also expand in a hot climate – I normally take a size 9, but when I walked across Australia in 09’ I wore size 11 ½ and thick woollen socks, after hard patches had grown on the soles of my feet during the first month I no longer got any blisters for the rest of the trip.
My advice when choosing footwear is; go large! A tight boot will cause you more agony that one that is too big and in extreme cold, tight footwear can restrict the circulation which will lead to an increased likelihood of frostbite.
Don’t choose something that is too heavy for the situation you are in; the ankle support that a robust pair of boots gives you is great where you may be walking across uneven ground with the risk of turning an ankle. However if you are just walking on roads, paths and bridleways then this will be unnecessary. Likewise a high ankle or a waterproof gore-tex liner can prevent water from entering your boots and getting your socks wet if you are crossing marshy ground or shallow puddles, but it will be redundant if you are in a humid climate or working in the jungle in which case your feet will get wet anyway and you might as well choose footwear which can dry out quicker and allow sweat to evaporate from the foot.
Also bear in mind the weight – if you have to carry all of your food over several weeks then calories may be at a premium; if you have heavier boots then think about how much energy it takes to lift that boot and swing it forward for each step, then think about how many steps you will take each day and ask yourself what the savings in energy expenditure might be if you went light – this applies to your personal gear as much as it does to your footwear.
The choice of socks is another vital decision, but here the choices are easier. My advice is to always used wool and always get a sock with a stitch-loop pattern on the inside sole. No matter whether its desert, jungle, arctic or closer to home I have always found that being a natural material, wool is tolerated better by the skin and flesh – it is also warmer in the cold but that is another subject for another essay.
The stitch-loop pattern is found when you turn a decent woollen sock inside out, you will see that on the inside there are thousands of tiny little loops, just like you will see on a towel only more densely packed, this creates a cushion, I don’t know how or why but this seems to work best at preventing blisters. Some lighter-weight socks only have the stitch loop pattern on the most vulnerable sections of the sock such as under the balls of the feet, toes and at the heel, these will be better for hotter climates, others have the same thick pattern uniformly distributed across the entire sock, making them very warm and durable, but also heavy – as with the footwear the best choice for you will depend on where you are going and the climatic conditions you face.
Some people advocate two pairs of thin socks, some advocate cotton. The one time I tried cotton in the desert it gave me foot-rot that needed to be treated. A few times in the extreme cold or with boots that were too big I have worn two pairs of thick woollen socks and this has worked well, but my advice is; never deviate from a woollen stitch-loop sock and you will not go far wrong.
Socks should be changed and washed as often as possible, if walking may miles over consecutive days in the heat, this may mean changing them more than once a day. Fresh socks and regularly powdering your feet do work to prevent blisters and stop infections setting in – it also makes your feet feel refreshed. If you can’t change your socks then you can swap them over from one foot to the other (I actually learnt this from a Biggles book); as the cushioned material of the sock gets repeatedly crushed beneath the hard points of the foot it will get dirtier and the cushioning effect will become diminished, swapping them to different feet will mean that un-crushed and dirtied sections of the sock will now be placed under the pressure points and give you a slight benefit.
On long trips where you don’t have access to a washing machine you must wash your socks by hand with soap, this will help to get all the sweat, dead skin and bacteria out of the wool and “fluff-up” the material so that it will offer better cushioning once it is dry. A good technique for washing them is to turn them inside out and wear them as gloves, then with soapy water as hot as you can bear it rub your hands together; scrub and massage the entire surface of the sock material repeatedly with the other sock before rinsing them. If you don’t have time to dry your socks then you can drape them over your shoulders under a shirt or jacket and they will dry from your body heat while you are on the move, this also has the added advantage of padding your shoulders from rubbing pack straps. (N.B. do not do this in extreme cold; getting your insulating layers damp or intentionally lowering your body temperature by wearing damp clothing is never a good idea).
Try to keep your feet dry; a dry sock is better at preventing blisters than a wet one and if the feet are wet for many hours it can cause the skin to swell and fold over on itself (think about what your hands look like when you have spent too long in the bathtub), these folds can be agony and lead to a whole host of complaints and infections, this is called trench foot. If it persists then the folds of skin will trap dirt, more pressure on them will pierce the skin and the foot will become infected. If this happens then NEVER try to cut away a folded piece of the skin, the only treatment is to dry the feet out, if you can’t stop to do this then you must powder the feet and change the socks for dry ones. If living in a wet climate, or the jungle then try to keep at least one pair of “pristine” dry socks and only wear these at night when you sleep to try and give your feet the best chance to dry out overnight.
If you have been taping your feet then used socks may have bits of zinc oxide tape stuck to the insides of them, when washing it is important to pick all these bits off the material , otherwise they can get rolled up with the sock material to form hard little balls of crud which can lead to a hot-spot or a blister.
Most modern boots & trainers come with their own insoles, however commercial inserts are available, if a pair of boots is not working for you or feels too big then changing the insole may be a cheaper alternative to getting a new boot. If insoles are slipping inside a boot and getting folds in them then this can give you an uneven surface which may also cause unnecessary blisters. If you can get hold of an adhesive then this can be used to stick the insole down inside the boot and prevent it’s slipping about (small amounts of skin glue or klister can do the trick). If you haven’t stuck down your insoles then your boots will dry faster if you take them out during rest periods. If drying a pair of boots in a dry room you shouldn’t leave them in a warm environment or over a radiator for many days/weeks as this can ruin the leather.
If your shoe/boot & sock combo isn’t quite perfect (and very few are) then after a few hours of walking you may feel hot-spots on the soles of your feet. These are caused by rubbing on the pressure points and may form on the heel, under the toes or on the balls (of the feet), these are the precursors to blisters and this is the time that you should stop, take your boots and socks off and tape over these hot-spots.
There are many products available for blister cure or prevention. I have tried compeed, gel-bag patches and mole-skin tape, but the only thing that seems to work consistently is bog-standard zinc oxide tape (the compeed turned into a wet, sticky mess which got infected).
Zinc oxide tape seems to allow moisture to escape so that the wet, seeping blisters have a chance to dry out. When taping over hot-spots or blisters you have to think about which direction the pressure that caused it will be coming from. Just placing a tiny square of tape over a blister will lead to it being rubbed off. You have to work to the tape’s strengths and try to avoid its weaknesses.
The main weakness of Z.O. tape is that the edges can easily be rolled up, but it is very sticky and quite strong laterally so when placing it you have to orient it carefully, to take advantage of this; if putting it on a heel then have a long strip running from under the sole from a place where there is no rubbing, up over the hot-spot and finishing higher up on the ankle where there is less chance of the ends being rubbed off. If you have to overlap multiple strips of tape to cover a larger area, then do so in such a way that the prevailing pressure runs over the seam rather than back across it – think of the way tiles overlap on a roof so that water runs down them. If taping right around a toe then leave a break in the tape on the upside, otherwise the blood flow to the end may be constricted.
Taping right around the toes can cut off circulation to the ends, once the foot starts being used it will expand and tighten the wrap, so leave a gap in the top or insides of the toes to allow for this.
Generally once you have put tape on then you should leave it on until you have stopped walking, or it gets too sticky & gungy, when this happens it can start balling under the foot and the uneven pressure this causes could itself create a blister. When you peel tape off it could carry away skin that has already formed a blister under it, worsening your condition.
If a blister forms before you can tape it or just seems to be getting worse underneath the tape, then you may have to bite the bullet; peel away the tape and do something about it. When peeling tape off try to do it as carefully as you can, away from any tear in the skin so that you don’t rip it further open.
Ffyona Campbell; the first lady to walk around the world (I know she cheated but she did go back and make up for it) used to use a hypodermic to drain the fluid from her blisters and then re-fill them with saline solution – and while I respect Ffyona enormously I think that this is F*$!?ing madness!
The only solution that I have reliably used to treat a bubble blister is to take a very sharp, sterile blade and make a careful incision on the side which is opposite to the direction in which the pressure that caused the blister in the first place is coming from. To work this out, have a careful think about how pressure is applied to that surface as the foot goes through its sequence of heel-ball-toe with each impact. If you are experiencing a blister on the underside of your toe then the pressure will be coming from the back running forwards, or the sides running upwards. If it is on the underside of the balls of the feet then it will likely be coming from the back forwards.
For the one above I’d make two incisions, these are the places where the fluid is being forced towards so give it somewhere to escape the blister and the skin may have a chance to bond back onto the flesh, looks like it might be too late for this one but at least you can prevent it from spreading. Then tape over the whole thing.
The objective is to get it so that continued pressure on the blister will force the fluid out of the incision you have made, out of the blister – without further tearing the skin that you have cut or peeling it back. If you get this right and tape over it then after a day the skin which has separated from the flesh will bond back onto it, after a few more days it will have formed a hard patch and in time it will fall away leaving a togher bit of skin beneath it.
If your blisters get really bad and have already torn open to expose a large area of flesh underneath then you should stop and leave this open to dry out and heal. If however this is not an option then treatment is tricky. My attitude (perhaps foolishly) has always been to get rid of the dead useless skin, if it is so torn that you cannot get it to bond back on to the flesh then cut, or gently tear it away, if its left under the tape then it could contribute to forming a mushy wet mess that will get infected and if its already torn up then it’s not doing any good there anyway. After removing the skin you should try to disinfect the raw flesh underneath by washing, you can use soapy water, TCP, Betadine or surgical spirit, but whatever you do it will sting like hell. Afterwards dry it off and try to leave it open for as long as you can so that it can dry and the raw flesh can harden. Do not put talc on this area, the already weeping flesh will just make it damp and mushy. If you can get this wound to dry over before you have to tape it then you have a chance to keep going, but if it gets wet and mushy under the tape then this is just a temporary measure and sooner or later you will have to stop and/or seek medical attention.
The one above, top looks like it could be recovered if the skin was taken off, allowed to dry and taped over, the one above, bottom; better to stop for a few days and let it dry out, cutting the skin away will help it dry faster and new skin to form underneath. If you absolutely had to go on using this foot then maybe cutting the skin away, disinfecting it and drying it out overnight would allow you to tape it up and keep moving, but I’m guessing that this would only deteriorate and before long it would get infected.
David Leaning is a consultant for Magnetic North Travel a tour operator which specialises in trips to show you Scandinavia at its best, including experiences to see the northern lights and find out what it feels like to drive a team of sled dogs for a week in the Arctic.
David has walked across Australia, (2,300 km) and skied the length of Norway (2,600 km) on solo expeditions, in 201 led a team to ski across the Arctic island of Svalbard (600 km). His experience includes several years’ service with the Royal Marines Commandos including deployments to jungles, deserts and the Arctic.
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