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BLISTERS

Do not let a blister take you out of the hike.


Blisters, Treatment and Prevention

by
Richard Speights

A blister can be painful enough to debilitate any hiker. Ignored, and it is prone to infection. Treated correctly and quickly, you can prevent a blister from becoming a problem. With the right technique, you can even prevent them from forming. 

As a medic in the Army, one of my responsibilities was the prevention and treatment of blisters. I was lucky to work under Doc Brown a physician’s assistant who had developed some wonderful preventive techniques he learned in Special Forces years before. 

Treatment

When you realize a blister forming, treat it as soon as possible. Treating a blister early keeps a small sore from becoming a large wound and reduces healing time and the chance of infection. 

Many people will tell you to burst and drain a blister. I take the opposite view. The fluid contains antibodies and healing agents designed to rebuild damaged tissue. The fluid filled bubble also cushions the injury and keeps out dirt, sweat, and germs. 

Despite your best preventative efforts, a blister can rupture anyway. Treat a ruptured blister as you would any open wound. Clean it with an , and then apply a layer of . The ointment will kill germs and keep the wound supple; nothing hurts more than a burst blister that has dried.
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I can think of no good reason to burst a blister on purpose. However, if, for some extraordinary reason, you must drain the fluid, then do so with as sterile a procedure as possible for your circumstance. Clean your hands and the affected area. Give the area a spritz with the antibiotic spray. It’s good to have a few surgical blades in your . If you don’t have any, the point of a good sharp knife will do nicely. Fire, alcohol, or an antiseptic will sterilize the blade. Nick the blister bubble along the lower edge and drain the fluid with a slight pressure on the bubble. If the fluid does not fully drain, increase the size of the cut or make another small incision. Don’t peel away the skin covering, unless it has become shredded beyond its ability to cover the wound or has become dry.
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Treat this burst blister as an open wound. Apply an antibacterial ointment and keep clean. Use sterile procedures with all open wounds. Even in the driest desert, you feet will not stay dry. Walking through water or sweating affects bandages. Change the bandages once-in-a-while, using your sterile procedures. There are some waterproof bandages on the market, but they don’t stop your foot from sweating. Besides, bandages that don’t breath don’t promote healing. Better to just change the bandages as necessary.
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(When out in the woods, try to bring at least a small first aid kit with alcohol or antiseptic wipes, Band-Aids, blades, and a few whatnots. Put in a couple of sterile rubber gloves for sterile procedures. Always carry a well-maintained , the most useful item you can posses; a pocketknife and a  can save your life. Make sure to include a little tincture of benzoin or Tuf-Skin in your kit.) 
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Cut Moleskin into a donut shape and apply around the blister.Moleskin

is the best stuff ever invented. If you have a spot on your foot prone to blisters, use Moleskin to lift the footwear off the area. Moreover, use Moleskin to lift the footwear’s pressure point off a blister after it has formed. However, simply slapping a layer of Moleskin over a problem area or a blister only adds more pressure, causing more damage and, consequently, more pain. You’ve got to prep Moleskin correctly to gain the best benefit it offers.

Cut a circle of Moleskin about a half-inch larger than the blister with a par of scissors. Then cut a hole out of the middle of the circle just larger than (and in the shape of) the blister—fold the circle of Moleskin in half to cut out the inner circle. Peel the sticky back and place the doughnut shaped piece of Moleskin around the blister. This will raise the pressure point off the affected area. If one doughnut shape layer of Moleskin does not raise the pressure point enough, cut a second doughnut shaped layer the same size as the first and stack the second on top, three layers at most. Any more than three layers stack too tall to work well. I like the thick Moleskin, but the thinner Moleskin works too. Thinner Moleskin can stack higher than three by building the layers in a pyramid.

Moist skin and foot powder can defeat Moleskin’s sticking ability. Clean and dry the skin well, and if the Moleskin still won’t adhere to the skin, use a touch of Tincture of Benzoin or Tuf-Skin on the skin around the blister to increase adhesion. Let the Tincture or Tuf-Skin dry to tacky. Usually, Moleskin stays put despite sweaty feet and sock changes. Cut some extra in case your application fails down trail. If you have a known problem area, cut a supply of doughnut shaped Moleskins and, if you want, pre-apply before your hike or shortly after you begin. 

The Moleskin doughnuts may not allow you to put a proper bandage on a burst blister. In that case, be liberal with your applications of antibacterial ointment. The rings of Moleskin will keep the sock off the wound.

You can get there only on your feet. Prevention

Of course, the best start to prevention is to wear only well fitting footwear. Footwear should not be too tight or loose. And leave your father’s Vibram soled, stiff-leather hiking boots in the closet. 

 today are as flexible as running shoes. Nonetheless, no matter how limber your new hiking boots, wear them around for a good break-in before wandering the woods. Blisters develop at pressure points, so if you discover a pressure point on the trail, use Moleskin before a blister forms.   

Develop the habit of drying your feet often. Use . Change your socks, and hang wet socks on your to air dry. I like extra thick  or . Some people prefer  or , which draw moisture away from the foot. Whichever you choose, hike only with newer socks. The fibers in old socks, especially cotton, become stiff trap dirt even after multiple washings. Stiff fibers and dirt act as sandpaper on your feet.


There is a certain but dramatic and unconventional method to prevent blisters. Blisters form where a pressure point rubs against the sock and the sock, in turn, rubs against the skin. Fiction generates ***heat and heat breaks down the skin tissue, forming a blister. To keep the sock from rubbing the skin, glue your sock to your foot. 

When Doc Brown first taught me this, I thought he was yanking my chain. He wasn’t, and his technique works. 

We used , a brownish liquid used in surgery to adhere large bandages to the skin. Today, self-adhesive bandages have reduced the need for tincture of benzoin, but you can still find it at some mom-and-pop drug stores or on Amazon. The mega chain stores rarely carry it in stock anymore. A good substitute for tincture is a product called . It comes in a spray can and is found in sporting stores, medical supply stores, and on Amazon
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When tincture of benzoin dries it creates strong skin adhesion. There two ways to apply it: 1. Put a shallow tray on the ground, and fill it with enough liquid tincture of benzoin to dip your feet about halfway up the sides, covering the toes. Us an alcohol wipe or a cloth dipped in alcohol to clean the tincture of benzoin off the hairy parts of your feet. Ripping these little hairs out by the roots at the end of your hike is almost as painful as a blister. If you can’t stand your toes glued together, clean between them as well. However, if you have a problem with blisters between your toes, learn to put up with them glued. 2. If you do not have enough tincture to fill a shallow tray, use an applicator to paint the soles and sides of your feet and or any other problems areas. 

If you have a problem with blisters higher on your foot, like your ankle or upper heal, then paint tincture of benzoin on the problem areas with a cloth or your finger. Let the tincture of benzoin air dry to tacky, and then roll your socks onto your feet, working out all the wrinkles and creases, pressing the material onto the skin. Your foot will now be too sticky to slide on your socks, so roll them on. Keep your feet off the dirt or grass; tincture adhesive sticks to and collects everything it touches.

Tuf-Skin is easier and convenient than the tincture compound. Baseball players spray Tuf-Skin on their hands to increase batting grip. Spray this on your foot, the bottom, sides, toes, and any other problem areas, and let it dry to tacky. Clean off areas you don’t want sticky with alcohol and roll on your socks, pressing out the seams and pressing the sock against the skin of your foot.

Since tincture of benzoin is specifically designed to adhere cloth to moist skin it works better under all conditions. It comes in a four-ounce bottle with an applicator, which comes in handy on the trail.

In addition, wear to reduce shock on heels, ankles, and shins, and help prevent blisters. Thick calluses can create painful pressure points. You can slice them off with a sharp razor* **. Be careful not to cut into living flesh. your toenails. If a particular pair of footwear causes you problems, get rid of them and find another pair that does not. 
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When you take a rest break, before you eat, sleep, or become engrossed in photographing small woodland creatures, take care of your feet. They receive the most punishment and require the most care. Keep them clean and dry, use foot powder, change your socks often, and treat all blisters early.

 

Rich 

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According to Wikipedia, some Army medics were draining blister fluids and then injecting tincture of benzoin compound into the emptied pocket. Apparently they called the procedure “hot shot”, in that the compound burns and causes an abundance of pain. Whatever you do, do not inject tincture of benzoin compound into the drained blister pocket. The reference in Wikipedia states it needs a verifying citation, so it’s possible this did not happen. If it did happen, shame on anyone who dreamed it up, and shame on those who performed this procedure. Again, do not inject tincture of benzoin compound into the emptied blister pocket for any reason. 

Copy edited, July 23, 2014

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*Diabetics:
Diabetics know not to cut on their feet, even to trim the dead skin associated with problem calluses. An injury, even a little injury to a diabetic’s foot resists healing. This essay is not and was never intended to advice the diabetic who desires an active lifestyle. Diabetics should consult their doctors before setting out on any adventure requiring intensive walking, for even a blister can cause a diabetic long-term health problems.

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**Don’t attempt to cut away dead skin from a shallow callus. This method works for calluses that have created a hill-shaped mound of hard, dead skin, which in turn produces a painful pressure point. In addition, don’t try to cut away all the callused skin. Cut only the mounded dead skin. This creates a flat spot or even a concaved spot in the callus over the pressure point. Thereafter, the pressure is spread around and not concentrated on the painful point.

I’ve heard some criticism over this advice. But consider the possibilities. If you are miles from civilization, and a mounding callus starts causing a painful pressure point, the pain could become debilitating. A doughnut-shaped ring of moleskin could cure the ill. However, moleskin works only if you haven’t lost it along the trail somewhere. You could reach for your pumice stone--It's right beside the kitchen sink in your backpack.

Solving problems on some remote trail many miles from civilization is not Obama Care. You’ll have to do for yourself to save yourself. Beside, if you can’t trim away a little callused skin from your foot without slicing off your foot, then stay at home. 


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***Take a paperclip and straighten it. Then, bend the wire repeatedly. Be careful; the wire will become hot. Eventually, the wire becomes hot enough to break. Skin rubbing against a spot or point in footwear does something similar. The tissue in the dermis, the second layer of skin, flexes back and forth, like the bending wire. Flexing skin, just like the flexing wire, creates heat. This heat, along with the abuse breaks down the tissue in the dermis, the second layer of skin.

In reaction, the body begins secreting fluids into the affected area. These fluids pushed the top layer of skin, the epidermis, out into a bubble blister. This blister bubble is designed as a protective cushion over the injury. If this bubble of fluids breaks, then pain does its part to protect the injury, forcing the hiker to stop and seek relief. 
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