The Danish philosopher Søren Kierkegaard once remarked, “I have walked myself into my best thoughts, and I know of no thought so burdensome that one cannot walk away from it.” What the famous thinker and father of existentialism did not consider, however, is that walking itself can be burdensome – particularly when you are suffering with a blister. And this difficulty is usually compounded by pain with every step.
Blisters are nasty little things that can really spoil a hiking tour, a summit attempt or a holiday. So what can you do if you suddenly get a painful bump on your foot? Here are a few small but hopefully useful tips on how you can prevent blisters from forming and what you can do in an emergency.
What actually is a blister?
Of course, we’ve all had one at some point. My first experience with blisters came after a long school hike through the Franconian Forest. Having hiked relentlessly over hill and valley all day, I found my first two blisters on my feet in the evening. But what actually are blisters?
A blister – in dermatological terminology also referred to by its Latin name “bulla” – is a fluid-filled cavity under the epidermis. The whole structure is usually the size of a pea – between three and nine millimetres – and is caused by excessive pressure combined with simultaneous friction over a long period of time.
The affected area of the skin is damaged. This creates a wound area and therefore, trauma. The surface skin (epidermis) detaches and tissue water, known as lymph, collects underneath. We can observe a similar process on a larger scale when we hit our head. The resulting impact trauma causes vascular water to collect and the affected area becomes a bump.
Back to the blister. Unlike burn blisters, which are usually caused by a brief exposure to heat, blisters are a result of mechanical factors. They can be the result of friction between socks and shoes on the feet, climbing ropes or tools on the hands.
How a blister appears
You can often act before the blister forms in its full glory as it usually announces itself in advance. The first signs of a blister are a slight burning pain and redness in the affected area.
If you notice a blister developing, you can often relieve it with a normal plaster or, if you don’t have one available, with medical tape such as Leukoplast and a clean piece of tissue for padding. This relieves the pressure from the wound, eases the pain and, in the best cases, prevents the blister from forming.
Got a blister, now what?
If you have a blister the best treatment is rest. Take pressure off the foot, take off your socks and shoes and rest the affected area for a few days – although this is not always possible if the blister appears before the end of your tour.
If you need to continue, the blister should be emptied. The first thing to do is to put a plaster on it. There are special blister plasters that are flexible and adapt to even the most awkward angles, adhere firmly and protect the blister from external factors. However, an ordinary plaster will usually do the trick. It is also best to change to light, open shoes so that the friction on the wound is reduced to a minimum. In summer temperatures, you should treat blistered feet to a sock-free walk in airy sandals.
If this is not possible either, you can make a plaster with a soft spot, which sounds more complicated than it is: First take a plaster and cut out a hole the size of the blister in the middle with sharp, fine scissors. Tape the whole thing over the wound so that the cut-out area is exactly over the wound area, leaving the blister exposed. If the blister continues to stick out over the plaster, repeat with another plaster stuck on top of the first one until you reach the level of the top of the blister. Finally, cover the construction with a final plaster. This provides the best possible protection against pressure and friction and also relieves pain.
Should you lance a blister?
Which leaves the important question of lancing, because a fluid-filled blister is a real pain in the neck. It may seem tempting to lance it, because the stretched skin and the tissue fluid exert pressure on the wound. However, you should refrain from attempting to puncture the blister. Why? Well, because underneath the epidermis is the injured subcutis, which is unprotected. There is considerable risk of dirt and bacteria building up. Moreover, pathogens and other germs thrive in the warm, moist environment beneath the detached skin. In short: if you lance without care the wound is likely to become infected.
If you are unable to rest your foot, change your shoes or use a soft spot plaster, you may be able to lance the blister to reduce the fluid pressure. The most important thing is to keep everything clean to minimise the risk of infection. Disinfect the area around the wound liberally, preferably with an antiseptic spray or alcohol swabs. To puncture the blister, use a sterile needle or a thin syringe. If possible, do not use a needle from a sewing kit. Disinfecting with fire or hot water is also not sufficient, as the needle will still not be 100 % sterile due to possible contamination.
Make a small opening at the bottom of the blister to allow the lymph to drain. If necessary, apply a little pressure with a sterile swab, which can also be used to absorb the fluid. Now close the wound with a blister plaster or a light wound dressing and bob’s your uncle. You should never remove the skin over the punctured blister. Firstly, it really hurts, and secondly, the wound underneath is completely exposed and difficult to heal.
If after one or two days you do not see any improvement or healing, and the wound instead becomes more and more painful, the surrounding area begins to redden and pus forms, then the wound has become infected. If this happens, you should avoid treating it yourself and go straight to a doctor. In the worst case, an infected and untreated wound can lead to blood poisoning.
How to prevent blisters
Now we know everything about how blisters are formed, how they develop and how to treat them, but how can we prevent them from forming in the first place? The easiest way is simply comfortable socks and, most importantly, comfortable and well-fitting shoes. As we said, blisters form through pressure and friction.
If you are going on a long tour or hike, you should always wear comfortable shoes. In terms of socks, you should try to avoid materials that chafe your feet. A lightweight functional material is better than a rough cotton fabric.Wearing thin functional socks under your walking socks also reduces friction and ensures that they fit snugly in your shoes.
It is also important to remember that new shoes may be comfortable the first time you try them on, but make sure you wear them in before you really use them for the first time! This may sound obvious, but it is often ignored. Correct lacing can also help. If your shoes are laced too loosely, your feet will not fit properly, which can lead to blisters.
Last but not least: give your feet a rest now and then. Let them breathe when you rest, take off your shoes and socks. It often works wonders.
Are your shoes comfortable and broken in? Are your feet cushioned in soft, chafe-free socks? Then that’s half the battle. However, if you still experience a painful blister, I hope that my tips on blister treatment will help.