Foot Care Part Two

Foot Care Basics, Part II
by John Vonhof, author of Fixing Your Feet: Prevention and Treatment for Athletes

Hot Spots and Blisters
A hot spot is an area that becomes sore from rubbing and without treatment will develop into a blister. Usually there is redness in the center and possible stinging or burning sensations. Hot spots can be protected with tape or a blister patch product. Using a lubricant will provide only temporary protection. The hot spot must be covered to protect it from further rubbing. Try to determine the cause of the rubbing and eliminate it. Change socks or shoes or cut a small slit in the shoe to eliminate the pressure point.

A blister forms when the outer layer of skin receives friction that causes it to rub against the inner layer of skin. As the outer layer is loosened from the deeper inner layers, the sac in between fills with lymph fluid. The outer layer is cut off from oxygen and nutrients it becomes dead skin. If this outer layer bursts, the skin loses its natural protective barrier. A few minutes spent protecting a hot spot can save hours of lost time later.

The blister should be drained if it is in a weight-bearing area. Use an alcohol wipe to clean the blister’s skin. Then use a sterile needle, or a pin sterilized by passing it through a flame, to make several small punctures in the blister’s edge. A small knife with a scissors can be used to make a small “V” cut in the side of the blister-this cut will provide better drainage than a needle puncture. The same V cut can be made with small nail clippers. Be sure to sterilize them with a flame before making the cut. The punctures or cut should be at the side of the blister where ongoing foot pressure will force fluid out of the blister. Use finger pressure to drain the blister. Clean and dry the skin before applying a blister patch.

Cloudy or hazy blister fluid indicates infection. Drain the blister and apply an antibiotic ointment. Recheck the blister frequently. Do not drain a blood-filler blister.

If the blister’s roof has ruptured, with either the skin torn off or held only by a flap, carefully cut off the remaining skin, clean the area and apply an antibiotic ointment. If you choose to skip the antibiotic ointment during your run, remember to apply it after the run.

Basic Blister Patching
Fixing blisters can be an art. Anyone can slap on a piece of moleskin and slather on the Vaseline and hope for the best. But knowing how to really fix a blister so you can continue running for another day or even a few more days takes practice. You need to know how to fix your blisters and not be forced to rely on someone else’s treatments.

Blister patching techniques include the use of Spenco 2nd Skin or Blister Relief (sometimes called Compeed or Blister Block) applied directly over the blister, whether or not the roof is still attached. 2nd Skin needs to be held in place with tape or Coban self-adherent wrap. An application of tincture of benzoin or other tape adherent to the skin will help the patch better adhere to the skin.

You can also use duct tape or Elastikon tape for blister patching. Apply a piece of toilet paper or tissue over the blister to prevent the tape from sticking to the blister’s roof. You can substitute a piece of duct tape cut in the blister’s shape and applied sticky-side to sticky-side to the tape over the blister.

The use of tincture of benzoin or a tape adherent to the skin around the blister will help the patch better adhere to the skin. Allow the tincture to dry before applying the patch. Apply a thin coating of Vaseline or powder to any uncovered sticky areas before putting on your socks. Avoid getting the tincture into the blister or any open cuts, it will burn.

Extreme Blister Patching
For those participating in multi-day trips, there are several extreme techniques to prevent and treat blisters. An extreme method of preventing blisters is to apply a tape adherent to the feet and then a liberal application of a silicone lubricant. Then put on good moisture-wicking socks, either single or double-layer. If your socks have large toe seams, put them on inside out to avoid getting blisters on the tops of your toes.

Extreme taping of the feet can be used both for prevention and treatment of blisters. Use either duct tape or Elastikon tape to tape any problem areas. This may include the balls of the feet, the toes, the heels, or any combination of these areas. Clean the feet with an alcohol wipe before applying a tape adherent to the areas to be taped. Round any corner edges of the tape and apply the tape to the problem areas. Apply a thin layer of lubricant to the edges of the tape to neutralize any adhesive leaks.

Remember to smooth the tape as it is applied. If you overlap the tape, be sure the overlapping edge is in the same direction as the force of motion. Practice taping before your hike. Trying to learn how to tape during a hike is asking for trouble.

Extreme blister treatment can also involve using a syringe (without a needle) to inject tincture of benzoin into a drained blister and then immediately applying pressure to make the blister’s roof adhere to the base skin. Be forewarned: this method produces short intense pain when the benzoin contacts the new skin but seals extremely well. An alternative is to inject New-Skin Liquid Bandage. It does not seal the blister as well or as long, but is less painful. Watch the blister for infection. A safer alternative is to dry out the blister overnight by injecting zinc oxide into the blister. Cover the sealed blister with benzoin or Instant Krazy Glue to help the tape or blister patch better adhere to the skin. If using moleskin or adhesive felt over the blister, use a disposable razor to shave the small tiny fibers which can catch on socks and exert a pull against the blister.

Adventure racer Dan O’Shea recommends applying a liberal coat of New-Skin Liquid Bandage over the entire damaged skin area (this may sting). After the first coat has dried, apply a second layer for added protection. Over the New-Skin apply a generous coating of tincture of benzoin. Let the benzoin dry to a tacky state for maximum adhesive properties. While the benzoin dries prep the moleskin for application. First, cut an oval patch of moleskin measured to encompass the width and length of the blister by ½-inch. Cut out the center of this patch the size of the blister itself to provide a measure of standoff. Cover this entire area with another oval moleskin patch of a slightly larger (by ½-inch) circumference. Securely wrap the entire area with self-adhering all the way around the foot (or toe) taping back on itself to provide maximum hold. Do not wrap too tight or you compromise circulation forward of the patch.

Foot Care Kits
There are two types of footcare kits. The first is a basic self-care kit for keeping your feet healthy and the second is to carry with you during your hike. Each is equally important. A basic self-care kit for good foot treatment does not have to be large. This kit is to be used at home and before your hike. The following items are basic. Add to the kit as necessary for your particular foot conditions.

For hikes of any length, make a small foot care kit to carry in your packs. The quantity of each item depends on whether you are by yourself or part of a group and the length of your trip. The following items are recommended.

A small Swiss Army style knife with scissors, or a nail clippers, and lighter or matches for blister puncturing

Your choice of tape(s) wrapped around a pencil or container of powder or lubricant

A plastic bag with your choice of blister materials and several pieces of toilet paper or tissues

You may consider other options to include in the kit, based on your personal foot problems or injury history.

Whatever you carry in a footcare kit, know how to use each item. If you are hiking as a group, each member should know how to fix their feet to prevent and fix blisters. Each member should work at finding what is best for their feet-lubricants or powders, two pairs of socks or one pair, double layer socks or single layer, how to lace their shoes for specific foot problems, and how to find the best fitting shoes for their feet. It is the responsibility of each person they are adequately trained in proper footcare. It can mean the difference between a great hike or a mediocre hike.

Dr. Trolan, an adventure race MD consultant, emphasizes, “It amazes me that individuals will spend vast amounts of money, time, and thought on training, equipment, and travel, but little or no preparation on their feet.” The same goes for hikers. Bad feet can quickly ruin a trip. By educating yourself about foot care options and methods; you increase your likelihood of finishing your hike successfully. Spend the same amount of time on learning about footcare as you spend on picking your other gear and you will enjoy your trip even more.