Blister Prevention for Podiatrists

Rebecca Rushton BSc(Pod)

BLISTER MANAGEMENT TODAY

BLISTER MANAGEMENT TODAY

I CAN IMAGINE IT BEING SO MUCH MORE

Instead, my guess is 80-90% of our blister prevention repertoire is this

BUT ARE BLISTERS THAT BIG A DEAL?

— Mike from Victoria

“I bought some new hiking boots some weeks back (Scarpa SL). Theoretically they are the same boots as my previous pair, same type size etc (and expensive). However, unlike the previous pair, these have caused me no end of frustration,

and I am still recovering from my last 2-day hike in the Victorian Alps where they took all of the skin off both my ankles and balls of my feet. Very painful, and I spent the last bit of the hike walking just in blood-soaked socks.”

— Marcus from Tasmania

“In 30 years of bushwalking in Tasmania I have never completed a walk of any distance without some kind of heel blister - on this trip I survived 6 days and 70 kilometres of walking carrying a 25 kilo pack without ANY blister of ANY kind.

The upshot of all of this is that I was able to enjoy the walk and that my wife and children were along for the trip with me. Under normal circumstances I would have been in quite serious discomfort after day three and basically become totally self-absorbed for the last 3 days enduring the pain.”

— Lisa from Victoria

“I’m training for the Melbourne marathon …

they saved me from giving up running. They are the best piece of kit I own as it doesn’t matter how much I spend on runners or socks I still end up with blisters and calluses”

— Garry from Queensland

“I’m now getting enjoyment out of my running shoes. (I no longer fear them!)”

50,000 VISITS PER MONTHPeople are looking for answers!

THEY’VE TRIED!

THEY’RE STILL HERE

Shallow

Unhelpful

Condescending

Just plain wrong

WHAT THEY FIND

THIS IS OUR CUE

Here’s What You’ll Learn

1. What causes blisters (and what doesn’t)

2.What shear is all about

3.The 4 requirements for blister-causing shear

4.How individual strategies work (and don’t work)

WHAT CAUSES BLISTERS?

o Rubbing

o Friction

o Heat, moisture and friction

o Burn

(Mainstream understanding)

“Many myths continue to be propagated regarding the prevention and treatment of friction blisters... Physicians, coaches and athletic trainers continue to advocate the use of petrolatum jelly and skin powders to prevent blisters while the scientific literature suggests these measures may actually increase the chance of blistering on the feet.”

Doug Richie. (2010). How to manage friction blisters. Podiatry Today. 23(6): 42-48

“Many myths continue to be propagated regarding the prevention and treatment of friction blisters... Physicians, coaches and athletic trainers continue to advocate the use of petrolatum jelly and skin powders to prevent blisters while the scientific literature suggests these measures may actually increase the chance of blistering on the feet.”

Doug Richie. (2010). How to manage friction blisters. Podiatry Today. 23(6): 42-48

WHO’S AWESOME?

“Many myths continue to be propagated regarding the prevention and treatment of friction blisters... Physicians, coaches and athletic trainers continue to advocate the use of petrolatum jelly and skin powders to prevent blisters while the scientific literature suggests these measures may actually increase the chance of blistering on the feet.”

Doug Richie. (2010). How to manage friction blisters. Podiatry Today. 23(6): 42-48

“Many myths continue to be propagated regarding the prevention and treatment of friction blisters... Physicians, coaches and athletic trainers continue to advocate the use of petrolatum jelly and skin powders to prevent blisters while the scientific literature suggests these measures may actually increase the chance of blistering on the feet.”

Doug Richie. (2010). How to manage friction blisters. Podiatry Today. 23(6): 42-48

Doug Richie

doesn’t think

we are!

“Many myths continue to be propagated regarding the prevention and treatment of friction blisters... Physicians, coaches and athletic trainers continue to advocate the use of petrolatum jelly and skin powders to prevent blisters while the scientific literature suggests these measures may actually increase the chance of blistering on the feet.”

Doug Richie. (2010). How to manage friction blisters. Podiatry Today. 23(6): 42-48

“Many myths continue to be propagated regarding the prevention and treatment of friction blisters... Physicians, coaches and athletic trainers continue to advocate the use of petrolatum jelly and skin powders to prevent blisters while the scientific literature suggests these measures may actually increase the chance of blistering on the feet.”

Doug Richie. (2010). How to manage friction blisters. Podiatry Today. 23(6): 42-48

Blisters are not caused by

rubbing on the skin surface!

They’re caused by rubbing

under the skin surface!!

WE’VE KNOWN THIS FOR40-60 YEARS!

NAYLOR (1955)Experimental friction blisters. British Journal of Dermatology. 67: 372-42

SULZBERGER et al (1966)Studies on blisters produced by friction. The Journal of Investigative Dermatology. 47(5): 456-65

COMAISH (1973)Epidermal fatigue as a cause of friction blisters. The Lancet. Jan: 81-83

WE’VE KNOWN THIS FOR40-60 YEARS!

• Not a burn caused by heat / rubbing• They’re a tear within the epidermis• A mechanical fatigue• Within the prickle layer (stratum spinosum)• Caused by shearing

WHAT IS SHEAR?

Rubbing under the skin… not on the skin!

Rubbing on top of the skin will cause a blister to deroof ...

INTACT BLISTER DEROOFED BLISTER

But rubbing under the skin caused the blister in the first place.

INTACT BLISTER DEROOFED BLISTER

What’s going on

under the

surface!

To put it simply if you're trying to prevent blisters start thinking less about what's rubbing on the skin surface …

and more about how you're going to stop the rubbing underneaththe skin surface.

BLISTER-CAUSING SHEARYou need all of them at the same time!

BLISTER-CAUSING SHEARYou need all of them at the same time!

Heat, moisture

& friction

BLISTER-CAUSING SHEARYou need all of them at the same time!

How often do you hear this

mentioned? It’s what we do!

COEFFICIENT OF FRICTION

FRICTION INTERFACES

Where’s the relevance to

blisters?

Skin-sock interfaceShoe-sock interface

FRICTION FACT

Reducing friction means increasing rubbing!

FRICTION FACT

This is good for blister prevention

FRICTION FACT

You can choose whereyou want it to rub

• within the soft tissues of the foot = blister• against the skin = potential for abrasion (deroof)• between shoe and sock = blister prevention

FRICTION FACT

How much rubbing is too much?

Traction is important!

INDIVIDUAL STRATEGIES

Footwear

Skin

Activity

FOOTWEARShoe-fit

FOOTWEAR Moisture-wicking socks

FOOTWEAR Moisture-wicking socks

FOOTWEARDouble-socks

FOOTWEARDouble-socks

FOOTWEARCushioning & insoles

FOOTWEAROrthoses

FOOTWEARENGO Patches

SKINAdaption

SKINAdaption

95% of blisters to occur in the first three weeks of military training:• Week 1: 35%• Week 2: 51%• Week 3: 9%

HOW MUCH SHEARCAUSES BLISTERS?

BLISTER PRONE / BLISTER RESISTANT

SKINAnti-perspirants

SKINAnti-perspirants

SKINPowders

SKINAstringents

SKINLubricants

Nacht et al (1981)

SKINTaping & dressings

SKINTaping & dressings

1. Protection from rubbing?2. Thermal insulation?3. Reducing friction levels?4. Spreading shear load?

http://www.blisterprevention.com.au/blister-blog/taping-for-blister-prevention

SKINTaping & dressings

ACTIVITYTechnique

ACTIVITYTraining regime

4 TAKE HOME MESSAGES

1. Blisters are caused by shear

2. Shear is “rubbing” under the skin surface

3. The 4 requirements for blister-causing shear

4 TAKE HOME MESSAGES

4. Reducing friction means increasing rubbing; This is good for blister prevention;Because you can choose where it rubs:

• within the soft tissues of the foot = blister• against the skin = potential for abrasion (deroof)• between shoe and sock = blister prevention

FOR MORE INFORMATION…

Blister Prevention website

Advanced Guide To Blister Prevention

www.blisterprevention.com.au