Blistering is a simple but potentially debilitating problem in many sports and walking activities. It results from the top layers of skin shearing away from the layers beneath, with serous fluid filling the space where the skin has been sheared away. Places with much friction, such as the back of the heels and the toes, are the most common places to develop blisters.

The cause is too much movement between the foot and the shoe. Heel slippage or forward movement of the foot in the shoe, mainly walking downhill as the shoe grips the ground, but the foot slides forward, quickly leading to blisters.

Shoes not laced firmly enough or incorrectly fitted shoes are usually to blame. Shoelaces tend to work loose over time, particularly during long events. Always pull each loop through the lace holes individually when lacing your shoes. Simply pulling on the ends of the laces will cause the laces to be tight at the top and loose at the bottom, the result being that over time, the laces will equalize in tension, and the shoes will become loose. There are many ways of tying laces to stop the foot from slipping or knots from coming undone; I will cover this topic later. 

Other factors predisposing to blisters are heat, socks, excessively sweaty feet, and soft, unconditioned feet.

An old-fashioned treatment is to soak your feet for 5 – 10 minutes daily in Mentholated spirits or a 5% solution. If you do this, use a large plastic container with a lid big enough for your foot. Place a few centimeters of solution in the bottom and reuse it. This will also benefit the skin by hardening it.

Sometimes, people will have bony prominences, lumps, and bumps on their feet, which will rub on their shoes. The shoes must be modified to accommodate these bumps or be padded and protected. Tapeing friction-prone areas will help. The best tape to use is Leucosilk, which has a smooth, slippery texture that helps reduce friction. This works much better than sport strapping or elastic tape. Plastic Band-Aids will make the problem worse as they macerate the skin. The generous use of Vaseline between and around the toes helps stop those annoying, painful little blisters. Some other products are on the market, including Blisterblock, Compeed, and Spenco 2nd Skin Blister kits, which work very well but are expensive. They all come in various precut sizes and is best applied before the blister forms. It can be used before you start on blister-prone areas, or if you begin to feel an area rubbing, put one on before a blister develops.

Another product, Silipos, is a silicone gel impregnated into a cloth bandage and comes in various forms. It is beneficial for protecting lumps and bumps. It is also reusable and available from podiatrists, although some pharmacies and online versions are available.

Once blisters have formed, the best management is to drain the fluid but leave the skin over the top intact as much as possible; apply a dressing such as those mentioned until the skin beneath has a chance to heal, usually 5 – 7 days. It is also advisable to use an antiseptic such as Betadine to reduce the likelihood of infection.