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Blisters with insoles

Discussion in 'Biomechanics, Sports and Foot orthoses' started by bartypb, Mar 1, 2013.

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  1. bartypb

    bartypb Active Member


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    Hi Everyone, I have been scratching my head with a problem concerning 2 pt's who are getting blistering from their insoles. 2 different ends of the spectrum -
    1. Male who runs upto 120 miles/week, has had a number of complaints mainly achilles problems. hypermobile joints high beightons score, medial deviation stj. Due to his hypermobility. he has numerous insoles all of which are generally focussing on the arch profile rather than any skives etc. He Runs in neutral asics but when he runs in stability asics he gets blistering.

    2. Female - again high beightons, med deviated stj all jts hypermobile B/F had a Rsided tib stress # 1yr ago and started getting same symptoms xray inconclusive but there is some periotial reaction going on. Made her up something simple with mid foot saddle and triplaner medial post to behind 1st mpj as thought she wouldn't tolerate any arch fill. I used a baileys xline as a base ( don't know if anyone uses them) again blistering in arch area approx 1" proximal to 1st mpj?

    anyone have any pearls or have had this in patients before? If more info is required please let me know?

    thanks

    Bartypb
     
  2. N.Knight

    N.Knight Active Member

    Is there any tightness gastrocnemius?? (compared to their normal, I am not on about 90+10 as we all know that is just not true) if there is tightness the foot will pronate to compensate for the tightness causing the blistering

    Also how medially deviated is the stjt axis?

    If he is pronated to his end range he will not tolerate anything with a built up arch, so issue custom orthoses with minimal or no arch and use your medial heel skive, post or MOSI (which ever you prefer)

    The way I explain it to patients if you have the stjt axis which is extremely medialy deviated anything medial to the access will apply a supinatory moment and lateral of the axis a pronatroy moment, so with a arch fill on a patient with a extremely medial stjt axis some of the arch fill will sit on the lateral aspect, obviously the arch fill will not pronate the foot however you will have a arch fill applying a supinatory moment and axis a pronatory moment so the joints and skin of the foot takes all the compression forces hence blistering and pain.

    Hope that makes some sort of sense. I am sure Kevin will explain much better than I will.

    Has you lady got a Functional Hallux limitus?

    Nick
     
  3. bartypb

    bartypb Active Member

    Hi Nick thanks for the reply, the male has some tightness in gastroc but not too bad he stretches regularly anyway he has to owing to the miles he does. The girl doesn't really have FHLimitus jacks/hubshers 2 B/F. makes sense on the mechanical side, I am somewhat limited by what I can perscribe as I work in the NHS and we basically have frelens, xlines and slimflex insoles with a lab that we can use, so i think I'll have to do some bevelling away of any arch fill on those devices and see what I can do!

    thanks again

    Marc
     
  4. Admin2

    Admin2 Administrator Staff Member

    Related Threads:
    Other threads tagged with blisters
     
  5. Asher

    Asher Well-Known Member

    Hi Marc,

    Blisters are caused by shear. Shear occurs under the combination of two conditions:

    a) high friction keeps the skin stuck to the sock and the sock stuck to the shoe (shoe, insole or orthotic).

    b) bones move relative to the skin

    The soft tissue in between is caused to stretch – this is shear. When shear is excessive and repetitive (different for everyone), the prickle layer of the epidermis suffers shear trauma and this is what blisters are.

    You have the ability to reduce shear by impacting on three factors: in-shoe friction, the bone movement or to a lesser extent the characteristics of the skin. Have a look at this flowchart.

    From your explanation, with ligamentous laxity comes a larger bone movement relative to the skin. This might be your best opportunity for blister prevention and involves biomechanical interventions such as an appropriate orthotic prescription, joint mobilisation, stretches, adequate shoe fit etc where applicable.

    Rebecca
     

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  6. efuller

    efuller MVP

    Where are the blisters? Medial arch or heel cup or?
     
  7. bartypb

    bartypb Active Member

    Hi the blisters are just behind the 1st mpj, along the neck of 1st met and 1st cuneiform

    Regards Marc
     
  8. petermac

    petermac Member

    I had 2 similar cases. Both were literally solved by changing the shoe. Different last seemed to stop the blisters. No idea what exactly caused the issues but once the footwear was changed they went away. The patients just changed brands but kept the same support IE mild "anti-pronating" support.
     
  9. efuller

    efuller MVP

    Just behind the MPJ is under the metatarsal head. Is the orthotic too long? Usually orthotic are made to end proximal to the metatarsal head. When looking at the medial side of the orthosis is there a dramatic plantar curvature at the distal end? This could be from improper medial arch fill. Is the medial anterior edge of the orthotic being prevented from touching the shoe because there is an arch cookie or some other rubbing of the medial edge of the orthotic against the shoe? That rubbing would be caused if the orthotic was too wide distally. On the other hand blisters beneath the 1s cunieform could be caused if the orthotic is too narrow. I'm also assuming that 1st cuneiform is medial to the plantar fascia and the rubbing is not from a promenent plantar fascia.

    Eric
     
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