Welcome to the Podiatry Arena forums

You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members, upload content, view attachments, receive a weekly email update of new discussions, access other special features. Registered users do not get displayed the advertisements in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!

  1. Everything that you are ever going to want to know about running shoes: Running Shoes Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
  2. Have you considered the Critical Thinking and Skeptical Boot Camp, for taking it to the next level? See here for more.
    Dismiss Notice
  3. Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
Dismiss Notice
Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
Dismiss Notice
Have you liked us on Facebook to get our updates? Please do. Click here for our Facebook page.
Dismiss Notice
Do you get the weekly newsletter that Podiatry Arena sends out to update everybody? If not, click here to organise this.

Severe blister prevention

Discussion in 'General Issues and Discussion Forum' started by RachWadd, Feb 22, 2018.

  1. RachWadd

    RachWadd Member

    Members do not see these Ads. Sign Up.
    Hi all,

    I am seeking any ideas on prevention of severe mechanical blisters for a 32YO female patient of mine.

    The blisters she typically suffers from occur on the lateral plantar surface of the heel, medial 1st MPJ, medial longitudinal arch and around the plantar digit/webbing area. They can be quite large - 5cm+ diameter - and deep and are incredibly painful so that the patient literally can't walk. She usually gets them when she walks around a lot which is always on holiday. It has got to the point where she feels she can't travel anywhere as most of the trip she is unable to get around.

    Her skin is moist and she suffers with hyperhidrosis which I feel is the cause of most of the blistering however given her history, I wondered if there was a skin blistering disorder component. Her visits to a dermatologist have not suggested this as a cause.

    She has been completely compliant with all instructions and trials including footwear changes, topical antiperspirants and Iontophoresis - at great expense I may add! We are now almost at the end of her options. She is going to try oral medication and/or botox next. After that, we are fresh out of ideas.

    I wondered whether wearing a shoe similar to the Vibram five fingers would help as I imagine there would be little friction in these - could anyone confirm that?

    If anyone out there has any experience with this type of thing or has any thoughts, we are open to every idea.

    Thanking you in advance

  2. efuller

    efuller MVP

    It is certainly unusual. Either you have got unusually high amounts of friction (anything unusual in gait?) or exceptionally fragile skin (pemphigus?) For dermy things I usually defer to others (is Belinda out there?)

    If you have fragile skin I could see the finger shoes causing more problems than helping. Much more skin contact and potential for friction around toes. I'm assuming you've tried the usual things like moleskin and acrylic socks on a vinyl sock liner. (That will really reduce plantar friction, but you will get more friction where the foot slides into the sides of the shoes. )
  3. Asher

    Asher Well-Known Member

    Hi Rach,

    I'm not 100% clear on where the heel blisters are. They sound like edge blisters https://www.blisterprevention.com.au/blister-blog/heel-edge-blisters-free-lesson. Or are they more plantar surface? Do you have any photos. I'd like to be clearer about where the toe blisters are too - are they pinch blisters that extend proximally to the webspace? Photos would help. Take a look at these images - it might help: https://www.blisterprevention.com.au/blister-blog/brr2016-three-most-common-blisters

    For the majority of blisters, the thing that helps most is reducing friction levels. Not reduce rubbing - I mean make it more slippery. Because the more slippery over the blister-susceptible area, the less the skin stretches (shears) and the less the tear in the stratum spinosum that kick-starts blisters.

    Of course, it's not great to have everything slippery-slidey in the shoe, because your foot still needs traction - and it gets traction form high friction levels. So it can get tricky when people seem to blister "everywhere".

    Check out Engo patches for targeted friction management. Check out Armaskin socks for more overall friction management. This is assuming you've tried all the basics - like moisture management, shoe fit, taping, biomechanics.

    Reducing friction levels under the heel is not great due to reduced traction. I'd go something more like Spenco or poron to absorb the blister-causing shear. And silicone gel toe devices absorb LOTS of shear and can be excellent for the majority of toe blisters. But silicone will absorb too much shear under the heel where it's important to have more traction rather than less, so I'd stick with Speco/poron.


Share This Page