After working in the medical tent at the Boston Marathon this past Monday, I’ve come to two conclusions:
A. I will never run a marathon. As a member of the medical team I saw the worst of the worst, as athletes piled in with chest pain, dehydration and electrolyte imbalances. Unfortunately, I didn’t get to see the thousands of runners who completed the race unscathed.
B. Blisters can be a marathoner’s worst nightmare, especially when they occur towards the front of the race, as with each step they are constantly reminding the runner of their presence!
The root of all evils when it comes to blister formation is moisture. Blister formation occurs when friction and moisture combine separating the top layer of skin (epidermis) from the second layer of skin (dermis) allowing the area between to fill with fluid. Typically, the fluid within a blister is clear (serous), but can be bloody or filled with infection. Even if you’re not running marathons, the following “Blister Tips” address some of the myths of blister care, guiding you towards appropriate treatment.
1. Don’t pop blisters at home! It can be rather tempting to pop a fresh blister and relieve the pressure by expressing the fluid, but that’s not recommended. Blisters, by nature, contain sterile fluid, meaning that there is no bacterium inside and infection is a remote possibility. If you decide to pop a blister with a needle that you might have “sterilized” in your bathroom, you run the risk of introducing infection. Resist the urge to pop your blister and allow your body to resorb blister fluid on its own.
2. If I shouldn’t pop blisters at home, why did the medical staff pop them during my marathon? In an acute setting, such as during a marathon, blisters are typically popped by the medical staff. The reason: immediate relief of the excess pressure allows runners to continue through the remainder of the competition. The medical staff cleans the skin surrounding the blister with alcohol, uses a sterile needle to puncture the skin, and drains fluid out at it’s lowest point of gravity. Although the method isn’t perfect, and not recommended at home, the medical staff does their best to prevent infection while providing immediately relief for the athlete.
3. What to do if your blister pops on its own: As mentioned above, once your blister is exposed to the outside environment, infection becomes a possibility as there is now an entry point for bacterium. When this occurs, you need to do your best to keep the blistered area extremely clean. Using warm water and soap is sufficient, making sure to dry the area thoroughly and protect it using a band-aid that covers the entire blister. Avoid using hydrogen peroxide to cleanse the area. If dead skin remains, leave the skin in place, as it is still capable of providing a barrier for infection while providing a good environment for new skin to grow underneath.
4. Get your feet measured for shoe-size accuracy. As we’ve mentioned, blisters are mainly caused by friction combined with moisture. Shoes that are tight in the wrong places can cause recurrent irritation and frequent blistering. Getting your feet measured for an accurate shoe size can make a difference if you’ve been wearing the wrong size! Adjusting your running shoes to fit your feet may also increase your distance and comfort level while engaging in activity.
5. Blisters can occur separate from friction and moisture. Blisters that are small in size and seem to continually appear for unexplained reasons may indicate a problem separate from friction and moisture. Check the other areas of your feet looking for scaly skin on the soles and heels. If you find areas of scaly skin, it is likely that you have a fungal infection and the blister formation is a result of that. Contact your Podiatrist for an appointment, as they can treat your fungal infection quickly with topical medications!
6. Prevention is your best option! The goal in prevention is to decrease friction and eliminate moisture, as those are the most common predisposing factors. As discussed wearing shoes that fit your foot is important in decreasing areas of pressure where friction is imminent. In addition, keeping your feet dry and wearing socks that allow the feet to breath, versus cotton socks that hold in moisture, is very important. Finally, treating any underlying conditions such as fungus that may be causing blister formation will help tremendously in prevention.