To Treat and ultimately Prevent Blisters we first have to understand what causes them and then use this information to head them off at the pass.(yes Grammarly raised the digital eyebrows at that analogy too!)
Blisters are defined as:
a small bubble on the skin filled with serum and caused by friction, burning, or other damage.
Our Skin has three layers: the epidermis, the dermis and subcutaneous (below the skin) fat. A blister forms under the epidermis as a fluid-filled sac. Typically, it may be filled with clear liquid or blood, depending on the injury that damaged your skin.
Blisters can be caused by:
- mechanical friction or trauma to the skin
- extremes of heat or cold for example – sunburn, scalding
- chemical contact for example strong detergents, disinfectants, poison ivy
- medical conditions like chicken pox, impetigo, hand foot and mouth disease.
For the sake of this Blog we are limiting our discussion to those blisters on the feet caused by friction and trauma. Patients present complaining of blisters that habitually happen over and over again. There is a predictable pattern to their appearance and location. Without a doubt these are caused by abnormal foot function and a thorough biomechanical examination will reveal the cause.
The majority of cases are more one-off appearances
Within this group, there are many considerations in identifying the source. A rapid increase in the level of activity or distance covered during activity. Change in terrain or grade of the activity surface (uphill or downhill). The sudden introduction of new footgear to a regular activity level. So clearly we don’t need to be psychic rather we are trying to identify what has changed, worn out, increased or decreased.
So Now We’ve Discovered The Meaning Of life,
What do we do with this enlightenment?
Firstly we use this knowledge to our advantage to prevent subsequent episodes from occurring. There is an astounding amount of research in this area which leads us conclude a few useful guidelines.
- avoid sudden changes in our activity levels or environment. Essentially gradually introduce increased activity, distance or intensity.
- changes in footgear for activities should be carefully chosen and gradually introduced avoiding sudden transition.
- the environment ideally should be as normalized as possible, including temperature, moisture, sock material etc
Most of the research in the area was conducted with organized sports and military exercise programmes. The clear message is that the skin with prior increasing exposure to the stimulus that cause blisters can be conditioned to a point where blisters will not occur under even extreme demands.
Do I need to have a doctor look at my blister?
Blisters generally do not need a healthcare provider to look at them. There are no tests or diagnostics for blisters.
If a burn or frostbite caused your blisters, a healthcare provider may need to treat the underlying cause. You may also need to see your provider if a blister shows signs of infection, such as:
- Pus (yellowish or greenish discharge).
- Hot or painful area around the blister.
- Red streaks around the blister.
- re-occurring blisters as mentioned earlier.
How do I treat blisters?
Blisters generally heal on their own within a few days. You can do a few things at home to make them more comfortable:
- Wash the area gently with a mild antibacterial soap.
- Apply antibacterial cream or ointment, my personal preference is iodine combined with povidone (Betadine). Creams can make the blisters mushy and more likely to rupture.
- Cover the blister with a bandage , gauze, or specialized hydrocolloid dressing. Regular bandaids may again macerate the tissue causing rupture.
Be sure to change the bandage at least once a day. And resist the temptation to pop or break a blister or peel it off. The skin on the blister protects deeper layers of skin from infection and if maintained new skin will form under the blister and the fluid is reabsorbed into the tissue. Eventually, the old layer of skin detaches revealing the newly formed skin layer beneath.
One final word of warning!. This new layer of skin does not possess the same characteristic of endurance to friction and trauma as its predecessor. It may require a period of “toughening up” before a return to full activity.
As mentioned earlier in this text, repeat location blisters are typically indicative of abnormal functional forces. This is where we come in, to examine foot structure, function, footwear and all the other associated factors involved in the activity that is producing the blister. Only then can we identify the underlying cause(s) and means of prevention.
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