* When our feet hurt, we hurt all over – Socrates *
Twisted ankles and blisters are the most common injuries hikers invite. Injuries related to knees are also very common but they are not directly related to choice of footwear, though the quality of cushioning provided by boots does play a role. The likelihood of these injuries also depends on factors like pack weight, nature of terrain, duration of hike, and conditioning of the hiker.
This post is about blisters.
Blister is a heat (friction) injury – caused by the rubbing of footwear against skin.
Best prevented than treated! And easily prevented.
- Use shoes/boots that are snugly fitting and well-broken in (snugly: not so loose and not so tight).
- Consider using two pairs of socks – thin synthetic inner and thicker material outer. Socks should be well fitting and of appropriate material which is not prone to creasing. There are hiking socks available today that can be used singly equally effectively – but keep a thin pair handy in case you feel the need to have two pairs on half way into your hike. (For more information on socks, read my blog-post here)
- While wearing socks, ensure that there are no wrinkles in them.
- Keep feet as dry as possible. Change socks regularly and wash used ones. Used or washed socks: dry in the sun or with body heat (e.g., inside the sleeping bag at night).
- Be aware of a ‘hot spot’ developing on a foot – this could fast blossom into a glorious blister. A ‘hot spot’ is the place where friction between foot and boot generates heat and causes pain – referred to as ‘shoe-bite’ by Indians!
Why is it important to talk of prevention?
It is common to see someone endure a hot spot for a considerable time and then have it transform into a blister. So:
As soon as a hot spot is experienced, do the following:
- Stop the group and attend to the hot spot – the idea is to provide relief to the spot by taking the friction off it
- See if there is a wrinkle in the sock that is creating the hot spot – sometimes the solution can be as simple as that
- Loosen the boot and/or remove a sock (if the person is wearing two socks on each foot) and see if that helps
- Put a piece of padding on the hot spot – this transfers the friction to that pad from your skin; the pad can be a medical tape (adhesive tape) or micropore tape
If the hot spot persists and/or a blister develops then it calls for more actions. When the blister has developed a bubble:
If the bubble is tiny then you may be successful in preventing the bubble from getting squashed while walking if you cover it with a padding with a hole in the middle of it (the padding needs to be taped in place).
A bubble larger than say a big trouser button is likely to burst during hiking. So it is better to drain the bubble of its fluid in a controlled manner and then pad the blister. Sterilise a pin or the tip of a small knife by holding it in a flame. Use the tip of such a tool to make a pin-prick sized hole in the bubble in such a way that the fluid drains out due to gravity. Use gentle pressure to drain out all the fluid. The small opening will minimise chances of the wound getting infected. The most frequent example cited is that of a blister on the back of the heel. The bubble should be pierced at its bottom end. Do not remove the outer layer of the bubble – it is the first protective layer over the tender skin underneath. Now take a suitable sized piece of foam-pad, cut out a hole in the middle of it that will encircle the collapsed blister-bubble. Then tape this piece of foam-pad in place using medical tape.
The patient with a taped up blister should now be alert to hotspots that could be created by the corners and edges of the foam-padding and tapes. If such a hotspot arises it may require repositioning of the pad-tape combination along with rounding of sharp corners. You may require more than one adhesive tape on each side of the pad to hold it in place. Adhesive tapes used on hotpsots or for taping paddings can be reused with minimal replacement with fresh pieces of tape; this will help you save on the supply of tapes from your first aid kit.
Note: This post is at basic level, and is not a substitute for what is learned in a wilderness first aid course. Supplement information presented here with skills picked up in a wilderness fist aid course.
If you are leading a group, make sure you talk to its members about hot spots. State the expectation that anybody who experiences a hot spot should alert you about it so you can deal with it. Explain to everybody how it is much harder to treat a blister and how it affects the group in terms of time and resources from the first aid kit getting depleted. People tend to meet with expectations when they are aware of the consequences of not doing so. Be especially vigilant in the early stages of a hike, when feet are still tender from back home and are getting adjusted to hiking boots after a gap of months if not years.
Click here for information on basic footcare and hiking gaiters.
Click here for information on hiking boots.
Click here for information on hiking socks.