Preventing Foot Blisters

Jacob Schor ND, FABNO

March 21, 2013

 

 

 

 

Over the past month I’ve become interested in foot blisters. These are those fluid filled blebs on the feet that occur frequently during athletic activities.

 

Apparently 39% of runners completing a marathon have blisters. [1]    These injuries are common in the military and have been the topic of military research as blisters can markedly reduce troop effectiveness.  In Army recruit training programs more than a third of the recruits will be plagued by blisters. The Ninth infantry reports that 42% of their male recruits will suffer from blisters.  Rates for female recruits are 60% higher (so 67%).[2]   In the Belgium army risk is even higher, 57% of recruits get blisters. [3]   Though in Operation Iraqi, Freedom only a third of the soldiers reported blisters. [4]

 

Studies show that blisters result from frictional forces that mechanically separate epidermal cells at level of the stratum spinosum. “Hydrostatic pressure causes the area of the separation to fill with a fluid that is similar in composition to plasma but has a lower protein level. About 6 hours after formation of the blister, cells in the blister base begin to make amino acids and nucleosides; at 24 hours, there is high mitotic activity in the basal cells; at 48 and 120 hours, new stratum granulosum and stratum corneum, respectively, can be seen. The magnitude of frictional forces (Ff) and the number of times that an object cycles across the skin determine the probability of blister development - the higher the Ff, the fewer the cycles necessary to produce a blister.”[5] 

 

Moisture seems to aggravate increase the risk of blister formation.  Various antiperspirants and drying powders have been tested to see whether applying them will reduce risk of blisters and to date these have not been proven effective.[6] 

 

Various combinations of socks have been tested and there is some evidence that this may help in certain situations:  “Wearing foot socks composed of acrylic results in fewer foot blisters in runners. A thin polyester sock, combined with a thick wool or polypropylene sock that maintains its bulk when exposed to sweat and compression reduces blister incidence in Marine recruits.”[7]  (My experience suggests that the thicker merino wool socks are more effective than these earlier combinations, but no research besides my own trial and error.)

 

I’ve been particularly interested in foot blister development as I’ve been on vacation.  As many of you already know I am in the habit of taking a late winter vacation in order to ski tour in British Columbia.  This is a somewhat esoteric form of recreation.  We ski without the benefit of ski lifts, to use a term promoted by the once time journal Couloir, we “earn our turns”, that we climb uphill in order to ski downhill.  So for the past three-weeks my feet have averaged 5,000 feet of climbing a day in heavy, tight, often sweaty, ski boots.  Thus I’ve been concerned about blisters.  I don't know what percentage of people who ski tour have blistered feet.  My guess is at least an equal number to those army recruits in the studies cited.

 

I think I’ve stumbled on a way to reduce blister formation. 

 

After three days of vacation both my heels were hot, red, swollen and starting to blister.  In desperation, [total deperation] I went through all my belongings looking for something to treat them with.  I rejected the idea of using toothpaste, chocolate, or instant Starbucks coffee crystals.  I settled on a paste made of curcumin and Traumeel Gel.  For curcumin, I used the brand of curcumin sold by Joe Pizzorno and Michael Murray’s company.  It was a sample they’d given me.  At the office we usually use Meriva or BCM-95.  This is what I had.

 

The results were nearly miraculous.  I coated my heels at bedtime, slept in wool socks and in the morning my feet were much better.  After a few more treatments, all the swelling and erythema were gone and for the remaining weeks, I had no return of irritation. 

 

I’ve not been able to find any direct research on curcumin and blister formation.  There are a number of papers that suggest topical curcumin treatment is helpful  to both prevent burn injuries and help heal them. Burns and blisters are certainly not the same thing. Yet the idea that this substance will speed wound healing seems as if it could apply to both types of injury. [8]   So is the idea that if curcumin pretreatment will reduce burn injury, it may also reduce blister formation secondary from friction.[9] 

 

So while I have no RCT to quote supporting this practice, I think I will make a habit of pre-treating my feet for a few days with topical curcumin prior to next year’s ski trip.  I will warn you that if you try this at home, make sure to sleep wearing socks.

 

In any event, I am flying home Monday afternoon and will once again be reachable both by phone at the office, 303 337-4884 or via email.

 

 

I should perhaps have taken before and after photos but sadly didn't.

Instead I will post a few ski pictures online LINK

 

References:

 

1.  J Am Podiatr Med Assoc. 2010 Mar-Apr;100(2):116-20.

Plantar shear stress distribution in athletic individuals with frictional foot blisters.

Yavuz M, Davis BL.

 

2.  Mil Med. 1994 Feb;159(2):130-5.

Foot blister risk factors in an ROTC summer camp population.

Patterson HS, Woolley TW, Lednar WM.

 

 3. Mil Med. 2009 Feb;174(2):183-9.

Sock systems to prevent foot blisters and the impact on overuse injuries of the knee joint.

Van Tiggelen D, Wickes S, Coorevits P, Dumalin M, Witvrouw E.

 

 4.  Mil Med. 2012 Feb;177(2):157-62.

Blisters on the battlefield: the prevalence of and factors associated withfoot friction blisters during Operation Iraqi Freedom I.

Brennan FH Jr, Jackson CR, Olsen C, Wilson C.

 

 5.   J Am Podiatr Med Assoc. 2010 Mar-Apr;100(2):116-20.

Plantar shear stress distribution in athletic individuals with frictional foot blisters.

Yavuz M, Davis BL.

 

6.   J Am Acad Dermatol. 1995 Oct;33(4):626-30.

Effects of an antiperspirant with emollients on foot-sweat accumulation and blister formation while walking in the heat.

Reynolds K, Darrigrand A, Roberts D, Knapik J, Pollard J, Duplantis K, Jones B.

 

7.  Sports Med. 1995 Sep;20(3):136-47.

Friction blisters. Pathophysiology, prevention and treatment.

Knapik JJ, Reynolds KL, Duplantis KL, Jones BH.

 

8.  J Mol Histol. 2013 Feb;44(1):83-90. doi: 10.1007/s10735-012-9452-9. Epub 2012 Oct 2.

The effects of topical treatment with curcumin on burn wound healing in rats.

Kulac M, Aktas C, Tulubas F, Uygur R, Kanter M, Erboga M, Ceber M, Topcu B, Ozen OA.

 

9. J Burn Care Res. 2011 Jan-Feb;32(1):135-42. doi: 10.1097/BCR.0b013e318203337b.

Curcumin reduces injury progression in a rat comb burn model.

Singer AJ, Taira BR, Lin F, Lim T, Anderson R, McClain SA, Clark RA.