Proper Care and Management of Blisters


Blisters are a common problem for athletes and active people and can cause significant pain depending on their size, depth, and location. Improper management can lead to tearing of adjacent skin tissue, infection, bleeding, and increased pain. However, learning to care and treat blisters early can reduce pain and damage to the skin and get the athlete back competing comfortably.

What causes blisters?

Blisters are caused by friction and shearing forces (forces directed across the skin). The friction causes the layers of skin to separate (epidermis from the dermis) and fill with either a clear fluid or blood (if a break in a small blood vessel occurs).

Blisters are most commonly found on the hands and the feet. Friction can be caused by a new shoe rubbing on the foot or by an object rubbing across the skin as in a baseball player swinging a bat.

Blisters start as “hot spots”. Initially, the skin area is tender to the touch and becomes red and irritated. If the friction continues, then the layers of skin separate filling the area with fluid. It is the pressure from the fluid that causes the pain because the pressure stimulates the nerves under the skin.


What athletes are prone to blisters?

Athletes who need sport implements to compete are prone to blisters because of the friction caused by the sport implement and the hand. These sports include baseball, softball, weightlifting, pole vaulting, rowing, shot put, and discus.

Gymnasts are especially susceptible to blisters in the hand caused by friction between the gymnast’s hands and the bars when they rotate. Although devices have been designed to help reduce friction blisters in gymnasts, this is still a significant problem in this population.

Baseball and fast pitch softball pitchers are another subgroup that are at high risk for blisters because of the amount of friction between the ball and the fingers especially when repeatedly throwing pitches that require significant rotation (i.e., rise ball in softball, curve ball, screwball).

Athletes prone to friction blisters on the feet are those in sports that require significant starting, stopping, and quick changes of direction. These movements cause the feet to shift in the shoe causing friction between the sock and the foot. These sports include basketball, soccer, football, volleyball, and tennis.

What is the proper treatment for a blister?

The proper treatment depends on whether the blister is intact or torn open. Each needs to be treated differently.

It is important to note that the skin overlying the blister is protective and should remain in place as long as possible. A common mistake athletes make is to remove the overlying skin of the blister. This exposes the underlying skin to possible infection. Also, removing the skin causes increased pain because raw nerve endings are exposed.

The question most often asked is “Should I drain the blister?” The answer depends on whether the blister is filled with fluid or not. Because the pain from the blister is caused by pressure from the built up fluid, draining a blister that is filled with fluid will immediately reduce the pain associated with a blister.

Draining a blister can be done safely at home as long as proper treatment protocols are followed. They include the following:

• Clean the area thoroughly with antiseptic soap (to remove any bacteria)
• Sterilize a household needle by heating the needle
• Gently apply pressure to one side of the blister causing the top skin to rise on one side (like a squeezed balloon)
• Create a small hole at the base of the raised side of the blister large enough for the skin to not reseal.
• With a sterile gauze pad, gently push the fluid out of the blister until all the fluid has been removed
• Cover the blister with an antibiotic ointment to prevent possible infection
• Cover the blister with and occlusive (air tight) bandage
• Recheck and change dressing daily until skin has completely healed

Open blisters have already torn and do not need to be drained. However, the athlete still needs to take care to keep the blister clean and free from infection.

If the open blister has a small tear, the goal for treatment is to keep as much skin tissue as possible to allow the underlying skin to mature. The treatment for an open blister includes the following:

• Clean the area thoroughly with antiseptic soap
• Allow the area to dry and apply antibiotic ointment to the open wound
• Replace the flap of skin (if possible) to cover the treated tissue and cover with a sterile, nonadhesive dressing
• Recheck wound and change dressing daily until skin has healed
• After a few days when the tenderness is gone, carefully trim away the dead skin

If the open blister has completely torn, it is important to remove the torn tissue so that it is not at risk for tearing into healthy skin. The athlete should clean the area with antiseptic soap and then carefully remove the skin with sterile scissors. The area can then be covered with antibiotic ointment and then covered with an occlusive bandage. Because the underlying tissue has lost its protective covering, the area will be tender for a few days.

What are some new products on the market to treat blisters?

Sports medicine professionals have a variety of new and innovative products available to reduce the pain felt by the athlete while blisters are healing. Because the typical bandaid tends to slip when under pressure or when wet, sports medicine professionals use other products to cover blisters.

One of the more common products used to cover blisters is moleskin. Moleskin is a thin piece of felt product with an adhesive backing. It can be purchased in square sheets or by the roll.

Moleskin is an effective product because of its adhesive backing and the process by which it is applied. The procedure of application actually distributes the pressure around the blister rather than on the blister. The following steps can be used to apply moleskin correctly:

• Measure the moleskin against the blister and cut two pieces of moleskin larger than the blister.
• Take one piece of moleskin and cut a circle in the middle of the piece equal to the size of the blister
• Liberally apply Tufskin (adherent) to a cotton-tipped applicator and apply to the skin around the blister
• Allow the Tufskin several minutes to dry
• Place the piece of moleskin with the cut-out directly over the blister
• Apply antibiotic to the blister
• Place the second piece of moleskin over the first

The benefit to the athlete of using moleskin is that the pain of the blister is reduced immediately because the external pressure of the shoe is displaced around the blister by the use of the double-layer moleskin. If the blister is located in an area of extreme friction (back of the heal), light elastic tape can be added around the moleskin to secure it in place.

In an open blister, the product that is most commonly used is called second skin. This is a unique product that can be purchased through sports medicine companies (Medco, School Health Supply). The benefit of second skin is that the product mimics the properties of the skin. Second skin can be applied directly to the open blister and then covered with either moleskin or a lightweight elastic tape.

The athlete feels immediate relief with the application of second skin to the open wound. Second skin comes in individually pre-cut squares. The product is moist, clear in color, and the thickness of several layers of skin. Once applied, the athlete can immediately resume activity with little to no discomfort.

How can I prevent blisters from forming?

The key to preventing blisters is to reduce the friction that causes the blisters and to prevent clothing (especially socks) from becoming wet with perspiration. For athletes prone to blisters on their feet, a lubricant can be applied directly to the hot spot areas to reduce the friction.

Powder can also be applied to the feet to help keep feet dry during exercise. Applying antiperspirant to the bottom of the feet has also been recommended.

Some athletes wear two pairs of socks to reduce the friction on the feet by transferring the friction to the socks rather than to the foot. Because cotton socks can be thick and wrinkle causing pressure within the shoe, changing to a lighter material sock may also be beneficial.

Shoes that are too small or too large may also be the cause of blisters. Shoes that are too big allow the feet to slide back and forth within the shoe creating hot spots on the feet. Shoes that are too small can rub on the sides or back of the feet and create blisters.

For athletes prone to blisters on the hand, the best recommendation is to wear protective gloves/equipment specifically designed to reduce friction in the athlete’s sport. In the sports of baseball, softball, and weightlifting, gloves can be worn to reduce the friction between the hands and the sport implement.

Proper care of blisters can reduce the pain and risk of infection associated with friction blisters while allowing the athlete to continue to compete in their sport without the painful side effects. Immediate care along with the use of innovative sports medicine products can further reduce the discomfort of blisters and keep the athlete performing at his/her best.

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References

Anderson, M.K., Parr, G.P., & Hall, S. (2009). Foundations of Athletic Training: Prevention, Assessment, and Management. Lippincott Williams & Wilkins: Baltimore, MD.

Arnheim, D.D., & Prentice, W. (2000). Principles of Athletic Training. (10th Ed.). McGraw-Hill: Boston, MA.





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