How to treat foot blisters

A blister (bulla) is caused when the outer layer of the skin separates from a layer of skin below, creating a collection of fluid between the layers. Blisters can be caused by chemical means, such as an allergic reaction; physical injury, such as from heat, frostbite, or friction; or from a disease.

A friction blister is a blister caused by the skin repeatedly rubbing against another object. It most often forms on the palms, fingers, soles, sides of the feet and toes. The top of the blister is rubbed off where skin is thinner, such as the top of the hand or foot, forming an abrasion. In areas of thinner skin, friction causes chafing without blistering.

Friction blisters should heal on their own within a week without needing any care, and the skin over the blister is its best defense against infection. Blisters can be painful while they heal, but you shouldn’t need to see a doctor.

If the blister is large or painful, however, you can drain the blister in such a way as to relieve the discomfort and hopefully avoid infection.

Important

Don’t ignore an infected blister. Without treatment it could lead to a skin or blood infection.

How you can treat a blister yourself

To relieve any pain, use an ice pack (or a bag of frozen vegetables wrapped in a towel) on the blister for up to 30 minutes.

To protect the blister and help prevent infection:

DO

• cover blisters that are likely to burst with a soft plaster or dressing
• wash your hands before touching a burst blister
• allow the fluid in a burst blister to drain before covering it with a plaster or dressing

DON’T

• burst a blister yourself
• peel the skin off a burst blister
• pick at the edges of the remaining skin
• wear the shoes or use the equipment that caused your blister until it heals

Complications of friction blister

Intact friction blisters usually heal up quickly without scarring. Healing is sometimes delayed. Problems may include:

• Pain impeding performance
• Wound infection: this presents with increasing pain and redness around the blister/erosion, a red streak heading for the groin or armpit, and pus formation. Infection is more common in diabetics and immune impaired individuals.
• Pyogenic granuloma may occasionally arise at the site of a blister some days later.
• Scarring due to infection or deeper injury.

Figure 1. Foot blister

Figure 2. Bottom of foot blister (severe blister on athlete’s foot)

Who’s at risk of developing foot blisters?

Athletes are at high risk of acquiring blisters due to repetitive friction between skin and shoes, socks, and sports equipment. Additionally, those who wear ill-fitting, uncomfortable shoes or who handle tools that cause friction are at risk for getting blisters.

Friction blisters occur from time to time in nearly males and females of all ages. Exacerbating factors include:

• Heat — they are particularly prevalent in tropical climates.
• Prolonged or vigorous exercise — they are common in athletes (especially marathon runners) and soldiers; one third of 872 American soldiers surveyed when in Iraq had blisters ¹. Blisters on the palms may arise from rowing, or in children playing on monkey bars.
• Carrying a heavy load increases the risk of blisters.
• Excessive sweating — hyperhidrosis softens the skin so the skin splits more easily.
• Tight, uncomfortable or new shoes, which repetitively rub on one or two areas of skin.
• Unabsorbent or thin socks — these do not absorb moisture well and do not protect the skin adequately from damage by shoes or boots.
• Rough or hard fabrics may cause blisters on other sites, such as armpits or groin.

There are some specific diseases that make the skin more fragile than usual, also causing blisters in response to friction or injury.

• Genetic disposition — epidermolysis bullosa is a group of disorders in which the skin blisters easily.
• Immunobullous disease — epidermolysis bullosa acquisita.
• Metabolic disease — porphyria cutanea tarda
• Sun damage — especially overexposure to solaria or tanning beds
• Certain medications — pseudoporphyria due to nonsteroidal anti-inflammatories or antibiotics (doxycycline)

What causes foot blister

Poorly fitting shoes and wet feet are the most common reasons for blisters to form. A friction blister occurs when there is contact, pressure and movement between the skin and something touching it – such as a heel rubbed by a new unfamilar shoe or poorly fitting shoe.

Sheer forces cause mechanical separation of the layers of epidermal cells. The gap fills with fluid, forming a subepidermal bulla (blister). A blister forms more quickly if pressure and movement on the skin is severe or the skin is damp.

Rubbing on the skin first peels off surface cells. More pressure causes the affected skin to redden, heat up and to sting. The red skin then becomes pale as the blister forms. The blister usually contains clear fluid but bleeding changes the color to red/brown.

Blisters occur where the stratum corneum (the outer cell layer) is very thick, as is the case on the sole of the foot and palm of hands. Where the skin is thinner, friction tends to sheer off the epidermis completely, resulting in an erosion (sore).

If the blister remains intact, the fluid will resorb and the damaged skin will peel off some days later.

You shouldn’t find that new shoes rub. However, some will because they’re not designed for the shape of your feet. They can also be made to a uniform style, such as boots or running shoes. You’ll need to make sure the shoes feel comfortable when you’re in the store. If they feel like they pinch anywhere, they are not the right shoes for you.

Get the best fitting shoes. Whenever you buy a new pair of shoes, try them on in the store and fasten them as you would when wearing them. Ask if you can try on both shoes. You’ll want to try taking a few steps to make sure that the shoes don’t pinch anywhere. Some of the most common areas are around your little toe or your Achilles tendon.

It doesn’t matter what type of shoes you buy. Make sure they fit well. This is especially important with shoes that you wear daily. The shoes won’t eventually start fitting to your feet. They will constantly cause a pinching problem if they don’t fit in the store!

When it comes to running shoes, get an analysis to find the perfect options. A specialist will be able to tell you how you run and where you need support. A high instep will need extra support on the instep for example. The specialist will help you find comfortable, well-fitting running shoes that will do the job when you are out on the road.

It’s also worth replacing your shoes regularly. Don’t wait for them to start falling apart. If they start to feel uncomfortable and start to rub, it’s time to switch them out for some new shoes. This applies to any shoes you’re wearing.

You’ll want to think about the style of shoe, especially when it comes to boots. Make sure there is a way for your feet to breathe to prevent moisture and sweat building up. If your feet end up extremely hot and sweaty, you’ll find blisters are more common.This can also lead to fungal infections of the feet and nails.

Think about your socks. It’s surprisingly not all about your shoes. The socks that you wear will also affect foot blisters.

Socks offer extra support for the feet. They help to prevent moisture affecting the skin and will eliminate some rubbing and friction. When it comes to trying on shoes, you’ll want to wear the socks that you would usually wear with those shoes. There are now all types of socks that you can buy, including thin stocking-material socks that cover around the heel and toes.

Your socks don’t just need to fit properly. They need to be made of a material that is designed to prevent moisture getting into your feet. Cotton is often considered one of the best materials you can buy, but not when it comes to socks! It’s the best for hypoallergenic skin and will absorb moisture, but it can soak up so much moisture that it creates friction with the skin. The shoes aren’t the problem. It’s the socks that are making your feet break out in the blisters.

Nylon socks are best when it comes to preventing blisters on the feet. They will help to prevent moisture but allow the feet to breathe well. Keeping the air moving is essential for preventing friction.

Avoid socks that have seams that dig or get in the way. If you can feel your socks pushing against your shoes, you’re at a higher risk of developing a blister.

Foot Blister Signs and Symptoms

Blisters typically develop on the soles of feet and the palms of hands when there is friction and irritation on the surface layer of the skin.

Depending on the severity as well as the stage of the blister, the appearance may vary.

• Early stage blisters – redness of the skin on the affected area, such as on the heel, the instep, toes, or palms.
• Mild, middle stage blisters – the affected area forms into a bubble-like swelling under the skin. The fluid is clear.
• Moderate or severe, middle stage blisters – the affected area forms into a bubble-like swelling under the skin and may be quite large. Infected blisters look red around the edge, and the fluid is often pus-like or red. Additionally, infected blisters are painful and warm to the touch.
• Late stage blisters – as the blister heals, the skin on the blister dries and typically sloughs off naturally, leaving healthy skin underneath.

How to prevent foot blisters

The best way to deal with blisters and calluses is to avoid getting them altogether. Blisters develop to protect damaged skin and help it heal. They are mostly caused by friction, burns and skin reactions, such as an allergic reaction.

Blood blisters appear when blood vessels in the skin have also been damaged. They are often more painful than a regular blister.

If you regularly get friction foot blisters, the following measures may be useful:

• Wear comfortable, well-fitting shoes, use orthotics if necessary to reduce pressure points.
• Neoprene insoles
• Various proprietary foam padding, cushioning and protective barrier products, which are available at the shoe counter of your local pharmacy
• When picking out shoes, be sure to go shopping during the middle of the day or in the afternoon, when your feet are their largest. (Feet normally swell as the day goes on.) Make sure you can wiggle your toes, and be sure that both the left and right shoes fit properly. (Many people have two different size feet.) Try on both shoes and walk around a little bit before buying them. Even if shoes look really cool, don’t get them if they don’t feel right. Often, a different size or width can make a big difference.
• Gradually break in new shoes
• Wear moisture-wicking socks, thicker woollen or acrylic socks during exercise, particularly ones that fit you well.
• Wear 2 pairs of socks: thinner inner polyester layer and thicker wool or polypropylene outer layer
• Changed socks as soon as they are damp
• Dust talcum powder in your socks if you get sweaty feet
• Apply talcum powder to your feet before activity that may cause friction.
• Cover friction ‘hotspots’ with hypoallergenic adhesive tape (again, your pharmacist can advise you) or use anti-friction skin balm
• Lamb’s wool padding over and around areas prone to blister

Antiperspirant, petroleum jelly or silicone lubrication, powders and topical skin adhesives have been advocated and may prove useful. However, they have not been shown scientifically to reduce discomfort or improve healing.

Some hardening occurs with repetitive low intensity exercise because of callus formation (epidermal thickening).

How to treat foot blisters

Your doctor might burst a large or painful blister using a sterilized needle. If your blister is infected, they may prescribe antibiotics.

Your doctor can also offer treatment and advice if blisters are caused by a medical condition.

If you do get a blister, callus, or corn, you can usually take care of it at home yourself:

• Blisters usually heal on their own. Keep a blister clean and dry and cover it with a bandage until it goes away. While it heals, try to avoid putting pressure on the area or rubbing it. You want to avoid popping the blisters if possible. This will reduce the risk of infection since the fluid helps to prevent bacteria from growing. Blisters that are left intact will disappear on their own.
• Blisters that are small can be covered with a bandage. You may need some gauze for larger blisters. You’ll want to use a porous piece of gauze to allow the blister to breathe and avoid infection. Blisters that haven’t popped will usually not need to be covered. This will depend on the location of it.
• If your foot blister is preventing you from walking or keeps catching, you’ll want to consider popping it. Always wash the area and use a sterile needle or pin head to pop the blister. Never tear the skin with your nails. With tissues, gently ease the fluid out from a small hole in the blister. Some of them will have separate pockets of fluid, so you may need more than one small hole to drain all the fluid.When there are signs of yellow liquid in the blister, consult with your doctor. This is a sign that your blister has become infected. Popping it will spread the infection and open yourself to risks of secondary infections.Once you’ve finished draining your blister, you will need to use an ointment to help prevent infections. Keep an eye on the area to ensure it doesn’t become infected at a later date. Cover the area with gauze and medical tape. This won’t just prevent infection but will make it more comfortable to walk with the blister.The skin that was on the upper layer of the blister will die and become hard. The skin that was in the second layer will become the new layer of skin. Continue cleaning, using the cream, and covering with a bandage until the blister has fully healed.Some blisters will pop on their own. In fact, you may never even see the actual fluid because the friction has burst it. This isn’t a problem. Just clean out the blister and use the ointment to prevent infection. Cover it up and give the skin chance to heal.
• You can help a callus go away faster by soaking it in warm, soapy water for 10 minutes, then rubbing it with a pumice stone. The stone has a rough surface and can be used to rub off dead skin. Go easy when you do this. Rubbing too much can make the skin raw and tender. You can also wear shoe pads inside your shoes to relieve pressure so foot calluses can heal. You can buy pumice stones and foot pads in many grocery stores and drugstores.

How to get rid of foot blisters

Blisters often go away on their own without needing any care, and the skin over the blister is its best defense against infection. If the blister is large or painful, however, you can drain the blister in such a way as to relieve the discomfort and hopefully avoid infection.

Blisters that look like they will pop on their own should be drained, unless the blister looks infected or you have a fever; multiple, grouped blisters; diabetes; or poor circulation.

You might decide to puncture a blister to drain the fluid if it is large and painful, but take care to avoid infection. To drain a blister:

• Clean your hands and the affected area with soap and warm water.
• Apply rubbing alcohol to the affected area.
• Wipe a needle with rubbing alcohol to sterilize it.
• Puncture the blister with the sterilized needle at its edge, making the hole big enough to drain fluid.
• Let the fluid drain, making sure to leave the overlying skin in place. Note: This skin will help prevent infection.
• Apply an antibiotic ointment (e.g, bacitracin) to the blister, and bandage the affected area.
• Once the overlying skin has dried, allow it to fall off naturally or use sterilized scissors to cut the dead skin off. Apply antibiotic ointment and a bandage, if necessary.

What to do with infected blister on foot

If the blister becomes infected, your doctor may want to prescribe antibiotics. Depending on the cause of the blister, your doctor may treat the blister ranging from conservative measures, such as watchful waiting, to treating the source of the blister(s) if caused by a disease.

1. Brennan FH Jr, Jackson CR, Olsen C, Wilson C. Blisters on the battlefield: the prevalence of and factors associated with foot friction blisters during Operation Iraqi Freedom I. Mil Med. 2012 Feb;177(2):157-62.[↩]