My friend Doc does twenty six mile hikes for fun. She has good well-fitting boots and socks, with plenty of break-in miles in the boots. And she still gets blisters sometimes on long hikes. How do you think most of us will fare if we need to bug out on foot? Here are some tips on blister prevention and treatment.
What causes blisters?
Friction causes blisters. When the top layer of skin is pulled across lower layers and the bond between the two separates, a fluid collects in the space. That’s a blister. Add more friction and the lower skin layer may bleed into the blister.
Avoiding blisters
First and foremost, have shoes and socks that are appropriate for long walking in the terrain you expect. I have a couple of pairs of hiking-specific socks with extra padding and low friction on the main trouble spots and they’ve been worth their weight in gold for blister reduction. Wool hunting socks are good too, but make sure they are the right size. Wrinkles are bad. (This post has a bit more about shoe sizes.)
While walking, if you think you might be getting a blister…you are. Take care of it right away or deal with the results for many days. Now is the best time to use any moleskin from your blister kit. I’ve had success simply putting a slick-surfaced band-aid over the trouble spot. If the friction is from one toe rubbing on another, separate them like you’d separate squabbling kids. Lamb’s wool is nicest but a bit of toilet paper has also done the trick for me. Changing socks partway through a walk is favored by some hikers, too.
The blister kit
I’m not a physician and don’t give medical advice. My hiking partner Doc is a physician, and someone who does marathon-length hikes for fun. While she didn’t give me specific recommendations, I noticed she had these things in her blister kit, all available from most pharmacies:
- Lamb’s wool, to put between a toe with a blister and it’s neighbor so they don’t rub one another.
- A little band that holds a blistered toe to its neighbor, again to reduce mutual rubbing.
- Lidocaine to reduce pain.
- Various sizes of moleskin, to put around the blisters so they don’t continue to rub.
- Antibiotic ointment for broken blisters. (She doesn’t break her own unless they’re too full to walk on.)
- Bandaging is part of the general first aid kit. Slick surfaces are best over blisters.
Most of these items are very small and light, so the kit ends up being tiny; well worth its space.
These ‘toe trainer‘ bands can prevent toe-on-toe friction and help control blistering.
Treating blisters
Opinions differ on draining blisters. Doc didn’t find it a terrible idea, but suggested if I were going to pop mine to prick it with something clean, not slice it open. She doesn’t drain her own unless they’re too full to walk on. (Twenty six miles in deep sand makes some Epic blisters, no matter the shoes.)
If the skin is ruptured, there’s an infection risk, so cleanliness and antibiotic ointment are in order. Now might be a good time to have waterproof boots. Bandaging should have a slick top to reduce additional damage, and moleskin can be built up around the edges to keep pressure off the wound.
This is how you use moleskin to reduce friction on a spot developing or with a blister.
Nail blackening
When the toes push up against the front of the toe box, the nail being pushed backwards can cause bleeding under the nail. It starts out deep red but turns black over days. If enough of the nail bed is affected, the toenail will eventually fall off. This happens more when shoes don’t have enough room in the toes but can happen with good shoes if you have to walk downhill a lot.
Downhills do this to nails even with good boots. It’s not painful and not really a problem.
Blisters are a problem; but nail loss is not a troublesome issue. If you keep the nail trimmed so it doesn’t catch on things, it doesn’t tend to cause pain or more damage while growing out. A new nail will replace it, eventually. You wouldn’t want foreign matter getting under the nail while it’s in the ‘turned black but not yet fallen off’ stage. I put a small bandage over one of mine for a few days during that stage, which worked well.