San Francisco Podiatry Video

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Friday, April 16, 2010

To Pop or Not To Pop: Blister treatment for runners explained by San Francisco's Running Podiatrist



Dr. Oz recently ran a segment on his television show instructing his audience to pop blisters whenever they occur on the feet. He went on to explain that if you successfully get all of the fluid out, the top layer of the blister will form a adhere down to the tissue underneath and create a "biologic dressing."

While this may be sound advice for a typical healthy woman who gets a blister from a new pair of high heels, the real question for Bay Area runners is: "Should I drain a blister" if I am a runner training for a race such as a marathon or triathlon?

The best answer is "sometimes you should, and sometimes you shouldn't."

The medical term for the type of blisters on the feet when running are "friction blisters." Blisters on the feet occur from a combination of skin friction and pressure. When your foot slides around inside the running shoe, you get friction. Rubbing the skin over and over in one spot (such as the back of the heel or ball of the foot) causes the layers of the skin to begin to separate. Fluid then seeps into this newly created space between the layers forming the blister.

Keep irritating the area and the blister continues to get bigger. Even if you simply continue to apply pressure to the blister (like pressing it against the heel counter inside the running shoe) it will continue to get bigger. This is because the fluid will try to spread outward and keep separating the skin layers. Then even more fluid seeps in to make the blister bigger.

If you keep rubbing the blister long enough, the skin on the top of the blister will tear effectively popping on its own. The blister then starts to ooze relieving the pressure as the fluid leaks out. So should you take charge and drain it yourself?

What sports medicine podiatrists know about blisters in runners is:

1) small non-painful blisters heal quickly
2) large painful blisters hurt less if drained and not irritated, but hurt more and have a slightly higher risk of getting infected if they are drained and the activity (such as running) is continued
3) blisters with the overlying blister roof removed will heal, but hurt more initially

So If you are runner with a small blister on a toe and it doesn't hurt don't drain it. It will heal quickly and has a very low risk of infection. If the fluid can't drain out, bacteria can't get in. If you have a blister that is small, put a felt pad around the blister. You need a donut shaped or U-shaped pad for this to work. You need to put the pressure around the blister and not on the blister. This will stop all of the rubbing that could make the blister get bigger. It will also stop the blister from hurting.

If you running a marathon or competing in an Ironman triathlon and get a huge blister that makes it hard to walk after the race, drain it. You can do this by poking a small hole at the edge of the blister. Heat the needle or soak it in rubbing alcohol. This will sterilize the needle so that you don't introduce any infection causing bacteria when you puncture the blister.

Cover the blister with a bandage that will soak up the fluid as it continues to leak out. If the fluid starts to build up again, then repeat this process and drain the fluid again. Marathon runners with big blisters may have to do this a couple of times. The blister can be quite irritated after running 26.2 miles.

So what are the "exceptions to the rule" about popping or draining blisters in runners?

1. If you notice the blister at mile 13.1 and still have another half-marathon to go, don't pop the blister. This is where the advice from Dr. Oz doesn't fit with runners. If you drain the blister on your heel then continue to run, more fluid will seep under that skin. The skin will slide back and forth. If the drained blister skin slides around, it can't work as a "biologic dressing" because it never has a chance to stick to the underlying raw area. The roof of the blister may also tear. That is what happened in the blister pictured above. All of the rubbing of the heal inside the running shoe caused the blister to rip open. If the roof of the blister tears, it needs to be removed (called "de-roofing" by podiatrists).

If the blister is drained, you need to secure the overlying skin in place with a dressing. Wait until the race is over. If you drain it mid-race it will hurt like hell, there is a higher risk of infection and it will take longer to heal. You also need to wear a pair of shoes that won't rub on the raw blister after it has popped. So once you drain the blister, apply a dressing that will hold the skin securely in place. Change the dressing daily. Studies show that hydrocolloid dressings works best to bake blisters heal fastest. But there is NO evidence than antibiotic ointment helps blisters heal any faster.

2. All blisters should be drained, completely de-roofed and treated by a podiatrist if you are diabetic. The risk of infection is much higher in diabetics. A blister anywhere on the foot in a diabetic runner is a medical emergency. I have personally performed many amputation on diabetics where a blister became hugely infected and spread to the underlying bone. Seek immediate medical attention if you have diabetes and a blister anywhere on the foot, heel or toes.

Although it is easy to prevent blisters, they still often occur in runners. In fact research shows that blisters on the feet are by far the most common running injury reported among marathon finishers. If you get a blister on the feet, treat it right and it will heal quickly so you won't have to miss much training at all.

Dr. Christopher Segler is a sports medicine podiatrist in San Francisco with a focus on runners. He is also a marathon runner and Ironman triathlete himslef. He makes house calls all over the Bay Area to treat running injuries like blisters, stress fractures and Achilles tendonitis. If you have a question about a running injury you can email him or call (415)-308-0833 to reach him directly. For the best source of running injury prevention information in the San Francisco Bay Area, visit MyRunningDoc.com or AnkleCenter.com.

30 comments:

  1. Hi there, awesome site. I thought the topics you posted on were very interesting. I tried to add your RSS to my feed reader and it a few. take a look at it, hopefully I can add you and follow.

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  2. How should I treat a large blister while training? Is there a way to tape it up so I can continue running?

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  3. Hi Dave,

    If the blister is small you can buy some felt pads that are U-shaped or O-shaped. Just apply the pad so the blister sits in the depression. This will stop the pressure and friction to the sore blister. Just make sure the pad is not on top of the blister itself (this would more).

    If you get a large blister form running or cycling, taping can help by keeping the top of the blister from sliding around, causing pain, and potentially tearing. By keeping the area protected, it may allow you to continue to run, cycle or otherwise train. I

    When taping a running-induced blister on the foot, it is important to use tape this is VERY sticky like mole skin, tenoplast, or elastoplast.

    Just remember, don't every do this if you are diabetic.

    I hope this helps...
    Dr. Christopher Segler
    Doc On The Run
    Podiatry House Calls for Runners
    in San Francisco, Marin and the East Bay.

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  4. Hello,

    I think I have a blister underneath an already existing blister! What should I do?

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  5. A blister that occurs underneath another blister that is still healing can be frustrating, painful and an obvious interruption of your running. This sort of problem is unfortunately common among marathon runners and triathletes. Here is San Francisco I have seen many runners with chronic blister formation.

    Because running blisters result from excess friction and pressure, and you got another before the first one even healed, you have to determine the source of irritation so that you can prevent it from happening again.

    There are two main causes:

    1) wearing incorrectly fitting/improperly laced shoes
    2) training on hills or trails

    Most often, the cause is the former. If you haven't already done so, you should seek advice on fitting from you local specialty running store. Fleet Feet located in the Marina district of San Francisco would be a good starting point. The staff there can offer some advice on making sure this doesn't continue to become a problem.

    In dealing with the blister itself, it depends upon the size, how painful it is, your overall health and your specific goals.

    If you email a picture of the blister to appointments@DocOnTheRun.com I can post it with an explanation of the most common treatment options.

    Cheers!

    Dr. Christopher Segler
    Award Winning Foot & Ankle Surgeon
    6-Time Ironman Finisher
    www.AnkleCenter.com
    www.DocOnTheRun.com
    www.MyRunningDoc.com

    Stay Fit. Go Long. Run Fast. Be Strong.

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  6. Hi, thanks for the great information on this site! I read it last week, the day after I ran my first marathon, when I had multiple blisters on my feet. For some reason, I've been highly suceptible to blisters throughout my entire running career. One of my blisters popped at about mile 23 (and I thought I was in pain before that!). I used your advice on the remaining 3 and it's worked beautifully. 10 days later, I've noticed a lot of redness around the one that popped during the marathon. It's located between my big toe and the toe next to it, and runs down to the bottom of my foot. It's refilled a couple of times, and I usually drain it. I'm concerned about the redness around the area of the blister. Can it be infected? I've read various things online varying from "no big deal" to "death"... Google can be a very dangerous thing!

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  7. Hi, I have a fairly large blister on the ball of my foot. I have tried draining it, but only a small dot of fluid comes out. It hurts like no other. What should I do?

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  8. Just keep running - no pain no gain

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  9. Not really, only joking :)
    See main article - lots of sound advice in there already. Keep pressure off & keep clean if it pops.

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  10. just finished my first Ironman feet are shredded blistered red and swoolen and you know I dont give a dam smile everytime I look down !

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  11. My blister occured when I played soccer at a training practice for all week. What should I do if I dont want to really pop it,due to the infection risk. And it's only Tuesday darn it!

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  12. I'm not a runner, I just so happened to be looking for help before I decide to head down to the ER. I went walking last Tuesday to try to burn some calories (total 4 miles). My prize was self satisfaction, and a blister on my big toe, I didn't think much of it, I figured it would heal. A week later (now), It doesn't hurt, it's not swollen, cant feel any irritation, but the fluid / blood went from maroon to a dark almost black texture, I'm worried.

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  13. Hi, I have a fire ant bite and it's swollen. I just popped it and it's still swollen. What do I do? Will the swelling be gone by tommorow?

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  14. Hello, I've had a blister for about two weeks on the bottom of my heel. The outer skin tore and now it still isn't healing like a blister normally would. What do you reccomend to do?

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  15. ı have one not on my heel but ın the mıddle underneath my foot... can ı pop ıt? ı really need to??

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    1. If you email a picture of the blister to appointments@DocOnTheRun.com I can post it with an explanation of the most common treatment options.

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  16. I'm really glad I came across your site. It's very informative. I'm fairly new into running (about 2 years) and have done my first 21k last week.

    May I just ask if dry, cracked heels are best treated with foot cream and NOT removed or scrubbed with a pumice stone ?

    Also, I developed a small blister right on top of my cracked heel (both feet) after doing my last long run. It's quite painful. Should I wait for it to dry up before running again ? or should i just pop and drain it ?

    Thanks and hope to hear from you.

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  17. so many websites re: blisters but I can't find an answer for my problem. I developed a blister while ice skating that popped before I even removed my skates. that was 4 days ago. The area is very, very red (bright cherry) and SO sore. It's just below my ankle bone by my heel. I've tried bandaids, pads, you name it, but just the shoe sitting against it is agonizing, and i have a half marathon to run on Sunday! I haven't run at all since i got the blister (I can't!) and hate the thoughts of all this training being done only to not finish because of a blister that I got while skating! GRRRR! I have been running for almost 20 years and never have suffered from a single blister. This is so frustrating.

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  18. Hi! I got a big raw blister on my big toe after my longest run while training for a marathon. The blister popped and the skin tore. It is essentially the whole front underside of my big toe. I have been keeping in wrapped in a thin piece of gauze with neosporin when I have shoes on and leaving it exposed to the air when possible. Is there anything I can do to speed up healing so I can continue to train? I think I had a fold in my sock. Thanks!

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  19. I have a blister on the right side of my right big toe. I am training for a half marathon and am very close to the end of my raining, but still have one long run left. My blister is popped and I have a blister bandaid on it. Can I still do my long run that is in a couple of days and if so, should I put anything else besides the bandaid on it?

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  20. I have a blister on my heel and I have a track meet tomorrow. What should I do?

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  21. I popped a large blister on toe next to little toe. It healed over but is now swollen and painful and red. I will send a photo from my cell phone. Does it require an office call?

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  22. Hello Anonymous,

    Without seeing the blister, or understanding the extent of redness surrounding the blister, or the severity of pain from the blister, it is not possible to provide any recommendation on how you could treat the blister yourself. We would need to see a picture and then decide wether or not a remote consultation via phone or Skype would suffice. It might be necessary to be in a podiatrist's office. But without undertstanding how extensive the blister is, we cannot tell you wether or not a podiatry office visit is necessary to get the blister to heal quickly.

    Dr. Segler

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  23. Do you have an email that I can send the photo to?

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    1. I sent a photo from my cell phone about 3 hours ago. Please let me know if it didn't arrive and I will re-send. Thank you.

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    2. Hello Sally,

      I am sorry, but I never received your photo. You may want to check the email address. Unfortunately I will be unable to respond again until Monday.

      Best of luck.
      Dr. Segler

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  24. I've resent adding the caps in your address. Hope that helps. Thank you for the fine blog, Dr. Segler. I appreciate the thoughtful guidance.

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  25. hello dr. Seglar,

    it is very frusterating I do uphill training for cardio walking on treadmil high incline and outside hill training and long walks i tend to get blisers al ot and for some reason blood blisters sometimes. I think it might be my shoe? I am probably going to buy the shoe i used to buy all the time the m587 new balance running shoe it is bulky but good for my wide 4 e 11 foot. The funny thing is I bought another shoe same width, size and get more problems with that style. The m587 is more roomy and i guess I might need to go back to that. Right now it is odd I have what looks like a blister in the crese the ending side of my right big toe formed inside it looks. On the side right where you see the ending of the toe. it came one day and went and it looked like it came back again

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  26. What should I do I have a league meet tomorrow and I have two blisters in he bottom of my foot? Should I tape them or pop them

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