Friction Blisters Treatment & Management

Updated: Apr 20, 2020
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Treatment

Medical Care

Management of friction blisters includes sterile drainage of the site while leaving the blister roof intact to serve as a dressing. This method helps relieve some discomfort and protects the site from superinfection. A donut of moleskin may also be applied to minimize additional trauma to the blister and to relieve discomfort. If the blister roof is already fully or partially removed, treat the site as an open wound with appropriate antiseptic and surgical bandage application. Hydrocolloid dressings have also been proven to decrease discomfort and encourage healing. Some recommend debridement of the skin of the blister, the use of a topical containing nitrofurazone, and the application of a bandage. [16]

Optimal therapy for blisters after prolonged walking is unclear. [17] A study compared two different regimens, wide area fixation dressing versus adhesive tape, evaluating 907 participants in Holland (aged 45 ±16 years, 52% men) who received 4131 blister treatments. [17] Owing to diminished effectiveness and satisfaction, use of wide area fixation dressing was not favored over adhesive tape for routine first-aid treatment for friction blisters.

Prompt attention to friction blisters is important to prevent the development of secondary impetigo with possible cellulitis and sepsis. Institute appropriate systemic antibiotic therapy if impetigo develops. Use of povidone-iodine solution (Betadine) may be beneficial. [18]

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Prevention

Foot blisters, caused by frictional forces, can be prevented by wearing properly sized boots, conditioning feet through regular road marching, wearing socks that reduce friction and moisture, and possibly use of antiperspirants to the feet. [19] Increased cutaneous surface hydration enhances the rate of skin temperature change and the risk of blister formation. [20] Prevention of friction blisters has focused on antiperspirant agents and appropriate footgear. [21, 22] Antiperspirant agents decrease the likelihood of developing friction blisters, but their use is confounded by a high incidence of irritant contact dermatitis. Since increased skin surface hydration may be a risk factor for blister formation, a product that lowers skin hydration might be useful. Three different preventative foot blister commercial products were tested on 30 apparently healthy adults. Only the powder product was beneficial. [23]

The incidence of friction blisters on the feet may be somewhat decreased by the use of neoprene insoles, acrylic-based socks, or thin polyester socks combined with a thick wool or polypropylene sock that can maintain its bulk in the presence of moisture from sweat and compression. [24, 25, 26, 27, 28] Appropriately fitted shoes also are helpful in the prevention of friction blisters.

Friction blisters, which occur when shear loading causes the separation of dermal layers, were avoided when a triglyceride lubricant with T-shirt knit cotton was used. [29] The results of such textile and surface treatment performance are of value.

Sock fabrics may have distinct moisture properties when tested in a realistic military setting. One pair of socks 99.6% polypropylene and 0.4% elastane was compared with a blend of 50% Merino-wool, 33% polypropylene, and 17% polyamide, one on each foot. In this study, the blend stored almost 3 times more moisture, making it more desirable that the polypropylene socks. [30]

Paper tape was not found to be particularly protective against blisters in marathoners, although this intervention was well tolerated and had high user satisfaction. [31]

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