Armed Forces Blister Prevention

This is  some general information to help the armed forces personnel, having learnt a lot about armed forces  training, the conditions that they work in and the uniform, I feel the  armed forces personnel are more like elite athletes but often fail to see themselves in that way. I feel a shift in that belief could help the armed forces to help themselves in respect to injury reduction and blisters!

TIPs for the Armed forces

Shoes/Boots- the principle of wearing the best footwear you can afford still applies and this is the most important footwear that needs to be right as they will be the one item that gets you through the training and tours that you will do. Always make sure you get the boots/ trainers at the end of the day or after a period of activity as then your feet will have retained a bit of fluid and be slightly bigger in size, this should be the time when your boots/ trainers should fit properly. If your feet are slightly wider then buy a wide fit do not size up the length in the hope it will compensate for the width of a shoe, that never works and you will end up with blisters on the feet. Wear new shoes in over time, do not do a strenuous event with a new pair of boots or trainers. Once the sole of a shoe has worn excessively, especially in the heel area, this can put the foot at an odd angle during heel strike and can cause injuries of the foot and higher up the body. The shoes function and ability to shock absorb has also been lost due to excessive wear

Lace locking – Some boots have their own lace locking system around the ankle area of the boot and you might have not realised why it is there? Lace locking at the ankle joint is so important in the prevention of blisters all over the foot as it prevents excessive movement of the foot in the shoe/boot preventing high friction areas against the skin, going downhill is partially a problem for the ends of the toes as they can impact at the end of the shoe as the foot is moving forward too much. Please refer to the “how to lock your lace tutorial” for guidance on how to achieve this.

Socks – If you are prone to blisters then consider what socks you are wearing? Moisture wicking socks are really important as they wick the moisture away from the skin, decreasing the chance of blister formation. Cotton socks keep the sweat next to the skin of the foot and this will cause blisters. Merino wool and coolmax are materials that do this the best. I personally like Darn tough as they are guaranteed for life and although can seem expensive to purchase initially, they last for much longer than all other socks. I always think these socks would make great Christmas and birthday gifts from family that are not sure what you would like? They come in different lengths, thickness, cushioning underneath and are all seamless. Some people need a liner sock and a outer sock, this sock arrangement allows the friction to be taken up between the socks and not between the sock and the foot. The liner needs to be of moisture wicking material as well. Waterproof socks are only a good idea if the outside water is more than the sweat produced from the foot, if the foot sweat is more than the external water ie the conditions you are in then the foot will end up being macerated. This I covered in the macerated section. below

Fungal Infection/Athlete foot – these are tricky customers and can cause problems for the skin of the feet especially if the climate suits them, ie warm and humid conditions, they present as red patchy areas, sometimes with fluid filled bumps on the skin and can itch when warm. They become a problem when the skin is broken from all the itching and a bacterial infection can then sneak in and can cause cellulitis if the conditions are ideal. A large percentage of the population struggle with fungal infections. If a fungal infection is confirmed in the skin I feel the easiest treatment for anyone in the armed forces especially those touring in humid climates is Lamisil once, it is a gel that need to be applied to all areas of the skin on the foot, top and bottom and in-between the toes, kept dry for 24 hours and then the skin is fungal for between 4-8 weeks. This does need re- applying as the problem is always there and I just needs managing. Treatment of the skin will help prevent the fungal infection affecting the nails.

Maceration of the foot/Trench or festival foot- This is where the skin of the foot become saturated with water often resembling a foot that has been in the bath for too long, the skin wrinkles like a prune. It is then more fragile and prone to tearing and blistering. Being in contact with water for long periods of time or feet that sweat a lot and cannot evaporate causes this problem. The skin ideally needs 24 hours open to the air to dry the skin, wearing flip flops allows this to happen. Wearing them in your down time is important, athletes do this all the time, when in camps on multiday events. The socks need to be dried out, preferably moisture wicking socks as in the sock section or use a liner sock like Armaskin that takes the moisture away from the skin. Allowing the boots to dry too is so important. Gaiters help to prevent water getting into the inside of the boot, so the boot remains dry. If you have the tough event kit then the materials needed to help macerated feet is already incorporated.

Cutting toe nails- if the toe nails are cut incorrectly or even torn then this will cause an ingrowing toe nail or even cut the next toe with a sharp edge of the nail. Nails do need to be cut straight across and filled to smooth the edges. Scissors and those small finger and thumb clippers often found in Christmas crackers are unsuitable and can often cause in growing nail problems. The nippers we use in clinic have straight or curved edge that close and meet together and then cut the nail with a straight clean edge. The smaller versions of our clinic sets are available on the website. If you have an ingrowing toe nail then soak the toe in a solution of table/sea salt and water for ten minutes, this helps to clean the toe and then dress it with a sterile antiseptic dressing. Book an appointment to see a Podiatrist and they will be able to treat it conservatively or to chat about removing the nail completely, with a local anaesthetic, which will sort the problem out permanently. This is not as bad as it sounds and is a better option than being on tour with a problem toenail that could hamper your duties. Correct cutting of the toe nails will help prevent that happening.

Under garments – There is no point looking after your feet in preventing blisters if they then the blisters present themselves in the groin or shoulders, use the blister prevention principles to the rest of the body.  Moisture wicking underwear is readily available from Runderwear, Rohan and Under- armour all have many options to choose from  as well as wearing undergarments next to your skin like long sleeve vests that have the same moisture wicking properties in preventing blisters and chaffing.

Pain the joints and soft tissues of the feet – Pain in the joints of the feet is often felt as a sharper pain and is present on weight bearing either from the start or it gradually builds up after a period of time. Soft tissue pain can be present all the time and increase in intensity if not addressed and treated. Both can be disabling and prevent the sufferer from performing any activity. Pain is there for a reason, it is a warning to seek help. Lower limb joint pain can be often be resolved by a biomechanical assessment and subsequently a prescription of orthotics (special insoles for the shoes) Soft tissue pain can also be treated with laser, shockwave and the help of orthotics to resolve the problem and help prevent a repeat. Consult a Podiatrist, who can easily diagnose any problem with the feet and help with a treatment plan to resolve whatever issue it maybe.

Silica gel sachets- Those small sachets of silica that some with everything you buy, keep them in a jar/ sealed plastic bag. They absorb 24 % of their weight in water, so when packing your kit for humid/wet climates, put these in with your damp garments in a sealed bag and they will keep your kit dryer.

KT Tape pro- if you are thinking of using this amazing tape then order the yellow colour as it is picked up better by the night vision equipment that you use.