Causes of heel blisters
Well these are the most common blister of the heel blisters and can be really painful, they take longer that other areas of the foot to heal, so they can hang around for weeks.
The shape of your heel bone - Haglunds deformity, where extra bone grows at the back of the heel and can cause bursitis, with irritation, making it even larger in size and will therefore get increased pressure at the back of any shoe causing increased shear of the tissues and blisters This condition needs to be diagnosed first by a podiatrist and confirmed by x-ray to decide on the best treatment protocol for you, maybe wearing softer back or open back shoes, stretching the calf muscles or orthotic prescription to control the excessive movement and irritation at the Achilles calcaneus insertion. Surgery would be the last option to remove the excess bone.
An early heel raise (lift) when walking, which will increase the repetition and pressure from the back of the shoe when walking or running. This problem can be caused by a Biomechanical issue like a tight Achilles tendon, tight calf muscles, which causes the heel to lift earlier and with more height than it should in the gait cycle. Simple stretches to the calves and hamstring can be enough to change that problem, otherwise heel raises might be simple solution to that problem. Physiotherapists and podiatrists are both really helpful professional’s to confirm and treat this functional issue.
Footwear can also cause blisters at the back of the heel, some shoes and boots can exert too much pressure and or friction at that point of the heel, and some brands can be very hard and unforgiving with their material choice. Always go shoe and boot shopping at the end of the day when your feet are warm and maybe a bit larger than the morning, if they don’t feel comfortable then walk away as they are not right for you. Take the socks that you always use for your chosen activity so continuity is a constant, everyone makes mistakes with shoe and boot shopping even podiatrists! However, we learn and try not to make those mistakes again?
Heel lifts prescribed by podiatrists
Lace locking- for shoes and boots, essential for keeping the heel retained in the back of the shoe, stopping any undue movement of the heel, with an early heel lift. Such a simple technique that can make such a difference to the prevention of heel blisters.
Engo patches to reduce the friction from the shoe
Armaskin socks- a silicone liner sock that sticks to the skin and prevents any friction that is occurring between the socks and the skin, you would then wear your normal wicking sock over it.
Wicking socks- these are socks that wick the moisture away from the skin. We know that wet skin increases shear and causes blisters.
2Toms blister shield powder is also a great way of reducing friction levels at the back of the heel link to 2toms blister shield
How to tape the back of your heel
Taping of the back of the heel works for some and is the cheapest prevention option. It doesn’t always have the success rate as the other options but if it works for you then that great news, and it may reduce the amount or severity of blisters you have. There is a technique for applying tape and if not put on correctly it can cause more blisters!
How to treat heel blisters
All of the treatments of heel blisters will need deflective (donut) padding if this problem arises in the middle of your activity, keeping the pressure off that area that has blistered, so it doesn’t repeat.
Wearing open backed shoes either flip-flops or clogs, reducing the irritation to that area whilst it tries to heal, this of course will be weather dependent?
What is a blister "hot spot"?
Hotspot - If you have recognised a hotspot on the skin in time before a blister has developed then a simple island dressing will be enough to reduce the shear on the skin and hence reduce the blister from forming further and if you have them, apply an engo patch on the insole as explained in the prevention of blisters. Deflective padding works really well here to reduce the pressure on the joints.
Treating Bubble blisters
Bubble Blister - If the roof is still on then treat it in a similar way to a hotspot on the skin, by applying a sterile island dressing, if the blister bursts (pops) when the dressing is on, then you know the dressing is already sterile and will prevent an infection from getting into the open sore. If you decide to pop the blister, then follow the instruction on “how to pop your blister” and treat it as a roof torn blister. Use an Engo patch applied to the insole with deflective padding applied to the feet.
Treating broken blisters
Roof torn blister - now this type needs its roof (skin) to stay in place, the roof may be broken but your own skin is still important for healing, so use a sterile saline swab to clean the wound first, then apply the povidone iodine stick over the torn area as an antibacterial action and apply a sterile island dressing. A deflective pressure relieving padding as shown in the video to prevent any further pressure and friction.
Treating "popped" blisters
Roof off blister - Hydrocolloid dressing is the only option for this stage of blister, swab the area with saline to make sure the wound is clean and dry before applying the hydrocolloid, add extra hyper fix tape to anchor it down and apply deflective padding if continuing an event or activity. Hydrocolloid dressings are great wound healers and Podiatrists have been using them for a long time in the management of ulcers, with great success. They are not used at any other stage of the blister treatment and can cause blisters if not applied at the correct stage. I like to use some fleecy foam padding over the dressing as it just gives a bit of cushioning to the blister area, which is always very painful.
Treating infected blisters
Infected blister this is the stage of blister that you need to recognise quickly, a bacterial infection has invaded the blister and it could look red, swollen, there may be yellow or green pus in the blister and it could smell? Extending into the skin around the blister might be red and hot with red lines tracking away from the blister. You may feel unwell in yourself and swing from having the chills or feeling quite feverish. This is the time to get medical help as the infection can easily travel into the blood stream causing the infection to move into the leg and cause sepsis.