Big Toe Blisters
These are very common blisters and ones that we see in clinic a lot of the time, they are mainly due to a biomechanical issue, where the function of the big toe has been compromised and there is an increased amount of pressure on that area of the toe causing increased shear and blisters.
Engo patches on the insole of your shoes under where the blister is on the toe, if you are unsure where the toe is relation to a the insole, then put a fabric plaster on the toe that is affected by the blister, mark it with a permanent marker pen and put your foot back in the shoe, the black marker pen should rub off on to the insole. Accurately marking the area of pressure on the insole, you can put the engo patch on the marked area on the insole.
Poron insoles for the whole shoe, poron allows the big knuckle to work harder and therefore will require less demand of function of the smaller joint under the big toe to do the work, when walking. This really is the mechanics of the foot anatomy, which podiatrists know very well, that if one joint doesn’t work very well, the body will ask the nearest joints to it, to work harder, otherwise we wouldn’t be able to walk at all!
Silicone gel big toe sleeves. The sleeves are put over the whole toe, either with the end or not and they decrease the amount of shear applied to under the big toe.
Armaskin socks– again will decrease the shear on that area of the big toe.
Running shoes and boots are designed with a large shock absorbing sole and a slight rocker in that sole. What this means from a functioning point of view is the big toe joint can drop into the shock absorbing sole without the jamming from a hard floor surface , allowing it to increase its workload therefore in turn, asking for less movement at the area that is blistering. Less pressure- less shear- no blister formation. This is Biomechanics of the lower limb and with abnormal compensation, causing pain and issues with the feet and ankles.
A Biomechanical Assessment would be recommended by a Podiatrist if all the measures above have failed to resolve the blisters on the big toe. They will be able to establish why the joint is experiencing an increase of pressure to cause the blister in the first place, the podiatrist may be able to make a simple insole or a prescription orthotic to solve the Biomechanical cause of the blister. You maybe also experiencing ankle, knee, lower back and sometimes neck pain which could very well be caused by the big joint dysfunction. I know this sounds very odd but this is a perfectly normal presentation of symptoms for a podiatrist to see.
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. 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 link 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.