Causes of Toe Tip (Pinch) Blisters
Pressure from shoes or other toes
These are similar to the tops of the toes blisters, the causes of both are similar in origin and hence the prevention of as well. These incorporate the pinching of the end of the toe blister too, where the ends of the toes get pinched by each other or the shoe and the next toe. The ends of the toes are getting too much pressure, this Is due to the retraction and curling of the toes.
Incorrect toe formula
Inherited – you inherit your foot shape from parents and grandparents, sometimes you can inherit an incorrect toe formula. What that means is your lesser toes can look too long in comparison to the big toe but actually it is probably the metatarsal shaft of the big toe that is too short making the lesser toes look longer. However that doesn’t really help you!
Shoes don’t fit your foot shape
When buying shoes the shoe manufacturers make shoes with a toe box shape for the perfect toe formula ie Big toe is the longest the 2nd to 5th in descending order. In practice, feet rarely present like that. With those statistics, the longer lesser toes touch the end of the shoe first before the big toe and they buckle and retract, like the pictures above. By doing this the depth of your toes ( ie looking at your feet from a sideways angle) have increased and touch the top of the shoe and the ends of your toes contact the floor creating a huge amount of pressure.
Unstable gait and balance
Biomechanics- if the foot is unstable at certain parts of the gait cycle then the toes will retract and grip in an attempt to try and keep the foot more stable, again by retracting, the depth of the toes has increased and touching the top of the shoe, which then increases the pressure on the ends of toes.
Pinching from the toes themselves- sometime the toes curl at the ends more than retracting and the ends of the toes can produce sharp edges of skin that will, under pressure, blister.
Tendon dysfunction- this is where one set of tendons become stronger than another set and consequently the balance of the toes sitting straight changes, a bit like a pulley system of ropes.
Prevention of Toe Tip Blisters
Wear the correct size and fit of footwear
Footwear – shoes, boots with more depth and that are long enough at the front of the shoe
Reduce moisture and friction
Wicking socks – Darntough socks are my sock of choice as they wick the moisture away from the skin, cushioning underneath which will also reduce the shear and have a lifetime guarantee
Wear individual toe socks
Injinji socks- are socks that also have wicking properties but have individual toes sections to put each one of your toes in, these help by propping your toes slightly, this may be enough to stop the blister formation at the ends of your toe?
Lock laces to prevent foot sliding forwards
Lace locking– keeps the foot from moving around in the shoe. Repetitive slipping makes the foot unstable and then the toes want to grip, increasing the pressure then shear which cause blisters.
Use toe props and bolsters
Toe props- these are custom made to prop the toes from underneath and straighten them and reducing the pressure on the ends of the toes , they are made by a podiatrist as they will be a custom made fit to your feet. These can help address the pressure caused by hammer, claw and mallet toes.
See a podiatrist
Biomechanical assessment with a prescription of orthotics – to establish the cause of the retracted toes, by a Podiatrist
Use blister prevention patches
Engo patches on the end of the insole of the shoe to help with a reduction of friction
Wear anti-blister socks
Armaskin socks– decrease the shear on all of the toes (link to armaskin)
Wear toe sleeves
Silicone sleeves -are ok for one toe but can be too bulky with any more in the shoe and they would need to be the ones with ends in. (picture of the end in silicone sleeves)
Use blister prevention powder
2toms blister powder which will reduce the friction to that area
Taping is tricky to do yourself but like everything else it gets easier the more you do it. It is very important that there are no creases in the tape as that in itself can cause blisters! The type of tape is important. The rigid tapes disperse the shear more but crease easier so I always prefer hyperfix, which is a medical tape we as podiatrists use all the time as we can manipulate the tape with minimal creasing. They can have a semi compressed felt toe prop to be incorporated in to the taping, for pressure and friction relief. For tape to stay in place it is better prepped with skin tac, which keeps it in place longer, even when the foot sweats.
Do not apply tape around toes with tension as this may restrict blood flow if the toes swell.
Apply cushioning between the toes
Alpaca wool- this is extremely soft and has virtually no lanolin content, weave the wool around the toes, in a figure of eight fashion and then put your sock on. Animal wool has been in and out of fashion over the years but I think it works really well at helping prevent these blister. Just remember to remove it at the end of the day. Do not use on a roof torn or de-roofed blister
Treatment for Toe Tip Blisters
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.