Blisters on the Top of Your Toes

Toe BlisterCauses of Blisters on the Top of Your Toes

These blisters develop quite quickly as the skin is slightly more delicate than elsewhere on the foot and the progression to the roof off blister can be quicker too!

They are caused by Hammer, Mallet or Clawed toes which when the toes retract and they easily catch on the top on the top of the shoe.

Why do toes change shape like this?

  • 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! 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 second toe touches the end of the shoe first before the big toe and they buckle and retract, . By doing this the depth of your toes ( ie looking at your feet from a sideways angle) has increased and touch the top of the shoe.
  • Biomechanics- if the foot is unstable at certain parts of the gait cycle ( in biomechanical terms) 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 toes.
  • 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

Wear the correct size and fit of footwear

Footwear – shoes and boots that are long enough so the toes don’t touch the end of the shoe and are deep enough so that he tops of the toes don’t get rubbed.

Reduce moisture and friction

Wicking socks – Darntough socks are Blisterhelp’s sock of choice as they wick the moisture away from the skin they are cushioned underneath which reduce the amount of shear applied to the underside of the foot and they have a lifetime guarantee

Wear individual toe socks

Injinji socks- are socks that also have wicking properties and have the five toe formula essentially a sock for each toe, this helps by slightly propping up the toes, this may be enough to stop the blister formation at the ends and the tops of your toes.

Lock laces to prevent foot sliding forwards

Lace locking– stops the foot from moving around in the shoe too much.This excessive movement makes the foot quite unstable, in response to this, the toes retract (curl) to grip which increases the pressure on the ends and tops of the toes leading to blisters

Use toe props and bolsters

Toe props- are Podiatrist made silicone toe props to help straighten the toes which then reduces the pressure on the ends of the toes, they are custom made fit to the toes These really help 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. Book Now.

Use blister prevention patches

Engo patches applied to the end of the shoe insoles to help with a reduction of friction

Wear anti-blister socks

Armaskin socks– decrease the shear on all of the toes

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.

Use blister prevention powder

2toms blister powder which will reduce the friction to that area

Try toe-taping

Taping of the toes- 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! and the type of tape, 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.

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

Toe Blister Treatment

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.