Blisters Under Your Heel

Causes of heel blisters

These are really miserably painful and quite capable of making you limp as they tend to be quite large in size.

Usually presents with heavy heel strikers where the angle of the heel as it contacts the ground is different when running than normally walking. As the length of the stride increases, then the force going down your leg through the heel into the floor will increase along with force back up into the foot. Force is pressure, which as we know increases shear of the skin causing blisters. This could be exaggerated through wearing a heavy backpack, which also increases the force through the leg and foot.
The same effect can be achieved by wearing high heeled dress shoes, which definitely alters the way you walk and changes the forces going through the foot. I think we have all noticed how differently people walk in heels than without? Stiletto heels leave their mark in soft flooring, even wood, showing how much pressure can be going through the heels when walking.
Manufacturer labels in the sole of the shoe that is ever so slightly raised in comparison to the surrounding surface, which with repetition will increase the friction levels then consequently increase shear then blisters.
Too much movement going on with the foot in the shoe, where the foot is not retained properly in the shoe, which then causes friction, pressure and with repetition- shear- blisters.

How to prevent blisters under your heel

Changing the way you walk, sounds difficult but actually with practice it is quite achievable. Shortening your stride length, when walking or running will decrease the amount of pressure going through the heel. This will take time to change and is not be done before an event as this will change not only your heel strike but other joints and muscles but over time gently changing your technique will have a positive effect on the pressure on the heel during heel strike. A physio or podiatrist will be able to talk to you about retraining your gait.

Softer insoles like poron, which is a memory material designed to increase shock absorption in walking. Podiatrists have used this material for years for the management patients who have Rheumatoid Arthritis and similar conditions, which leaves the joints inflamed and extremely painful, so decreasing the pressure applied to an area is what poron is designed for. Decreasing pressure decreases shear and therefore blister production. if there is not enough room for a full insole then it can be cut and just used in the heel area. Always to be used in both shoes, so one leg doesn’t become longer than the other

Engo patches applied inside the shoe on the area that correlates to the blister on the foot. Sometimes only a small patch is enough or if the blister covers a large area then the whole of the heel part of the insole will need to be covered with the patch. Engo patches reduce the friction- reduces shear- reduces blister formation.

Lace locking of walking boots and trainers- This keeps the heel in the back of the shoe, preventing the excessive movement of the foot in the shoe decreasing the repetition of movements, decreasing shear and decreasing the production of blisters.

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

2Toms blister shield powder is also a great way of reducing friction levels under the heel either in the sock or sprinkled onto the shoe insole

Wicking socks -these are socks that wick the moisture (sweat) away from the skin hence keeping the foot dry. We know that wet feet cause an increase of shear which in turn causes blisters.

Taping- This another option to prevent blisters if all of the above preventions fail to solve your particular blister, soft or rigid tape can be used but using skin tac to prepare the skin is essential as the taping needs to stay in place, if it crinkles or starts to pull away at the edges then it will cause a blister.

Treatment of under heel 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.