Jewish World Review May 6, 2003 / 4 Iyar, 5763

To pad or to pop? Here's the lowdown on blister treatment

By Marlene Cimons | There is one perfect method for preventing blisters when playing any sport: Stop midway, take a shower, dry your feet and change your socks.

Perfect, yes, but not at all practical. Unfortunately, we don't live in a perfect world and blisters may always be the bane of athletes. They can be annoying and painful, and certainly can ruin a good workout or a long walk. But most of the time, blisters are nothing more than a temporary nuisance.

They are caused by friction -- something rubbing against the exterior of your skin -- and exacerbated by heat and moisture. For runners in particular, whose feet may get wet either through perspiration or by running through puddles, the situation worsens. This helps explain why many runners suffer blisters only during races, especially marathons. They're perspiring more, running faster and often longer, sloshing through water stations -- and, if it's warm, pouring water over their heads.

The body responds to the friction by producing fluid that builds beneath the part of the skin being rubbed, causing pressure and pain. A blood blister occurs when the friction actually causes the skin to bleed. The most vulnerable parts of the foot often are the back and bottom of the heel, and on the toes and under the toenail, the infamous "black toenail.''

While most blisters don't pose a serious health risk, they nevertheless should be treated with respect. A painful blister, when treated carelessly, can become infected and put you in the hospital.

If you try to "pop'' a blister by pricking it with an unsterilized needle, you're asking for trouble. If you're going to drain a blister yourself, clean the needle with alcohol first, or boil it. Both methods will make it sterile. Don't put the needle in a flame; you'll put carbon particles into your skin, and you could have a reaction because you've introduced a foreign body. Just wipe the needle with alcohol, punch a hole, and squeeze the fluid out. Then put on a tight bandage.

You can take the bandage off periodically and bathe your foot; soaking in Epsom salts helps, says Dr. Sheldon Laps, a foot surgeon and podiatrist in Washington, D.C. But put the bandage back on. It's important to keep the area clean and covered. "It's a good idea to keep the bandage on until the skin tightens up again,'' he says.

Another thing to keep in mind before you reach for that needle: The environment under the skin where the fluid has collected is sterile. Before you try to drain it, consider just leaving it alone. That approach will avoid the risk of infection. You can cut a hole in the middle of a piece of moleskin -- the hole is to accommodate the blister -- place it over the blister, then cover it with gauze.

Once you puncture that sterile environment, bacteria can get in; thus, it's a good idea to remove the entire layer of skin so you don't have a pocket of dirty fluid underneath.

A blister under a nail is best treated by a professional. "If it's under the base of the toe, we take an electric file and drill a hole,'' Laps says, adding that "you don't ever want to deliberately remove the toe tail.''

Don't try to drain a blood blister (a blister that obviously contains blood in the fluid). That increases the risk of bacteria entering the bloodstream. Again, let a professional treat of it.

To prevent blisters, experts recommend that you maintain good foot hygiene at all times. Use skin creams and lotions liberally and regularly to maintain proper moisture. Wear acrylic socks rather than cotton. Acrylic wicks moisture away from the skin. Cotton may be lighter, but it retains fluid.

Socks with reinforced heels and toes also help. You might try wearing two pairs of socks so the friction occurs between the two socks rather than between the sock and your skin. And try wearing your socks inside out so the seams don't rub against your toes.

Avoid competing in wet socks, and do wear shoes that fit well. Shoes that are too short will cause blisters under the toes and on the ends of the toenails. Anti-skid pads in the shoe will help keep the foot from sliding or cramming into the toe box.

Before you compete or engage in a hard workout, coat the skin of your feet with petroleum jelly or another lubricant to help decrease friction, or use a a tape similar to "bubble wrap'' that stays on even when wet and serves as an interface between the shoe and your skin.

Some people put little circular bandages or special artificial skin products that act like an additional layer on areas of their feet prone to blisters.

One ultra runner swears by the following method: She lubricates her feet with petroleum jelly, puts on a pair of ankle-length nylons (what we commonly call knee-highs), then puts regular sports socks on top of those. It has worked for her for years, she says, although she advises men to buy "queen size.''

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