Author Topic: Blister treatment  (Read 12395 times)

adi

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Blister treatment
« on: September 20, 2013, 03:39:28 PM »
I have recently been asked another emotive question. How to treat blisters.

The best advice is prevention is better than cure. However from personal experience I know prevention is often not possible. Especially if you are new to walking or doing larger distances than normal.

The first thing is to break in your feet. Once your feet have been toughened up you are less likely to get blisters. There are many ways to try breaking in your feet, including peeing on them and soaking them in white spirits. I suggest you don’t bother trying these. I suggest taping your feet with a good quality Zink oxide tape. Good quality tapes can stay on the skin for weeks, will not bunch up and breathe.

Secondly get good quality footwear that fit well after spending hours walking; your feet will swell up. Make sure they will accommodate your walking stocks. Take time to break in your footwear. I try to stay away from goretex lined boots because goretex boils your feet in a bag. Your feet cant breath and get moist with perspiration leaving you prone to blisters.

Thirdly is your socks. There is lots of advice about socks, such as wearing thick socks or wearing two pairs of thinner socks. Personally I have tried both and don’t like either advice. I prefer a medium thickness ankle sock preferably made of wool. 

And finally we come to foot care. The most important thing I have discovered is to adjust your boots on the fly. People I walk with get upset because after a mile or so I will stop and retie my boots. In most cases I retie them a lot looser than they were. Change your socks daily and don’t sleep with socks on. Your feet need time to cool down, dry and air. At the end of each day remove your boots and socks wash your feet or if in snow rub your feet into the snow. Then the most important bit is let your feet air dry. This is invaluable and I have found it to work everywhere from the high arctic to the tropical rain forest. Air your feet for at least 15 minutes to help them dry out and cool down. Then sprinkle some powder on them.  Best is an antiseptic talc but don’t waste your money on expensive medicated foot powders. Never talk your feet in the morning this only attracts moisture and germs.

There is a view that you must keep your feet dry. This has led to goretex lined boots and waterproof soaks. It should be allow your feet to breath. Footwear made of a natural material that cam breath is far more effective than manmade materials that attract and hold moisture. Saying that though many approach shoes are made of aqua phobic materials that reject moister which are great but sadly many use goretex inners. If you use these try to find a foot bed made of cork. Cork is natural and is less likely you become slippery when wet stopping your foot sliding around inside the footwear causing friction blisters or de-gloving of the sole of the foot.

If you get a blister, the advice says you should not drain it or remove it’s roof if intact. However I have found it is best to drain the blister, leave the roof intact and tape it with a good quality zinc oxide tape. One the tape is on leave it on, don’t try removing it; it may well rip off the roof of the blister. If the blister fills up again then drain it through the tape. I carry Hypodermic needles in my kit for this reason. 

If the blister has de-roofed then clean the area and carefully cut away any lose skin. Cut a piece of gauze that will fit in the socket left by the blister and then tape up. The gauze will stop the tape sticking to the floor of the blister.

I try to make the above treatments one off treatments. I.e. I am aiming for the taping to stay on for the length of the trip and for a couple of days after the trip. The blister will start to dry out and white blood cells will start to protect the blister, gauze and tape from infection. Whereas if I were to remove the tape, I have the possibility of tearing weak tissues, introducing infection and generally effecting my general wellbeing.

It is still important to air dry and power your feet every evening though, even when covered in tape. 

Ok this flies in the face of all the medical advice however that advice is for treatment in a hospital or more correctly a civil environment. When you are on the hill you need to promote recovery whilst limiting pain and discomfort to allow you to get home.

This is what I do; I do not teach this on my expedition courses however I do discus the many options beyond medical advice. If you choose to follow the above that is own risk and I am in no way responsible. I posted this as information only to invoke thought and conversation.

If you are interested on what medical advice has to say on the subject it can be read here  http://www.nhs.uk/Conditions/Blisters/Pages/Introduction.aspx and because this is best practice this is what I would have to teach you on one of my courses. 

How do you treat blisters?
   
« Last Edit: September 20, 2013, 09:30:46 PM by adi »
"We do not belong to those who only get their thought from books, or at the prompting of books - it is our custom to think in the open air, walking, leaping, climbing or dancing, of lonesome mountains by preference, or close to the sea, where even the paths become thoughtful." Friedrich Nietzsche

Callum

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Re: Blister treatment
« Reply #1 on: September 20, 2013, 04:19:28 PM »
Prevention, as you say Adi, is everything, as it is for safety and well-being in all outdoor activities.

Yet, every week, the centre welcomes youngster with newly bought, never worn before boots, some with totally inappropriate footwear or nylon socks to those who, on an excursion, quietly decide to be trendy and remove their socks – never quite figured this last action out? All this despite very clear instructions to their guardians about what to bring, in some instances at no extra cost to those who care for these youngsters, however, still they come unprepared.

We do our best to kit them out properly and never at risk to themselves, however, with a summer throughput of some 200 11-18 year olds every week I feel somewhat qualified to talk about this subject as it is the single most common injury we encounter at the centre.

The following is the treatment regime we have devised, over the years and is as near perfect as we can get it – any new ideas most welcome, so thanks for posting Adi :)

1. Sterilise a safety pin – not a pin as people are less frightened on safety pins – by passing it over a lighter flame.
2. At the edge of the blister make a small pin prick inserting the needle parallel to the skin
3. Using a sterile gauze gently drain the fluid, never touching the blister with your fingers
4. Clean the blister by spraying of chlorohexidine on it and use no friction
5. Allow it to dry and gently apply a thin layer of Salvalon using gauze
6. Cover with circular bandage – the new Compeed oval shaped plasters cover the entire blister and mould around the foot to give protection.

Notes
For large blisters we apply thin sterile gauze before applying the plaster.
For underfoot blisters we use a ring cushion plaster, again Compeed underfoot plasters have proven the most effective.

adi

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Re: Blister treatment
« Reply #2 on: September 20, 2013, 04:42:22 PM »
great advise their Callum. And your circumstances of caring for young people means you need a very transparent policy because your duty of care is that much higher.

May I make a suggestion?
Clean the area with a sterile wipe before puncturing the blister and maybe clean the safety pin with it too.
My only other concern is the use of Salvalon but I am sure you mention Salvalon in your parent packs which they must sign before the the young people are handed over.     
"We do not belong to those who only get their thought from books, or at the prompting of books - it is our custom to think in the open air, walking, leaping, climbing or dancing, of lonesome mountains by preference, or close to the sea, where even the paths become thoughtful." Friedrich Nietzsche

Pete McK

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Re: Blister treatment
« Reply #3 on: September 23, 2013, 09:50:32 AM »
Thanks for this really instructive and helpful thread Adi, good advice. On out geography field trips we encounter the same issues as you have at the centre Cal, only lower in numbers, yet with the same results, so I have already copied out your excellent 6 point treatment plan to put onto laminated cards for the supervisors on these expeditions.

Adi, how would you recommend cleaning the wound before puncturing the blister?

Callum

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Re: Blister treatment
« Reply #4 on: September 23, 2013, 11:54:26 AM »
Cleaning the area first is probably a good idea Adi. The reason this was not done was when we drew up our 6 point treatment plan - thanks Pete ;) - we applied an iodine solution to cleanse the area afterwards using sterile gauze. However, we now use a chlorohexidine spray, negating the necessity to physically touch the area; therefore we will now incorporate your recommendation into our 7 point treatment plan.

Hope this answers helps you too Pete.

adi

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Re: Blister treatment
« Reply #5 on: September 23, 2013, 12:53:59 PM »
Hi Pete To clean the area I would use a none alcohol sterile wipe however with a child with an open blister I suggest you do not touch the raw exposed area of a de-roofed blister with the Sterile wipe else the child will scream, hit the ceiling and run for the hills never to be seen again. It can smart a little. Clean the area around and away from the blister site.

Callum's 6 point plan is excellent for working with kids. Personally I would and do carry and use sterile hypodermic needles for this sort of treatment. Although I know some people are scared of needles and they are an added expense as well as an issue with safe disposal. 

 
"We do not belong to those who only get their thought from books, or at the prompting of books - it is our custom to think in the open air, walking, leaping, climbing or dancing, of lonesome mountains by preference, or close to the sea, where even the paths become thoughtful." Friedrich Nietzsche

Pete McK

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Re: Blister treatment
« Reply #6 on: September 24, 2013, 10:20:06 AM »
I have run this past the school's first aid folks and it is now approved for our field trips - thanks boys :)

PS First aid folks said it was the best advice they have seen!

Hugh Westacott

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Re: Blister treatment
« Reply #7 on: September 24, 2013, 10:57:17 AM »
I always carry a metre of so of duct tape wrapped round my water bottle. I have sometimes cut off a piece and used it to secure a dressing more firmly.

Hugh

Callum

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Re: Blister treatment
« Reply #8 on: September 24, 2013, 12:14:10 PM »
Afraid I don’t agree Hugh.

Duct tape is a really handy piece of kit which I too routinely carry BUT it should never be used in direct contact with human skin, as the adhesives have not been tested for this use, unlike medical dressings and bandages. In some people, adverse skin reactions can be serious, so be safe and use only plasters and medical adhesive tapes.

adi

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Re: Blister treatment
« Reply #9 on: September 24, 2013, 04:18:18 PM »
Good advice Callum. I use and carry duct tape in my kit and I teach it use in austerer medicine but it can cause some very nasty reactions to some people.
 
"We do not belong to those who only get their thought from books, or at the prompting of books - it is our custom to think in the open air, walking, leaping, climbing or dancing, of lonesome mountains by preference, or close to the sea, where even the paths become thoughtful." Friedrich Nietzsche

Hugh Westacott

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Re: Blister treatment
« Reply #10 on: September 24, 2013, 04:47:24 PM »
Thanks for the advice! I've never had any problems using it either on myself or on others but I shall be more circumspect in future.

Hugh

Lyle Brotherton

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Re: Blister treatment
« Reply #11 on: September 24, 2013, 05:16:21 PM »
Terrific posts! I have personally learned loads from this Forum, thanks guys
“Opinion is the medium between knowledge and ignorance” - Plato

captain paranoia

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Re: Blister treatment
« Reply #12 on: September 24, 2013, 06:56:15 PM »
Regarding duct tape, our first aid instructor recommended it over micropore or zinc oxide tape, saying that it had been found to cause fewer allergic reactions.  Zinc oxide is, apparently, quite poor in terms of allergic reaction.

Hugh Westacott

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Re: Blister treatment
« Reply #13 on: September 25, 2013, 08:42:16 AM »
I'm intrigued by the discussion on the use of duct tape for securing dressings over blisters and wounds. There is quite a lot of information on the internet including http://firstaid.ygoy.com/2010/07/20/using-duct-tape-as-first-aid-tape/ http://www.instructables.com/id/Duct-Tape-in-your-First-Aid-Kit/step3/Tick-Removal/ that advocate the use of duct tape in first aid, but a quick search has failed to find any mention of allergic reactions.

It is understandable that Callum and others who work for outdoor organizations have to follow specific first aid guidelines, but I wonder if there is any evidence, as distinct from hearsay, that the use of duct tape on unbroken skin can cause serious problems.

A significant proportion of the population is allergic to something. In my case it's penicillin, and I once worked with a man who claimed that he was allergic to himself which must have been very distressing.

Hugh

Lyle Brotherton

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Re: Blister treatment
« Reply #14 on: September 25, 2013, 11:08:50 AM »
I have a strong sense of Déjà vu, or as the French would say, already seen ;)

A posting you made Hugh, about the incidence and cause of accidents in the outdoors, along the lines of nothing had ever happened to you or your party, to which I replied:

My late father saw active service in WWII, smoked from the age of 15 years, drank more than his weekly allocated units of alcohol, never wore a car safety belt and had a diet so high in saturated fats if it had been a film it would have had an X rating, yet he soldiered on until into his 80’s and I am very pleased that he did. Yet just because he survived these high risks, does not mitigate against precaution based upon sound evidence. This evidence, based upon good empirical science and statistical analysis, is the only sensible premise upon which we should act not individual anecdotes or the exceptions to the norm. Just because something has not happened to an individual, does not alter the risk of it occurring. Prevention should based upon sound evidence and this evidence derived from good science and statistical analysis.

Pharmaceuticals, medical devices and surgical dressings (which includes over the counter bandages and plasters) are rigorously tested and for good reason.

I firmly believe, as forum members, it is our collective responsibility to always advocate best and safe practice. Therefore, duct tape, Selotape, gaffer tape or plumbers glue should never be used in First Aid where it is in contact with human skin.
“Opinion is the medium between knowledge and ignorance” - Plato