Blisters between the toes
Blisters between the toes (interdigital blisters) can be the most painful blisters of all. There are two types of blisters that could be classed as interdigital blisters:
- True interdigital blisters – blisters literally between two toes. These aren't as common as the next type - pinch blisters.
- Pinch blisters – blisters towards the bottom or end of the toe, common with adductovarus (curly) toes. The underside of the toe often takes on a triangular shape. These blisters are a result of how one toe curls under the next toe and basically gets 'trodden on' with a blister being the result.
The bony anatomy of the toes
Phalanges - toe bone anatomy
Toes are bony little things. There are 3 phalanges (toe bones) in each toe (except the big toe which has 2, like your thumb). Phalanges aren't smooth straight bones, they're pretty lumpy. Look at the x-ray of the big toe and second toe. In this image you can see the soft tissue of each toe and even the nails if you look closely. And you can see the phalanges under the skin. Notice how they are wide at the ends and skinny in the middle.
Even at the best of times, you can see how the bony prominence of one toe can press on the bony prominence of the adjacent toe. This is even more-so when a toe is bent or curly - one gets "trodden on" and pinched. And the toes don't necessarily remain still in the shoe as you walk and run. They move relative to one another.
Before we delve into ways you can prevent both types of blisters between the toes, have a look at the interdigital blister below.
How To Stop Blisters Between Toes
1. Foam or gel wedges
Foam and gel (pictured) wedges keep the toes physically separated and cushion bony prominences. The silicone gel material absorbs a lot (repeat, a lot) of shear via its very low shear modulus. Interdigital wedges are almost always comfortable because the material is soft. But they can dislodge and move around, because apart from the toes sitting close together, there's nothing actually holding them in place. In-shoe conditions (sweat/grit) cause them to degrade prematurely, especially foam wedges. These products are available at pharmacies and from some podiatrists.
2. Silicone gel toe sleeve
These are like a little sock for an individual toe and come either open or closed at one end. The best ones have gel all around thereby providing 360 degree toe protection. Compared to the wedges (above), they are more likely to stay in place because they are elasticised. The silicone gel material is the same so they still absorb a lot of blister-causing shear (in fact, silicone gel absorbs too much shear for the main weightbearing parts of the foot, but for toes they are perfect). They can be helpful for pinch blisters as they encapsulate and hold the soft tissue component of the toe together so it’s not getting "trodden on" as much with each step. Some people find they make the skin too sweaty; and I have seen this happen (a runner whose skin became macerated after 6 hours of wear). But I have also seen an ultramarathoner wear one of these 24/7 for 6 days (6-day ultramarathon) without skin maceration. So the relative success will be very subject specific, but I highly recommend trying them.
3. Otoform K wedge
Otoform K is a moldable putty material that sets and holds its shape. Podiatrists use it frequently to achieve an even pressure along the entire interdigital space, in spite of even the most significant toe deformities. It's the best way to achieve even pressure - better than cushioning methods (above). The aim is either to get the toe to sit straighter; or if not, at least prevent high focal pressure by moulding the material to the interdigital space. You need to be standing while the material sets - because non-weightbearing toe alignment is always different to weightbearing alignment. The good thing about Otoform K is it's long-lasting (months to years) and is easy to keep clean. However, they aren’t always tolerated because they can feel hard and foreign. Watch this video to see this material in action.
Tapes or dressings can be used to reposition a toe, to encapsulate the soft tissue of the toe or just to protect the skin from rubbing. To reposition a toe eg: a curly toe that tucks in & under the next toe, you can tape it up & out so that it sits a bit straighter. But tape stretches and/or comes loose over time so it requires reapplication each day or sometimes several times a day depending on your activity. Because sweat is a constant threat to adhesion. For toes that suffer pinch blisters, often the fleshy underside of the toe is misshapen to the point where it can be triangular! Anything that can hold this soft tissue in and less triangular, means there’s less toe that the next toe can tread on – and that means less blisters. Here's a video on toe taping technique by Anna Beetham that may help. There are a plethora of different tapes: Fixomul, Leukoplast, Rocktape, Kinesiotex ...). Read this for tips and insights about blister taping.
Lubricants reduce friction. However, research shows that after a while, they actually increase friction above baseline measures. So to remain successful, reapplication is required. Because without reapplication, you're actually more likely to get blisters. And lubricants are occlusive and lock sweat within the skin and increase maceration, a common issue between the toes anyway. On the upside, if used only between the toes, at least the initial lack of traction will be a minor issue at this anatomical location. Read this article for more on how lubricants work.
Toe-socks add a little more bulk to the interdigital space so they work a bit like an interdigital wedge by cushioning. They also work like a double-sock system by forming an additional interface (sock-sock) at the interdigital space. But double-socks rely on different materials being used for friction-reducing properties and this is not the case with toesocks – it’s the same material on each side. But this small difference may be enough to stop blisters. A common brand of toe-socks is Injinji. While toesocks can reduce interdigital blisters, it's not difficult to understand how they can cause the shoe to get too tight in the toebox and cause additional pressure and more blisters to the outside of the big and little toe.
7. ENGO on toesocks
Applying an ENGO Patch to toesocks will reduce friction a lot more than the toesocks alone. Here I've cut a rectangle patch into strips (you'll get about 4 strips from a rectangle patch). Wrap it around the sock so that the ends meet on the top. Don't apply any compression around the toe, just in case your feet swell! Just lay it on and press to adhere. By applying one strip to the 2nd toe, I've got protection for both the 1/2 and 2/3 interdigital spaces here. If I'd put the other strip on the 4th toe, I'd have protection for all interdigital spaces with just two strips of ENGO! So you don't need ENGO on every toe. This is a great way to reduce friction levels. The only problem is it won't last like ENGO on the shoe or insole does because unfortunately, it won't survive a soapy washing machine cycle. John Vonhof suggests two further ways to use ENGO Patches for interdigital blisters here and here.
Blisters between the toes can be the most painful blisters of all - and they're common. It's no wonder when you consider the anatomy and function of toes and the micro-climate of the interdigital spaces.
WRITTEN BY REBECCA RUSHTON
Rebecca is an Australian podiatrist with over 20 years experience. She has spent a lifetime dealing with her own blister prone feet in her sporting and everyday life. Rebecca specialises in helping athletes and sports medicine professionals figure out how to manage foot blisters with ease. And for kicks, she enjoys providing blister care at multiday ultramarathon events.
Rebecca is the founder of Blister Prevention and author of both "The Blister Prone Athlete's Guide To Preventing Foot Blisters" and "The Advanced Guide to Blister Prevention".