(Chapter 8 of The Blister Prone Athlete's Guide ... click here to buy the book on Amazon)
Cause of blisters on tops of toes
Clawed toes and hammer toes make the toe joints sit up higher and are hence more susceptible to blisters. This can be a structural thing - the toes are fixed in this position. Or it can be a functional thing - the toes are perfectly able to straighten, but when you walk and run, they bend over.
5 preventive options
1. Shoe toe box depth
Let’s talk shoe fit, specifically for these blisters:
- The depth of your toe box simply must accommodate your toes. You can’t expect to be pain-free or blister-free without this important aspect of shoe fit being met.
- Tie your laces firmly to prevent your foot slipping forward into a shallower part of the toe box.
- Shoes with a more flexible upper in the toe box region will help.
- Seams across the prominent toe joints are going to make this worse.
2. Change toe posture
The toes can adopt a clawed posture for a number of reasons. If it’s a fixed deformity, you’ll need to hope that the other options explained here do the trick. Otherwise, your only option might be to have the toes surgically straightened. If your toes can straighten, a podiatrist may be able to do something to encourage your toes to maintain this straighter posture. This could involve orthotics, stretches, toe devices or other treatments. Toe props can be used to take up the space under the toes and prevent them bending over so much. While the toe prop is in place, the toes will sit straighter, making the joints on top less prominent. Athletes should experiment with these to ensure the material between the toes doesn’t irritate in any way, particularly over long distances.
The skin on the top of the toes is easily abraded if it rubs against the top of the toe box. Tape can provide a protective layer to minimise that abrasive rubbing, helping to stop abrasions and blisters. Although a non-stretch tape will help distribute shear load better, a stretchy tape is easier to apply without leaving creases - it’s difficult but important for this area. A good technique (one that is most likely to stay intact) involves closing in the end of the toe. Take one piece of tape over the toe from bottom to top, and another around the toe so the tape ends meet at the top of the toe.
4. Silicone gel toe sleeve
A silicone toe cover will both cushion the prominent joints and absorb a large amount of the shear that causes blisters. These devices are a little bulky, so it could get tricky if you need protection for two or more toes on the same foot - there might not be enough room in your toe box to accommodate them. Whether you choose a silicone gel toe sleeve (open at the end) or silicone gel toe cap (closed in at the end) is up to you. Considering your blister is on the top of the toe, you only need the open-ended sleeve, like the one pictured below. Being open at both ends will have the added advantage that sweat can escape from both ends, minimising the chance of skin maceration. But if your toe is bent over and you’d also like to protect the tip of the toe, consider a closed-in cap.
5. ENGO Blister Prevention Patch
When silicone covers are not an option, an ENGO Patch applied to the inside of the toe box is an excellent way to reduce friction levels at the tops of the toes. This is especially the case if you feel like you’ve done everything you can with shoe fit and the posture of your toes. Remember that if your shoe upper is permeable to water, the patch could dislodge if it gets too wet.
I'm 100% sure one of these preventive strategies will work for you.
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".