Biomechanical considerations for management
What causes blisters under the heel?
Blisters under the heel are most often suffered by hikers and runners on downhill terrain. They're:
- Difficult to treat
- And you don't want them to deroof!
So it makes prevention all the more important!
1) Change your gait
The best preventive strategy for blisters under your heel is to alter your gait, if possible. The following will help. Please keep in mind, these compensations may have a detrimental effect elsewhere and must be implemented gradually:
• A shorter stride length
• Making your heel strike more underneath you rather than out in front
• More knee and hip flexion
• Avoiding a heel strike and opting for more of a midfoot or forefoot initial contact
2) Lace firmly
Make sure your laces are tied firmly. If that’s not enough to stop your foot from sliding forward in your shoe, use the Lace-Lock (aka Heel-Lock) lacing technique: After making a loop on each side using the last eyelet, take each lace through the opposite loop, pull down to tighten, then tie your normal knot and bow [video here].
Oh, and make sure your socks aren't bunched up under your heel.
3) ENGO Patches
If changing your running (or walking) style is insufficient, and you’ve got your foot firmly secured in your shoe with lacing, you’ll need to reduce friction levels. Do this with an ENGO Patch.
- You could cover the whole heel area of your insole with a rectangle patch (lower image). My concern with this is your foot needs a bit of traction when it first hits the ground. ENGO reduces friction so well it will negate much of this traction. I've tried this myself - my balance and stability was noticably effected, so please be careful. [I'm assuming your initial contact is heel strike - not always the case for runners].
- My recommendation is this: If you can possibly get away with it, use a small oval patch to cover only the area that requires protection (upper image).
If none of these work, tape your heels. I suggest using a rigid (non-stretch) sports tape. The theory is it will distribute the shear load over a larger area. It might not be enough to stop the blister from forming, but it will at least help keep any blister roof intact (that is, until you have to pull the tape off!).
They're not the most common type of heel blisters. But they are more difficult to treat.
A little prevention will go a long way.
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".