The back of the heel is my most common blister site. This is where my blister prevention quest all started.
Blisters are bad enough. But when these blisters become torn and the top rubs off (deroof) leaving a red raw sore, it's even more painful and brings with it more risk for infection. Heel blisters are worth avoiding. They can be debilitating! Just read this email I received from Marcus:
Heel blisters and foot function?
As we walk and run, the calcaneus (heel bone) is pulled upwards by tension in the Achilles tendon. This biomechanical function is normal. However if the calf muscles are tight, extra tension in the tendon causes the calcaneus to lift sooner, higher and with more force! That can be a problem when it happens in the presence of high friction.
The internal lining of shoes is a material with relatively high friction properties. So are socks and insoles. This is necessary to provide traction for the foot within the shoe. It’s a good thing. But in certain situations (prolonged exercise), under certain conditions (excessive sweating or running over wet terrain) and for certain individuals (blister prone), high friction can quickly lead to blister-causing levels of skin shear.
This is how it happens: the lining of the shoe behind the heel grips the sock; and the sock grips the skin. That's what the force of friction does - it makes surfaces grip together for longer. Meanwhile, as the calcaneus is moving up and down within the foot, the section of soft tissue in between is being stretched (video). We call this shear. If shear is excessive and repetitive, microtears develop underneath the surface of the skin and within the hour, fluid fills the cavity to form the entity we all know as a blister.
5 Heel blister prevention strategies
As a longtime heel blister sufferer myself, here are my top 5 prevention strategies.
(1) Lacing - Minimise rubbing
Stop the rubbing by keeping your heel secured firmly in your shoe. This one technique will go a long way to saving you the pain of a heel abrasion. It's called the Lace-Lock technique.
(2) Calf Stretch - Less bone movement
Reduce tension in the Achilles tendon by stretching the calf muscle complex (there are two muscles so two stretches are needed - I couldn't find a good video so this is just an image). This is almost always overlooked and could hold the key to ridding you of heel blisters by reducing shear and rubbing! Hold each stretch for at least 30 seconds and do it at least 3 times each day for 6 weeks. Don't forget it's also very important to stretch after exercise during your cool-down. Your Podiatrist will also help identify and rectify other biomechanical issues that cause excessive tension in the Achilles - other treatments might include heel lifts, orthoses, joint mobilisations or other therapies.
(3) ENGO Patches - Allow the sock to protect the skin
ENGO Patches are the best way I’ve found to reduce friction. There are other ways (like lubricants, powders and antiperspirants). But they all encourage the sock to move against the skin – at some point, that can become damaging if repeated over and over (read more here). With ENGO on the shoe, the sock and skin remain together and function as a single unit - so nothing is rubbing against the skin. This is blister prevention gold!
These are the patches for blisters at the back of the heel. You get one pair of patches in the Heel Pack. Watch the video below to see how to apply them.
(4) Taping and Dressings - Protective Layer
By adhering a protective layer to the skin, the skin can't be abraded. I found tape spared me from the red raw sores on the back of my heels and that was a big relief! But it didn’t always stop me from getting blisters. Because depending on the friction properties of the tape, blister-causing shear can still occur under the tape. Podiatrist Chris Hope shows you how to tape the heel using Fixomul in the video below.
(5) Donut Pads - Reduce Pressure
By cutting a hole in a piece of thick orthopedic felt / moleskin and adhering it to the back of the heel (so the blistered-area is in the cavity) pressure and rubbing is reduced.
There is no doubt about it: the singlemost effective preventative strategy for heel blisters is the ENGO Blister Patches. The other strategies will help for sure. But ENGO has it for me.
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 "The Blister Prone Athlete's Guide To Preventing Foot Blisters".