Blister Taping

Your first line of defence against blisters

Blister taping with three different tapes ©iancorless.com - all rights reserved

Blister taping with three different tapes ©iancorless.com - all rights reserved

Runners, athletes and hikers worldwide tape their feet to prevent blisters. It's without doubt the most popular blister prevention strategy out there. 

Not only that, go to any Podiatrist complaining of blisters and they'll tape your feet. And show you how to do it yourself. And if you present to the first aid or foot care tent at any event, chances are, you'll be getting your foot taped.

This may surprise you, it certainly surprised me!

There is a distinct lack of research on taping for blister prevention. This is from American Podiatrist and blister researcher Doug Richie in his 2010 literature review:

"Other topical agents that have been advocated for blister prevention include moleskin, tape ... and viscoelastic dressings. However, there are no published studies to show these measures actually work."

Since Richie's literature review in 2010, two prospective randomised trials using blister taping have been published (2014 and 2016). They were performed using competitors in Racing the Planet 250km, 7-day self-supported ultramarathons. The lead researcher of both papers was Dr Grant Lipman. The same intervention, 3M Micropore paper tape (also known as surgical tape), was used in each study. 

Both studies used the same outcome measure: if the first blister developed on an untaped area, the intervention was deemed successful; if the first blister developed underneath a taped area, the intervention was deemed unsuccessful.

  • The first study found the paper tape did not prevent blisters
  • The second study found it did

The main difference between each study was:

  • The first study compared one taped foot to the other untaped foot
  • The second study compared taped areas of one foot to untaped areas of the same foot

I'm not sure one study was better than the other in terms of methodology (my statistical analysis skills are not what they should be!) and so I wouldn’t like to go with the conculsions of one study over the other. I can see that the limitations mentioned were at least limitations of both studies (no blinding, an inability to rule out the intervention being used inappropriately, an inability to rule out additional strategies being used in conjunction with the intervention tape, data collection by questionnaire). 

Of note, the ‘end point’ of data collection for both studies was the development of the first blister. This was on day one for 66% (2014) and 50% (2016) of subjects; and on day two for 23% (2014) and 30% (2016). So by day two, data collection for this research ceased for 89% (2014) and 80% (2016) of the subjects.

One discussion item that was mentioned in both papers was that of the tape's low adhesion: 

  • It was seen as a benefit in one way - in that if a blister formed underneath the tape, then removing the tape was unlikely to tear the blister roof.
  • It was seen as a limitation in another way - in that it was not uncommon that the tape came off prematurely, particularly in wet conditions.

So at this stage, the jury is still out on the effectiveness of taping - using this particular type of tape (paper tape). But at least someone is doing research on a blister prevention strategy!

 

The pre-taping procedure in the first study (image credit)

The pre-taping procedure in the first study (image credit)

Consider how taping works

Can you believe, we haven't figured out how taping works to prevent blisters yet! I can think of four potential ways. 

1. Protecting the skin surface from the effects of rubbing

Tape does this well. It's stuck to your skin and so nothing abrasive can rub against your skin (sand, grit, the roughness of your sock, scratchy shoe seams etc). That's absolutely helpful. But this describes abrasion prevention, not blister prevention (it's not rubbing that causes blisters). Abrasions and blisters are different injuries [video].

 
Zhang and Mak (1999) recognise blisters are caused by shear and are deroofed by rubbing

Zhang and Mak (1999) recognise blisters are caused by shear and are deroofed by rubbing

 

2. Thermal insulation

A blister discussion on Podiatry Arena in 2013 explored another possibility around thermal insulation from the heat produced by rubbing. Firstly, we know blisters don’t require rubbing. And secondly, we know blisters are not thermal burns. But it is plausible that heat is indirectly causative, as Comaish (1973) and Kirby (2013) point out. Although plausible, research to date does not support the theory that local surface heat generated by dynamic friction is a significant factor in blister formation. If heat transfer from the skin surface to the stratum spinosum is a major factor in blister development, one would expect higher friction levels and faster rubbing would increase blister occurrence. Naylor (1955) found this not to be the case (below). And one would expect the thicker corneum of the soles and palms would afford a level of blister protection. In fact, a thick corneum is one of the requisites for blister formation (Naylor, 1955; Akers and Sulzberger, 1972).

Naylor's results from 1955 show that higher temperatures don't increase blister incidence. So thermal insulation is unlikely to provide blister prevention. 

Naylor's results from 1955 show that higher temperatures don't increase blister incidence. So thermal insulation is unlikely to provide blister prevention. 

3. Reducing friction levels

I’ve assumed tapes reduce shear by lowering the friction level. But we don't know whether they do or don't. Because none of the tapes used in blister prevention (Fixomul, Micropore, Leukoplast, Kinesio, RockTape) have had their friction properties tested in any research. Not even by their manufacturers (I've asked them)! There is no coefficient of friction (COF) data for any sports tapes! Some in-shoe material COF data does exist. And Polliack and Scheinberg (2006) measured the COF of some blister dressing, but not tapes. This fact is quite alarming and represents a huge area for improving our understanding of how blister taping works. And provide some guidance on which tapes would work better than others. 

Polliack and Scheinberg (2006) measured the COF of several blister dressings

Polliack and Scheinberg (2006) measured the COF of several blister dressings

4. Spreading shear load

Another possibility first documented in The Advanced Guide to Blister Prevention is a spreading of shear load and comes from personal communication with Marty Carlson (CPO) of Tamarack Habilitation Technologies Inc. 

"An alternative mechanism of action – Although not described in the literature, it is plausible that tapes reduce shear at discrete locations due to the fact that they’re adhered to the skin. Just as cushioning spreads the vertical load over a larger area to reduce peak pressure, because tape is adhered to the skin, does tape spread the ‘pull’ of the horizontal load over a larger area to reduce peak shear distortion per unit area of skin? In other words, by spreading the shear load, shear per unit area of skin will be less (Carlson, 2013: personal communication).” 

If this was the case, you would think a rigid (non-stretchy) tape would work best. Interestingly, most blister tapes are stretchy!

How to get the most out of blister taping?

So you'd like to try preventive blister taping on your feet. Here are a few things you need to know:

  • It takes time – As blister taping expert John Vonhof, author of ‘Fixing Your Feet’ says in his precision taping blog post “It takes as long as it takes to do it right.” This could be a problem in a race situation. But also consider if you need to tape on a day to day basis for each and every run you do. That 5-10 minutes before you head out becomes a bit of a bane (it did for me anyway). 
  • It takes skill – It might look easy, but it takes practice to ensure a good job. In the following video links, Anna Beetham takes Oxfam Trailwalkers through some taping techniques for the toes, big toe joint and heels. I've embedded videos from Chris Hope (Entire Podiatry) of the same techniques; Trent Salkavich's video of taping the whole bottom of the foot, and mine for taping the ball of the foot (all below).
  • Which tape? - Leukoplast, Fixomul, Elastikon, RockTape, KinesioTex Tape, Micropore? Rigid tapes or stretchy? Thick or thin? There is no consensus on which tape works best. This is no surprise because a mechanism of action has not been established. But this from John Vonhof is the most considered account of tape versus tape.
  • Getting it to stay stuck – Sweating is a constant compromise to adhesion. One way to maximise tape adhesion is with an adhesive enhancer, like Compound Tincture of Benzoin (TBCo) or Skin-Prep. You wipe these on the skin (where the tape will go), allow it to dry and then apply your tape. It can be a bit messy but it's one way to maximise adhesion. Another threat to adhesion is environmental moisture – body run-off (sweat, rain, drink stations), dew-laiden grass, river crossings etc. John Vonhof has trialled many kinesiology tapes and has a few recommendations in his taping in the Amazon blog post - particularly a tape called StrengthTape
  • When tape becomes a blister cause - The result of poor application technique and/or inadequate adhesion is a doubled over bit of tape that becomes a blister-causing irritant!

Taping the ball of the foot: https://youtu.be/yfYImgScJKc

 

Taping tips (most I've learned from John Vonhof)

  • Round the corners.
  • Rub the tape for 20-30 seconds after applying it to the skin - it warms the adhesive to make it more tacky.
  • Apply tape at least one hour before use (or even the night before). It allows the tape's adhesive time to bond with the skin.
  • When using kinesiology tapes, lay the tape on the skin. The more stretch you apply, the more likely the tape is to come loose, especially in wet conditions.
  • It takes as long as it takes - a precision tape job can take more than 30 minutes.
  • Practice makes perfect!
 

What's next?

Clearly, we have a little more work to do in understanding preventive blister taping - how it works, how it doesn't work, which tape for which conditions, which tape for which foot region and specifics about application technique. For a modality that is arguably the most common blister prevention strategy, it's odd that we know so little about it.


R Rushton

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".


References

  1. Akers WA and Sulzberger MB. 1972. The Friction Blister. Military Medicine. 137: 1-7.
  2. Comaish JS. 1973. Epidermal Fatigue as a Cause of Friction Blisters. The Lancet. Jan 13: 81-83.
  3. Naylor P. 1955. Experimental friction blistersBritish Journal of Dermatology. 67: 327–42.
  4. Polliack AA and Scheinberg S. 2006. A New Technology of Reducing Shear and Friction Forces on the Skin: Implications for Blister Care in the Wilderness Setting. Wilderness and Environmental Medicine. 17: 109-119.
  5. Richie D. 2010.  How to manage friction blisters. Podiatry Today. 23 (6): 42-48.
  6. Vonhof J. 2011. Fixing Your Feet – Injury Prevention and Treatment for Athletes (5th edition). Wilderness Press.
  7. Zhang M and Mak AFT. 1999. In vivo friction properties of human skin. Prosthetics and Orthotics International. 23: 135-141.
  8. Lipman GS, Ellis MA, Lewis EJ, Waite BL, Lissoway J, Chan GK, Krabak BJ. 2014. A prospective randomized blister prevention trial assessing paper tape in endurance distances (Pre-TAPED). Wilderness & Environmental Medicine. Published Online: October 30, 2014.
  9. Lipman GS, Sharp LJ, Christensen M, Phillips C, DiTullio A, Dalton A, Ng P, Shangkuan J, Shea K and Krabak BJ. 2016. Paper tape prevents foot blisters: A randomised prevention trial assessing paper tape in endurance distanced II (Pre-TAPED II). Clinical Journal of Sports Medicine. Published Online: April 14, 2016.
Taping for blister prevention (Image credit)

Taping for blister prevention (Image credit)

11 Comments

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".