With Orthotics / Without Orthotics
You can get blisters anywhere on your feet. And under the arch is no different.
Arch blisters without orthotics
“These shoes are giving me blisters in my arch”
Paul did all the right things when he brought new shoes. He was happy with his old pair, so naturally, when the time came, he upgraded to the new model.
“As with all new trainers I wore them in by using them as my weekend trainer - walking in them and doing a few shorter runs here and there so they were adjusted to my feet, trying to minimise the potential of blisters / problems.”
As his distance increased, he started to notice something happening under his arch.
“The first 8 mile run I had no problems. Then I used them for a 20 mile run and I could feel a little tingling in the arch area, but no massive blister. But on a cold wet day, severe blistering occurred, despite covering my arch areas in Zinc Oxide tape and wearing my usual anti-blister socks.”
Paul went back to his local running shoe store to get some advice.
“They told me the [new shoe model] has an extremely high arch which certainly may have been a factor in the blistering occurring.”
What would you do at this point? You’d probably start looking for a new pair of shoes. Something a bit lower in the arch? That’s a reasonable thing to do, in my opinion. But let’s remember, Paul was otherwise happy and comfortable in these shoes. And covering some decent miles!
My advice to Paul was to get some ENGO Patches and use the 2-Patch Technique for applying them to his shoe and insole. His arch blisters are what we call “edge blisters”. And they form where the edge of the insole meets the side of the shoe. You'll need 4 large oval ENGO patches. Put one patch on the insole, and one on the side of the shoe. This allows your sock to slide over the (now) smooth shoe/insole interface. The result is no blisters. Why? Because the patches have a very low friction level (COF=0.16) - the lowest friction of any material you find in a shoe.
If you find yourself in a similar position – and you don’t want to buy another pair of shoes, get some ENGO patches. You’ll need two patches for each shoe (the large oval shape). Read more about how they work here. And watch the video below for a quick tutorial of the 2-Patch technique for edge blisters.
These oval-shaped ENGO Patches provide versatility for any blister situation. The shape makes them easy to apply to any area of the shoe and the size provides perfect coverage for most blisters. Most commonly used for blisters under the ball of the foot, top of the toes and edge blisters. Required component for blister kits - don't leave home without one!
- 4 x Large Oval Patches (4.4cm x 7cm) in each pack
Arch blisters with orthotics
“My orthotics are giving me blisters under my instep”
The majority of arch blisters with orthotics are edge blisters. And so the ENGO Patches can be used in exactly the same manner – except you put one patch on the orthotic instead of the insole. But some occur more underneath the foot, away from the orthotic edge.
Orthotic arch blisters are quite common in runners. A quick scan of running forums shows just how common. And some insights into preventing them:
These discussions highlight two important recommendations. Firstly, the skin of your arch will toughen as it gets used to dealing with the new forces being applied to it (pressure and friction). And secondly, your podiatrist can modify your orthotics to stop your blisters.
Let me expand on this second point with a few techniques your podiatrist will be thinking about in trying to stop your arch blisters:
1. The arch is too high
This one’s easy to understand. Your podiatrist may reduce the arch height of your orthotic, reduce its stiffness or change the arch contour in some way. Alternatively, a cushioned orthotic cover might be added to reduce pressure and absorb shear. Something like Spenco - it looks and feels a bit like wetsuit material. Research has found Spenco works better than Poron at preventing blisters. As a DIY option, if your orthotic has no cover on it and you feel like you need a bit of cushioning / shear absorption, you could try putting the shoe’s innersole (flat non-contoured) on top of your orthotic - worth a try if you’re in a pickle. But your podiatrist can organise something more permanent for you.
2. The ‘support’ is inadequate
If your orthotic is not dealing adequately with the forces causing your foot to pronate and arch flatten (assuming this is why you have orthotics in the first place) you may get blisters under the arch. Your podiatrist will be thinking about something called the windlass mechanism.
This is a function of the arch/big toe where when you lift your big toe, your arch lifts also. It’s an important function for preparing the musculoskeletal structures of your foot for propulsion. For the skin, put simply, if the windlass mechanism isn’t working properly, there will be more forces for the skin to deal with under your arch. Craig Payne has written and lectured a lot about how we can facilitate the windlass mechanism with various orthotic prescription variables (design features) – things that reduce the force needed to engage the mechanism; and things that bring it on earlier. Here’s a quick overview:
- Reduce the force needed to establish the windlass mechanism by:
- Inverting the rearfoot
- Everting the forefoot
- Plantarflexing the first ray
- Promote earlier onset with:
- A heel lift (including pitch aka drop)
- Lifting the big toe
There are many design features (and physical therapies) that podiatrists can use to achieve these requirements.
If you're dealing with arch blisters, consider two things:
- Reducing friction levels with ENGO Patches
- Letting your podiatrist know so he/she can modify your orthotics
- Or both
Payette M. 2010. Friction management for diabetic foot problems. Presented at the 36th Annual Meeting and Scientific Symposium of the American Academy of Orthotists and Prosthetists.
Spence WR and Shields MN. 1968. Prevention of blisters, callosities and ulcers by absorption of shear forces. Journal of the American Podiatric Medical Association. 58: 428-34
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".