Beware: A Hot-Spot Is A Pre-Blister State

by Rebecca Rushton 3 Comments

Preventing blisters is all about having a plan for blisters and putting it into action at the first sign of trouble.

That first sign of trouble is called a hot-spot. It's your one last chance of preventing a blister from forming.

What is a hot-spot?

A hot-spot is a pre-blister state. It’s a warning that your skin is stretching too much and it’s starting to fatigue.

  • IT’S SUBTLE - It feels warm, like something’s rubbing, and it looks a bit red.

  • AND IT’S BRIEF - How long does it last? Well might not last 5 minutes. It might not even last 1 minute.

If you feel a sting, you’re too late. That’s the tear under the skin surface that kick-starts blister formation. Within two hours of that stinging sensation, you’ll have a blister.

Your tiny window of opportunity

The hot-spot stage is a brief window of opportunity for blister prevention. Take it. Don't ignore it. Be thankful you've received it.

hot-spot stage of blister development

A hot-spot is your last opportunity for blister prevention

A pre-blister state

A hot-spot is a brief sensory warning that a blister is on its way. This is what Joseph Knapik and his colleagues (1995) have to say about how blisters develop and the entity of the hot-spot.

"Studies using (rubbing) techniques have demonstrated a predictable series of events that lead to blister formation. First there is a slight exfoliation of the stratum corneum and a reddened region (erythroderma) forms in and around the zone of the rubbing. The area encompassed by the erytheroderma is referred to as a 'hot-spot', presumably because the study participant experiences an increased sensation of heat. With continued rubbing of the area, the participant may suddenly experience a stinging or burning sensation with a pale, narrow area forming around the reddened region. This pale area enlarges inward to occupy the entire zone where the rubbing is applied. The area becomes elevated over the underlying skin as it fills with fluid."

Knapik et al (1995)

Two things!

There are two things you need to do to stop a hot-spot from becoming a blister:

  1. STOP


You won't want to stop - I get that. But you need to, unless you want this blister to happen.

What are you going to do about your hot-spot?

Firstly, do some general stuff. Have a look. What’s going on in there? Can you see where it’s red?
Are your socks bunched up? Is your insole not sitting right? Is there sand in your shoe? Sort this out.

Then do something more specific for that location. What do you have planned for this blister location? Whatever you have planned, implement that plan. Is it a silicone gel toe sleeve? Is it tape? You’ve got this stuff on you right? You’ve got your “on-the-move” blister kit right there, yes? No good it being in the car, back at camp or at home!

Here's an example of the importance of hot-spot treatment:

"When I've been able to work intimately with a group of trekkers or runners (ie: having opportunities for one-on-one time and supervising hotspot detection, blister prevention and treatment) I notice a very high success rate of blister avoidance with hot-spot taping with Fixomull. Up to four or five layers sometimes. I've had trekkers on Kilimanjaro, trekkers in the bush and the Simpson and other places and pretty much zero blisters due primarily to immediate hotspot taping."

Lucas Trihey

Stop. And Do Something!

Do something and you might just remain blister-free. Do nothing and you will get a blister. Get a blister and you'll be mucking around with antiseptics, dressings, donut pads, changing all these things a few times a day and monitoring for infection. Oh, and you'll be treating this blister for about a week until it heals.

If only you'd stopped and treated the hot-spot!

Rebecca Rushton
Rebecca Rushton


Podiatrist, blister prone ex-hockey player, foot blister thought-leaderauthor and educator. Can’t cook. Loves test cricket.

3 Responses

CHRISTINE Dimopoulos
CHRISTINE Dimopoulos

April 17, 2020

Hi Leo a I wake up most mornings by a burning sensation on my heel. I sleep on a couch due to my hip problem. Im assuming this is a pressure sore forming? Thanks for any help. I can send GB ou a picture too

Rebecca Rushton
Rebecca Rushton

October 09, 2019

Hi Leona. You need to reduce friction levels and pressure.
- Friction levels are best reduced with Engo Patches:
- To deal with pressure, it depends where your edge blister is. Tell me more about your blister location.

By the way, what are the edge blister pads you mention – I’m not aware of such a product.

Leona  Alexander
Leona Alexander

October 04, 2019

Edge Blood Blisters, how do I prevent them?! I’ve had no success w/ edge blister pads, tapes, mole skins. Help me Please.

Leave a comment

Also in Blister Blog

How To Hold A Toe Straight With Strapping
How To Hold A Toe Straight With Strapping

by Rebecca Rushton BSc(Pod)

Here's a quick video to show how to strap a curly little toe to stop it bending under the next one and getting blisters on it. Learn the technique and understand the pros and cons to decide if this is worth trying on your toe.

View full article →

Why Do I Wear Holes In The Back Of My Shoes?
Why Do I Wear Holes In The Back Of My Shoes?

by Rebecca Rushton BSc(Pod)

Ever worn holes in the back of your shoes before the rest of the shoe wears out. It’s kind of annoying (and expensive). Here why it happens and a few ways to fix it.

View full article →

At night, remove all dressings from the blister to expose the area to the air. This will speed up healing.
Should A Blister Be Exposed To The Air To Dry Out, Or Bandaged?

by Rebecca Rushton BSc(Pod)

Leaving your blister open to the air to dry out and scab over is either counterproductive (deroofed and torn) or inconsequential (intact). It is certainly not beneficial to any blister, only maceration. Here's why.

View full article →