Top Tips For Arch Blisters: With Orthotics | Without Orthotics

by Rebecca Rushton BSc(Pod)

Arch blisters are curious, in that the arch isn't a particularly weightbearing area of your foot.

• Table of contents

• Arch blisters with new shoes
• Arch blister with orthotics
• How long does it take to heal an arch blister?
• Conclusion

In this article, you'll learn how to prevent arch blisters:

• Without orthotics, thanks to a support request from Paul who has just bought new shoes.
• With orthotics, a common problem I deal with as a podiatrist.

 

1) Arch blisters with new shoes

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. 

These shoes are giving me blisters in my arch. 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.

This is what Paul’s arch blister looked like in the early stages (below). If you want to see how his blister ended up (and you’re not squeamish) take a look here (right foot) and here (left foot).

 

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!

Do this instead

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.

If you have blisters in a similar spot, you'll need 4 large oval ENGO blister patches. Here’s the 4-Pack you can get from us. Put one patch on the insole, and one on the side of the shoe. It’s called the Two Patch Technique. Watch the video to see how to apply the patches and why this technique is best.

 

Using Engo Patches in this manner 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. Take a look.

 

2) Arch blister with orthotics

My orthotics are giving me blisters under my instep.

The majority of arch blisters with orthotics are edge blisters. 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: 

• https://www.runnersworld.co.uk/forum/health--injury/instep-blister-from-orthotics/41922.html
• http://www.coolrunning.com.au/forums/?showtopic=15919
• http://www.coolrunning.com.au/forums/?showtopic=4860
• https://www.runnersworld.co.uk/forum/health--injury/orthotics-and-blisters/286660.html

These discussions highlight two important recommendations. Firstly, the skin of your arch will toughen a little as it gets used to dealing with the new forces being applied to it (pressure and friction). If your skin doesn't become resistant enough, or you don't have time to wear them in gradually, just use the ENGO Blister Patches as above.

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:

 

2a) 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 a little 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. Oh, and don't forget gluteal strengthening exercises to reduce the amount of internal leg rotation and foot pronation.

 

2b) The support is inadequate

This one's a little counter-intuitive. 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. Sorry if this is double-dutch to you - your podiatrist will know all about it.

• 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.

Windlass mechanism Image credit

How long does it take to heal an arch blister?

The skin of the feet, particularly the bottom surface, is much thicker than skin elsewhere. It will take around 6 weeks for the last of the damaged skin of your arch blister to shed and be completely healed. But you can take the pain out of it almost immediately, even if it hasn't healed yet. The prevention strategies you've just learned are a very big part of this. 

Blister Treatment = Blister Prevention + Looking After The Damaged Skin

To heal an arch blister and make it feel less painful, just follow the same blister treatment principles as you would for any foot blister.  

Conclusion

If you're dealing with arch blisters, consider two things:

1. Reducing friction levels with ENGO Patches
2. Letting your podiatrist know so he/she can modify your orthotics
3. Or both

References

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

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