The Art and Science Of Blister Prevention

Or Are Blisters Caused By Wearing The Wrong Shoes

Or socks?

Let Me Tell You A Quick Story

One day back in 2008 I was on my morning walk. I was 8 minutes in and I started to get that familiar hot-spot feeling at the back of both heels. I tightened my laces, which relieved things a bit, and kept going. But shortly after that, I felt that familiar stinging pain of a blister.

What the ...

I was confused. 

Not only was I 100% sure my foot wasn’t moving in my shoe, but just as I did every morning before going for my walk, I had taped my heels. So how on earth could anything be rubbing on that skin? It was fully covered with tape! 

I do my laces up tight to stop blisters -  image credit

I do my laces up tight to stop blisters - image credit

The fact is, there wasn’t anything rubbing my heel. 

But because of the way my heel bone was moving inside my foot, my skin was stretching up and down with every step I took. And I could feel it! 

When the skin stretches (shears) too far and for too long, the connections between skin cells fatigue and break. These tiny tears under the skin surface are the start of the blister injury. Fluid fills the injured area and that when it starts to look like a blister. [Interesting fact: It can take up to two hours for a blister to fully fill with fluid].

This is what skin shear feels like

Step 1 Place the tip of your right index finger on the back of your left hand. 

Step 2 Wobble it back and forth but keep it stuck to the same bit of skin. Notice how your skin stretches? This is shear and this is what causes blisters. Keep wobbling as you read:

Shear might look like rubbing but it’s not. Notice how your finger tip has not moved relative to the skin of the back of your hand? But your skin has moved relative to the underlying bone. This is shear - a parallel sliding of connected tissue layers across one another. Shear happens internally, whereas rubbing happens to the surface of the skin. When skin shear is excessive and repetitive, blisters form. 

skin shear

The relevance of heat, moisture and friction!

The popular theory is that heat, moisture and friction cause blisters. While these factors are relevant, they represent a shallow and incomplete understanding of the blister process - and an unhelpful one at that. Here's why:

It gets hot in your shoe - that's unavoidable. This makes your foot sweat (moisture) - that's unavoidable. This increases friction levels.

Try keeping your feet cool and dry in your shoes when you're exercising - it's impossible!

[Friction has an unfortunate double meaning: one is rubbing, the other is the degree of grip or slipperiness. The latter definition is the one we need to use].

It's how high friction levels contribute to skin shear that causes blisters. High friction levels cause the skin, sock and shoe to stick together for a bit longer. And because the bones continue to move inside your foot, the skin is made to stretch.

Shear is normal and it happens with every step you take. Thankfully, the feet are able to tolerate a lot of it. Blisters only occur when shear is excessive and repetitive. That threshold is different for everyone ... some people are blister prone, others seem to be blister-resistant.

If you want to stop getting blisters on your feet, you’ll need to start from this new understanding of what causes blisters.

Actually, we’ve known since 1955 this is what causes blisters. Somewhere / somehow, it all just got lost in the translation.

You’ll need to start thinking about how you can:

  1. Reduce friction levels

  2. Reduce peak pressures

  3. Reduce bone movement

  4. Alter your skin’s cellular make-up to increase its resistance to blister-causing shear

Everything you’ll read and see from me about preventing and treating foot blisters is focussing on these 4 factors.