The Agony of de Feet

2000, July/August Adirondac Adirondoc

I am writing this column while flying home from the Boston Marathon. Fortunately, there is no one else sitting in my row, so no other passenger has to look at my bare, bloodied feet. I am once again reminded that two of my favorite avocations, marathon running and backpacking, share a nasty propensity to produce blisters. There is no better time for me to discuss this problem than now.

The skin is an amazing organ, critical to temperature regulation and defense against infection, and able to regenerate itself continuously. It is built as a series of layers. each with a somewhat different function. The top layer is continuously peeling off (that’s what dandruff is), as the lower layers move upward to replace it. When sideways (“shearing”) forces are applied to skin, a split can develop between layers. This split fills with fluid, forming a blister.

In an earlier article (Adirondac. May/ June, 1999), I reviewed some ways in which the feet can be toughened before a hike to minimize the chances of blisters forming. Now we will consider how to handle developing blisters while actually on the trail.

Foot care on the trail begins with paying attention to the way your feel are feeling at all times. At the first suggestion of any discomfort (“hot spots”}, immediately stop, take your shoes and socks off, and carefully examine your feet. If the painful area still looks normal, simple, immediate intervention may prevent its evolution into a blister. Paint the entire area with a small amount of compound tincture of benzoin. available under a variety of brand names in any drug store. Benzoin is a very sticky product, which will strengthen the upper layer of skin somewhat. More important. it will help your inner sock (which should be thin polypropylene or similar fabric) to adhere to the skin. This will result in the sheer forces being expended between your two socks. and not between the inner sock and the skin.

If the painful area is starting to turn reel, but has not as yet blistered, additional protection is needed. This is the place for a piece of moleskin. cut to extend a few millimeters beyond the borders of the reddened area. Moleskin will adhere much better if the area is first painted with benzoin and allowed to dry. Once moleskin is applied, it should not be pulled off: doing so may rip off a layer of skin and will be very painful. Instead. if the moleskin loosens, reinforce it with strips of cloth adhesive tape. which should also be applied to skin pretreated with benzoin.

Once a blister is actually established, treatment is much more difficult. The area may be exceedingly painful, and walking may be difficult if not impossible. Until recently, treatment options for such advanced blisters in the field were limited and unsatisfactory. Today, however, there is a nearly miraculous product, Spenco 2nd Skin Blister Pads, which has revolutionized blister management. These pads place a hydrocolloid compound over the blister, keeping it moist while it heals. Pain is almost completely eliminated, and the blister heals without a scab within a few days.

At nearly two bucks a pop, these pads are not cheap. Nonetheless, high-mileage runners find them indispensable; they have gotten me through some hundred-mile weeks. You can learn more about the use of these pads at a very informative Web site – <>.

Finally, a tip from my son, a pretty fair backpacker in his own right. Instead of packing foot and blister care products in your first aid kit, consider putting them together into a separate “foot repair kit.” This avoids frequently breaking into the first aid kit, and keeps all of the items I recommended above in one spot. Such a kit should contain benzoin. moleskins, cloth adhesive tape. 2nd Skin blister pads. cuticle scissors (for cutting moleskins as well as toenails), and a needle for draining large blisters before dressing them.

With modern techniques and supplies, blisters can truly be eliminated as a cause of distress in hiking. Remember. though, that much can be done before your hike even starts to ensure that your feet are protected.

-Thomas R. Welch. M.D.

Meet the “Doc” AdironDoc columnist Dr. Thomas Welch will present a lecture entitled “AdironDoc on Backcountry Health, Safety and Sanitation,” at ADK headquarters on Wednesday, August 9, 2000, at 7:00 p.m. He will discuss a variety of issues regarding staying healthy in the backcountry. This lively. interactive presentation will include time for questions and discussion. The lecture is free and open to the public. Reservations are required; call 518- 668-4447.

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Topics: Foot