Friction Blisters of the Feet: A Critical Assessment of Current Prevention Strategies

Abstract

Friction blisters are a common injury of the feet sustained by individuals participating in sporting, recreational, and military activities. The high incidence of friction blisters brings into question the effectiveness of common prevention strategies. The purpose of this article was to review current evidence for established blister-prevention strategies and to explore how these interventions address the factors that cause friction blisters. Preventive strategies, focusing on previously overlooked elements of the blister-causing mechanism, are proposed. Areas of future research that are much needed to reduce this common skin injury in active individuals are outlined.

Keywords: blister prevention; foot blister; running injury; shear; skin injury.

Figure 1

Blister-prevention strategies mechanisms of action.

Figure 2

A diagrammatic representation of the opportunities for blister prevention.

Figure 3

Laboratory product comparisons using a custom-made friction measurement apparatus. Used with permission of Elsevier, from Polliack and Scheinberg.⁴⁶ A new technology for reducing shear and friction forces on the skin: implications for blister care in the wilderness setting. Wilderness Environ Med. 2006;17(2):109–116; permission conveyed through Copyright Clearance Center, Inc. Abbreviation: CoF, coefficient of friction.

Figure 4

Coefficient of friction (COF) between cotton and 4 different support surface materials. The moisture content of the cotton sock is the independent variable and varies between 0% and 100% by weight. The COFs of the sock against polytetrafluoroethylene (PTFE) and against Plastazote are approximately 0.17 and 0.47, respectively, and those values are not significantly affected by increases in sock moisture content. Spenco, an insole material, shows a rather continuous COF increase as the sock gains moisture, and PPT-Poron showed a significant jump in COF to a moisture content of about 35% and then little further increase. Spenco, Implus Footcare LLC, Inc. PPT-Poron, Langer Biomechanics. Plastazote, ZOTEFOAMS. From Carlson JM. Functional limitations from pain caused by repetitive loading on the skin: a review and discussion for practitioners, with new data for limiting friction loads. J Prosthet Orthot. 2006;18(4):93–103. https://journals.lww.com/jpojournal/pages/default.aspx. and republished with permission. The Creative Commons license does not apply to this content. Use of the material in any format is prohibited without written permission from the publisher, Wolters Kluwer Health, Inc. Please contact permissions@lww.com for further information.