Preventive Medicine: Blisters

Welcome Preppers and Survivalists,

During and after a disaster, you and your family may find that the only way to travel is to walk. Depending on where you live, this could be a very long distance.

There are many historical incidences where walking was the only way to leave an effected area, the San Francisco earthquake 1904, Berlin 1945, and New Orleans 2005. Heck, about 2000 years ago, the Roman army walked about 1100 miles (1800 Km) from Italy to Great Britain, plus a little bit of a boat ride, to conquer England.

Lucky for us, we have better technology to protect our feet from blisters.

Before I start, I have to give you my street cred. I was a light infantryman, we walked everywhere; an infantryman that walked almost everywhere; and my wife and I have completed 4 half marathons (13.1 miles or 21 kilometers, not including the training miles/kilometers) by walking.

Prevention
First, you are going to need socks. No, the white cotton socks you normally wear aren't going to work. You need specialized socks made out of wool or a wool-blend. These specialized socks have additional padding on the bottom to protect your feet from blisters.

When you are buying your socks, you need to put them on in the store. They should be snug but not tight. They should fit your feet with no extra length between the heel and your toes or material bunching up on your foot. Plus, the socks should snug but not too tight on your ankle and calf.

There are also sock liners. Just like the name says, they line the inside of your socks. They are normally close fitting socks that protect your feet when they slide in your socks and wick moisture away from your feet. They are usually made out of nylon or silk.

I have only worn sock liners during cold weather because my feet sweat, a lot. The sock liners would wick moisture away from my feet helping my feet to stay warm. It seems that in really cold weather; the moisture in my wet socks would cool causing my feet to get cold. I really hate cold feet.

After you buy your hiking socks, you are going to need comfortable footwear. For this discussion, footwear is going to be limited to boots and shoes.

When buying your shoes, you want to wait until the end of the day, after you have been up and standing/walking all day, because your feet swell from your body's fluids, such as  blood, draining into your feet from the effects of gravity.

Next, you want to buy from a store that specializes in walking and running. The clerks will have experience in fitting shoes for long distance walkers and runners. If you are looking for boots, you will need to find a store that specializes in boots. Just tell the clerk that you are planning to do some long-distance hiking.

Note:

You can go to Wal-mart, K-mart, Target, Famous Footwear, or ... for your shoes, but understand that you are buying a certain level of quality and comfort. Don't get me wrong, I buy shoes from the china-marts, but I don't walk half-marathons in those shoes.

Now, you can skip all this and purchase boots issued by the United States military. Before you older vets laugh yourself to death, the military has come a long way in boot technology,

However.

A U.S. military issued boot isn't for everyone. Some folks find the shaft too tall because the shaft 'bits' into their calf. Another problem is the boot's sole is glued on; it can't be resoled. Plus, some military boots, such as the Jungle boot, just suck for long distance walking.

No matter which way you go, military or civilian boots, you want to wear the same types of socks and sock liners you plan to wear when you purchase your new boots. This will ensure your buy the right size. Believe it or not, different types of socks have a different thickness. One brand/type of sock may be thicker than another brand.

So you have your socks and boots.

The next thing you want to do is break them in. Now, this doesn't mean that you put 'em on, lace 'em up and go for a 12 mile walk. Not at all, for me, this means you take it slow.

Now, I'm going to tell you one method that I used for the black leather military boots. First, I would polish the boots then I would put the boots on with the the laces loosely tied. Next, I would walk around for about one to two hour that day. After those two hours, I would remove my new boots and polish them, again. I won't wear them until the next day. I would do this for one week.

The next week, I would tighten up the laces a little more and wear the boots for three to four hours. The week after that, I would tighten the laces some more and wear them for five to six hours. On the fourth week, I would wear them like normal.

Taking it slow and easy like that allowed the leather boots to flex and slowly conform to my feet, ankles, and the way I walk. Plus, it reduced my chance of getting a blister, for four weeks.

After breaking in the boots for four weeks, they were ready to wear for road marches (another way of saying long nature walks carrying a lot of stuff)

I have also used light hiking boots made from various synthetic materials. These boots are great for walking on smooth trails or roads. They usually don't need breaking in. But be warned, you want to take a few short walks before going on longer hikes to allow your feet to adjust to your new light boot.

As I said, I have experience with long distance walking, so I knew where I would have problems before I started.

For a couple of years, I would always get blisters between my little toe and the one next to it, on my right foot. On my left foot, I would get a blister on the pad of my foot just behind the toe next to my big toe.

So, for my right foot, I would wrap each toe with a plain old Band-Aid adhesive bandage around the pinkie toe and the other toe (with the pads towards the other toe) before each walk. On my left foot, I would cut a piece of moleskin in the shape of a donut. The 'hole' of the donut-shaped moleskin would be placed over the spot where I usually got a blister.

Another time, I had a pair of dress shoes that would 'bite' me on the back of my heels. I would cut four strips of moleskin then I would take one strip and place it over another strip, making the moleskin two layers thick. This two layer moleskin would go over the spots where my dress shoes 'bit' me.

After I had put padding on the places where I normally got blisters, I would put foot powder on my feet. Now, I did this for a couple of years then one day I didn't have any foot powder, so I went without. I didn't have any problems, so I quit using foot powder.

I had friends that would spray their feet with an antiperspirant, supposedly this stopped their feet from sweating. I don't recommend it.

Next, I put my socks on. I am very careful to make sure that my sock are snug but not tight and that there is no extra material at my toes, bottom of my foot, or on the heel of my foot. If I am wearing a sock liner, I put the sock liner on first (checking just like my socks) then my socks.

Lastly, I put my boots on and lace them up. My boots laces are snug but not tight. I will walk a few minutes then, if needed, I will relace my boots if they are too tight.

With all this careful selection of socks, sock liners, boots and preparation of my feet, I still get blisters.

Treatment
Now, you can screw this up.

I had a battalion commander who decided to do an EIB (Expert Infantryman's Badge) 12-mile forced march with a new pair of boots. (12-miles, in less then 3-hours, with rifle, pack, and other stuff) No, the new boots weren't broken in.

Needless to say, he developed some blisters. A whole lot of blisters

Well, he gets back to his office and rips the blister off. He was on crutches for two-weeks.

Enough stories.

So you and your family are walking along and your daughter, son, partner, or even you start feeling a 'hot spot' on your foot. (It feels just like it sounds) If possible, you should stop and take care of it right then. If you don't the 'hot spot' could turn into a blister.

To treat a 'hot spot,' first, take off your shoe and look at your foot. You might see a red spot. If you don't see a red spot, you can poke around with your finger to find the 'hot spot'. It will hurt.

Just like I did to prevent a blister, you want to cut a piece of moleskin into a donut-shape. The hole of the donut goes over the 'hot spot.' Next, put your sock back on, smoothing your sock over your foot, then snugly lacing up your boot.

If you have time, everyone in your group should take off their boots, check their feet, and smooth out their socks. Another if, if you have extra socks, have everyone change their socks. Also shake your boots out; a small stone could have gotten into your boot.

Note:

In a tactical situation (other folks possibly shooting at you), you don't want everyone to take their boots off at the same time.

If you start feeling pain on the bottom of your foot, toes, or heel, you may have a blister.

Just like treating a 'hot spot,' cut a piece of moleskin into a donut shape and place the spot over the blister. In the picture, I linked to, WedMD shows a small blister. I have had a blister as long and as wide as my thumb. Cutting a piece of moleskin with a hole that large took a little effort.

Now, you may have to stack two pieces of moleskin like I did for my dress shoes. That's OK, the objective is to take pressure off that part of your foot.

Another method, using moleskin, is to cut a donut as mentioned before then cut a second piece of moleskin to cover the hole. You have to leave the (I can't think of what's it called but it's the plastic paper that covers the sticky side of the moleskin) so the moleskin won't stick to the blister, but remove the edges, so the second layer of moleskin will stick to the first layer.

Once you're finished, smooth out your socks and snugly lace up your boots.

There is going to come a time when you are going to have to lance a blister to remove the fluid building up to protect that area of your foot.

To do that you need a sharp, pointy object. A sewing needle or safety pin is preferred, however; the tip of a knife can be used. You will also need something to sterilize your needle, such as an alcohol pad, and where you are going to lance the blister.

First, you want to sterilize your needle. I have used toilet paper dipped in alcohol, a store bought alcohol pad, the needle dipped in alcohol, Povidone-iodine (Betadine) instead of alcohol, and a match.

To use a match to sterilize the needle, not your skin, light and hold the match below the needle, warming the needle. You don't want to have carbon, black stuff, build up on the needle. Some of the carbon will be left in your skin when you lance the blister.

After you sterile the needle, you sterilize your skin where the blister is. Next, find a spot on the edge of the blister and poke it with the needle. You make have do do this in a couple of different places for a large or odd-shaped blister. The intent is to drain all of the fluid out of the blister.

Note:

This clear fluid is not puss; the fluid is a clear liquid produced by your skin to form a cushion to protect your skin.

To drain the fluid out of the blister, you may have to gently push on the blister from the center moving to the spot where you poked the needle through your skin. Once you have removed as much fluid as possible you will need to do one of two things.

If you have to continue moving.

Clean the area around the blister again with alcohol or other disinfectant. Next, you need to use the moleskin to protect your foot as described.

If you can stop

Remove your shoes and allow your feet to rest by wearing soft shoes or sandals. The skin under the blister will harden, like your regular skin, and the outside skin will wear away. Whatever you do, do not tear the old skin off your foot until the new skin has toughened up.

Lastly, you may have to continue and the skin covering the blister will tear off exposing the tender skin. You must protect the tender skin with band-aids or other dressings and moleskin because you can do additional damage to your foot.

Note:

President Calvin Coolidge's youngest son died from an infected blister

Update: 1:00 pm 19 Oct
I think this is it, but I have to think about it.

PS. Thank Spartan for this article. He suggested it.

Link:
Free Map Tools - How Far is it Between London, Uk to Rome, Italy
http://www.freemaptools.com/how-far-is-it-between-london_-uk-and-rome_-italy.htm

Historic-UK.com - Roman England:  The Romans in Britain 43 AD - 410 AD
http://www.historic-uk.com/HistoryUK/England-History/RomanEngland.htm

Wise Geek - What is Street Cred?
http://www.wisegeek.com/what-is-street-cred.htm

REI - How to Choose Backpacking Socks
http://www.rei.com/expertadvice/articles/backpacking+socks.html

Hiking Dude - Hiking Socks
http://www.hikingdude.com/hiking-socks.shtml

Wikipedia - Footwear
http://en.wikipedia.org/wiki/Footwear

eHow - Why Feet Swell
http://www.ehow.com/why-feet-swell/

CABoot.com - Diagram of Boot Terms
http://www.caboots.com/category/u/

ABC of Hiking - Hiking Boots: Features & Characteristics
http://www.abc-of-hiking.com/hiking-boots/hiking-boot-features.asp
http://www.abc-of-hiking.com/hiking-boots/hiking-boots-buying-guide.asp
http://www.abc-of-hiking.com/hiking-boots/hiking-boot-types.asp

Hiking Dude - Hiking Boot and Hiking Shoes
http://www.hikingdude.com/hiking-boots.shtml

Wikipedia - Band-Aid
http://en.wikipedia.org/wiki/Band-Aid

The Backpacker - Beginners: Gortex
http://www.thebackpacker.com/beginners/moleskin.php
Note: Yes, I know the page says Gortex but the link says moleskin.

Wikipedia - Expert Infantryman Badge
http://en.wikipedia.org/wiki/Expert_Infantryman_Badge

WikiHow - How to Treat a Foot Blister
http://www.wikihow.com/Treat-a-Foot-Blister

ABC of Hiking - Foot Blisters - Preventing & Healing Skin Blisters
http://www.abc-of-hiking.com/hiking-health/blisters.asp

WedMD - Blisters - Home Treatment
http://www.webmd.com/skin-problems-and-treatments/tc/blisters-home-treatment

Betadine - Home
http://www.betadine.com/

Wikipedia - Calvin Coolidge Jr.
http://en.wikipedia.org/wiki/Calvin_Coolidge,_Jr.