Welcome to ‘Podiatrist Mike McColgan’s article on blister pathology’ Blisters occur in vigorously active populations and result from frictional forces that mechanically separate epidermal cells at level of the stratum spinosum. Hydrostatic pressure causes the area of the separation to fill with a fluid that is similar in composition to plasma but has a lower protein level. About 6 hours after formation of the blister, cells in the blister base begin to take amino acids and nucleosides; at 24 hours, there is high mitotic activity in the basal cells; at 48 and 120 hours, new stratum granulosum and stratum corneum, respectively, can be seen. Forces involved The magnitude of frictional forces and the number of times that an object cycles across the skin determine the probability of blister development – the higher the frictional forces, the fewer the cycles necessary to produce a blister. Moist skin increases the frictional force, but very dry or very wet skin decreases friction force. Blisters are more likely in skin areas that have a thick horny layer held tightly to underlying structures (e.g. palms of the hands or soles of the feet). More vigorous activity and the carrying of heavy loads during locomotion both appear to increase the likelihood of foot blisters. Antiperspirants with emollients and drying powders applied to the foot do not appear to decrease the probability of friction blisters. There is some evidence that foot blister incidence can be reduced by closed cell neoprene insoles. Wearing foot socks composed of acrylic results in fewer foot blisters in runners. A thin polyester sock, combined with a thick wool or polypropylene sock that maintains its bulk when exposed to sweat and compression reduces blister incidence in Marine recruits. Recent exposure of the skin to repeated low intensity frictional force results in a number of adaptations including cellular proliferation and epidermal thickening, which may reduce the likelihood of blisters. Studies More well-designed studies are necessary to determine which prevention strategies actually decrease blister probability. Clinical experience suggests draining intact blisters and maintaining the blister roof results in the least patient discomfort and may reduce the possibility of secondary infection. Treating de-roofed blisters with hydrocolloid dressings provides pain relief and may allow patients to continue physical activity if necessary. Blisters tend to be ignored or de-emphasised but account for a large number of medical problems and when present, can result in altered gait patterns which go on to result in or exacerbate other more proximal musculoskeletal injuries. What is more concerning again is that blisters become open wounds and as such are susceptible to infections (Berkley et al 1989). This will have a debilitating effect on the movement which is becoming increasingly stressed in all members of society. From the sedentary office worker to the military personnel involved in operations. A case series reported the death of a soldier and hospitalisations due to Staph aureus infections in association with blisters (Brennan et al 2002) Friction blisters can have a negative effect on an individual’s ability [...]

'Foot Bumps and Blisters: PART 1’ Welcome to ‘pain and prevention of blisters as part of my walking series articles’. Have you  ever set out only to find that after a short walk you notice there is a burning pain somewhere on your foot? You put up with the increasing discomfort but by now that walk that you set out, and look forward to, is by now far from fun. There is a reluctance to take the shoe or boot off.  If you dare to look you know that you might not get that shoe back on! Back home the footwear is removed, the sock seems to have stuck. You survey the damage once the material has been unglued from the skin. A blister has formed and ugh you look at the raw red skin, bright, moist and stingy… what now? Blisters are common and are associated with friction. Essentially the more resistance over the skin surface, the more damage that arises on the skin through tearing and heat generation. The process of a force that arises at one point prevents gliding over the skin surface. When I taught students podiatric medicine I simply said; think of ice. The foot slips easily as there is no resistance  between the surfaces with ice. But two dry surfaces resist easy movement. Rather than yield they meld together with movement setting up heat. Simple? Er, no… Breaking in shoes? New shoes are one factor. I love my walking boots. They are heavy duty and made of quality leather, but they took a while to become comfortable. Sure I tested them in the shop, but that is no substitute for getting out there and trialling them on different terrain. All this takes time. It is only when you go for that long walk that you realise there is no going back. So is there a solution? Well Footlocker wanted to consider our options and come up with a bit of self-help advice. But as far as that ‘breaking them in’ well get the choice wrong and they will break you skin not the shoes! If you know the foot is likely to clash with the skin and shoe, DO NOT BUY THE SHOE no matter how lovely and stylish that shoe appears. TAKE THREE ELEMENTS The skin The surface of the skin is ONE element, the SECOND element is the material that our footwear is made from. The THIRD element is walking. That is to say, the time to walk, the type of terrain and the existing conditions. If you live in the UK you know we swing between wet and soggy, to dry and hard on the ground. Wet and soggy means you slip everywhere. Dry and hard means if your foot hits a rut or ledge of dry earth, the foot can teeter all over the place. In another article on walking I shall expand on the ankle, its function and why it goes over.  The shoe fit is important because there are several places where the foot will rub. The [...]

A ‘mysterious’ heel bump (Part 2) Thanks for reading my latest article on ‘Haglund’s deformity’ Let me try to demystify one type of heel pain known simply as the pump bump. Patients often ask how does a heel bump it arise and what we can do about my heel bump? Vaishya (2016) calls it a ‘common but mysterious condition’ in his paper . The reader needs to be aware that heel bump is a simplification and has some complex names. There are plenty of reasons for heel pain and this is one. The retro calcaneal exostosis or Haglund’s deformity sound mysterious. Haglund as a name for a heel condition was so called after the man who described the problem in 1927. I have this heel condition myself. My problem has been with me for thirty years. It was not until I was in my late forties that I experienced problems. My main concern was whilst driving, then latterly when wearing some designs of shoes. This has made me more aware of the design of my shoe. Pressure from the floor of the car stung my foot like crazy because my heel rubbed the skin while the foot was against the floor of the car.  There were times when some shoes could rub the skin forming a blister. What is it? When studying to become a podiatrist, we called these heel bumps an exostosis or simply Haglund’s. The condition is not a disease but a deformity of the back of the heel bone (calcaneus). The term syndrome suggests that there is more than one condition. Those who read my articles regularly know that I try to keep descriptions as simple as possible. Here is Vaishya’s complicated reasoning about the condition but I will explain what all the jargon is after his paragraph. Haglund’s deformity is an abnormality of the posterosuperior part of the calcaneus, where there is a bony enlargement at the attachment of the Achilles tendon. The adjoining soft tissues can get irritated when this bony lump rubs against rigid shoes. It often leads to retrocalcaneal bursitis, calcaneal tendon bursitis, and thickening and inflammation of the calcaneal tendon. This combination of pathology is known as Haglund’s syndrome. Inflammation of the different parts of soft tissue in the area can lead to an isolated condition; however, the treatment options are different in these conditions, and so they should be differentiated. We now know the heel has a protrusion but let’s keep it simple. ‘Posterosuperior‘ is an anatomical position. The back of the heel! What about the tendon. Most people only have the minor form of bump. However, in a few people the bump becomes larger. If the extent of the bone extend across the heel, where the big tendon of the calf is anchored, then part of the tendon can also be involved. It can do so in three ways. The tendon can be damaged, or the skin can form a spongy fluid filled sac called a bursa. Where the deep tendon sac becomes inflamed the condition can deteriorate. The skin surface can [...]

Welcome to the Futsal Trial looking at the Pellitec(R) product to minimise the effect of friction across the skin Mike McColgan presents his second article on ‘blisters’ looking at a new and specifically designed product which has been anecdotally tested using the testimonial evidence from both amateur and professional sports and military personnel. Click here to review the first part. On the 30th June 2017 a world record attempt was made to play a continuous game of indoor Futsal by the Tranmere Futsal hub in Birkenhead, Wirral. They were successful and have been recognised for their achievement of 50 hours continuous play. PelliTec is a multi-layer friction reduction technology which addresses the three factors involved in blister formation. The Silipos silicone gel central layer reduces pressure, the Mylar discs reduces friction, and the top Baltex top cover wicks away moisture. It is easy to apply and adheres to the inside of the shoes creating a friction free, pressure reduced, dry area to tackle potential areas of increased movement. Method Futsal is a variant of association football which is played on a hard court, smaller than a football pitch and mainly indoors. It can be considered a version of five aside football. It is played between two teams of five players each, one of whom is the goalkeeper. Unlimited substitutions are permitted. Unlike some other forms of indoor football, the game is played on a hard court surface delimited by lines; walls or boards are not used. Futsal is also played with a smaller heavier ball. The surface, ball, and rules create an emphasis on improvisation, creativity, and technique as well as ball control and passing in small spaces. Eight subjects (7 male, 1 female) were recruited to the study on a voluntary basis. Age range 18 to 35 (Ave 29). All had previous history of blistering and all had played futsal previously and attended the training and preparation sessions which were carried out in the preceding 2 months. They were allowed to wear their own brand and style of footwear and socks. Each participant was allowed to request pads as they went along. The pads were fitted by one of 2 members of the research team and the subjects name, age, sex, and area that the pad was placed, time and date, were recorded on a data sheet. In one case, the subject, a 23 year-old female, started the challenge using her own padding but changed to the trialled product around half way through and was able to continue and complete the 50 hours. One subject, an 18 year-old male, wore the product from the start on his 1st metatarsal heads which remained blister free but then went on to develop blisters on the apices of his 3rd toes after the first 20 hour period. Pads were placed into his boots at the symptomatic places and he reported that he ceased to feel the pain and was able to continue. A 26 year-old male reported pain under both metatarsal heads [...]

With coronavirus COVID-19 spreading across the nation, stricter measures have been put in place by the Government to keep members of the public from catching the virus, and most importantly, slowing down the spread of the virus. The following restrictions have been put in place from 23 March:  Only go outside for food, health reasons or work (where this absolutely cannot be done from home)Stay 2 metres (6ft) away from other peopleWash your hands as soon as you get home With that in mind, how can you and your family stay fit and healthy during this global pandemic?  Get out of the house once a day According to government guidelines, individuals can still get out of their homes once a day to exercise. Exercising can include walking, running or cycling. You can leave your premises alone or with anyone you live with, but when you’re out of the house, you must stay 6ft (two metres) away from others. The best places to go to exercise include open spaces such as beaches - particularly when the tide is out, local parks and fields and National Trust sites. Although following the Government’s more stringent guidelines the National Trust has had to close car parks to the public to stop them flocking to their outside spaces, many of their countryside and coastal locations are still open to the public. The National Trust is urging its visitors not to travel but to stay and enjoy the coastal and countryside locations local to them. If you’re out and about, don’t forget to purchase a set of our PelliTec blister prevention pads. We are open online - business as usual. Stay safe out there and keep your feet comfortable on your daily walk! Get fit indoors  We’re all lucky to have such a vast online community to tap into during self-isolation. Fitness coach, Joe Wicks has been streaming live videos every morning at 9 am. With these workouts aimed at both parents and children, the videos aim to get us all moving while we’re experiencing self-isolation. His new YouTube channel, The Body Coach TV, offers video workouts ranging from P.E.-style exercises to workouts for seniors - we’re sure you’ll find a fitness routine that works for you! Try something new Like many Brits working from home, you might have a little more spare time you would have otherwise spent commuting. This free time could be spent exploring new exercises - you might even come across something you really enjoy! On-demand fitness session company, Moviing has reported a 30% increase in online subscriptions since the coronavirus outbreak, inews said. And many yoga and pilates teachers have transitioned their classes across to the online space - using Facebook Live and other streaming services to offer their students a chance to ask questions and take part in an interactive class.  It’s challenging but try and view this time at home as a chance to find a new routine and way of life where you can peacefully co-exist in your [...]