Pictured, Andrea Hunt from 381 Footcare. Earlier in the year we spoke to Andrea Hunt, who said, "As a Podiatrist looking after professional female footballers, the majority of foot problems seen on a regular basis include blisters - predominantly on the toes, calluses, bleeding under toes nails, verrucas, sweaty feet, athlete’s foot and ingrowing toenails. Blisters are by far the most common problem especially at the beginning of each season. The advice we give on treatment is to try and leave them intact as breaking the skin can cause more trauma and lead to infection. If they are in an area where there’s lots of pressure it’s a good idea to drain them with a sterile scalpel, dress and then redistribute the pressure with semi compressed felt. Recently I have introduced some players of the Manchester United FC Women’s team to PelliTec to help prevent blisters and therefore having unnecessary treatment with risk of infection." Andrea went on to say, "We’ve also added PelliTec pads to the inner arch of an orthotic to prevent friction. The team members using them have found they work successfully in decreasing friction in the area and help to prevent blister formation." Learn more about Andrea at 381 Footcare. #womensfootball #PelliTec #blister #blisterprevention #podiatry #podiatrist

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 [...]