Blisters: 9-Step Plan for Treating Blisters on the Run

Adapted from “Training Essentials for Ultrarunning”, by Jason Koop and Jim Rutberg. Buy your copy today!

In 2011, Martin Hoffman and Kevin Fogard published an article titled “Factors Related to Successful Completion of a 161-km Ultramarathon.” Their study explored the characteristics and issues that affected the performance of runners during the 2009 Western States 100-Mile Endurance Run and 2009 Vermont 100 Mile Endurance Run via pre- and post-race questionnaires.

The section of Hoffman and Fogard’s survey that examined the reasons athletes failed to finish demonstrates that blisters remain a prevalent issue and do limit performance. In many cases, it’s not the blister that leads to the DNF. The blister just starts the process by changing the way you run, and over time those changes lead to other biomechanical problems, slowing you down, knocking you off your nutritional strategy, exposing you to the elements longer, and so forth. This does not have to be the case. Blisters can be largely prevented through training, prevention, and better race-day management.

However, even the most prepared athletes sometimes get blisters and have to treat them. Treatment is relatively easy, requiring a few basic products and skills to fix the majority of issues. It takes practice, but it’s worth it.

Fix it or Forget It?

If you do get a blister (or the precursor, which is referred to as a “hot spot”), you have a decision to make: You can save some time and continue running, or stop and lose some time treating your feet. In making this decision, you need to balance your race-day goals, performance expectations, safety, and race situation. Generally speaking, the more time you have left to run and the bigger the problem could become, the more it is worth your while to take a few minutes and fix what is wrong. Don’t let little problems become big problems. My advice is to always err on the side of caution and fix problems early, particularly at the 100K and 100-mile distances, where there is a lot of ground to cover.

If you are in a situation where you choose not to stop and fix a blister, or you are many miles from the next aid station and you have no products to treat the blister, it is time to suck it up. Blisters hurt because the foot is highly innervated, and runners tend to find relief by changing their gait or foot-strike pattern. While this is a logical strategy (“I have pain there, I am going to try to avoid it”), the ramifications of changing your gait too much can have consequences up the kinetic chain. Your foot, ankle, knee, and hip are all connected and constantly affect one another. Although I am an advocate for manipulating gait and biomechanics in an effort to combat muscular fatigue, I do not advocate doing so in the context of a blister. In this case it’s time to be tough and keep your gait as normal as possible. Running with your normal gait may make the blister worse, but that’s still only one problem, and one you can treat and get under control. Changing your gait to “run around a blister” can lead to pain or injuries you can’t effectively treat and control while continuing to race. That said, you might have to tough it out and run on a blister on race day, but it’s not a strategy to rely on. Blisters can and should be prevented and treated.

Simple Blister Treatment on the Run

Blisters come in a variety of shapes, sizes, and levels of discomfort. Treatments also come in many shapes and forms. Unless you are a medical professional with many years of blister management experience, a simple solution is always best. I have found success with the following nine-step plan:

  1. Clean the surface of the blister and the surrounding skin. If an alcohol pad or disinfectant is available, use it. If not, it is still usually best to proceed to step 2. You are less prone to infection if you can properly manage the blister while it is small and treatable. Large broken blisters will become more prone to infection more readily than small broken blisters because there is more opportunity to become infected through the larger area of damaged and exposed skin.
  2. Puncture the blister with a needle, sharp scissors, or scalpel. Take care to puncture the blister enough to allow fluid to drain but not so much that the 
blister roof becomes detached. If you are using a needle (safety pins from a race number also work well), put three to four holes in the blister so that it will drain. Ideally, place the punctures such that fluid can continue to drain while you keep on running.
  3. Squeeze the fluid out of the blister.
  4. Clean and dry the surface of the blister and the surrounding skin. You are 
now prepping the skin to apply a patch, so ensure that it is dry and free of debris. You can choose to add a very small dab of lubricant to the blister roof. This is to prevent the patch from sticking to the blister roof when you eventually peel the tape off.
  5. Size up the area you are going to patch, and cut a piece of tape or bandage to cover the blister. The patch should be large enough so that it can stick to the surrounding skin. If the blister is on a toe, this might mean wrapping the entire toe. If you do have to wrap a toe, it’s usually best to wrap the adjacent toes also so that the tape does not rub directly on adjacent skin.
  6. Apply a tape adhesive such as tincture of benzoin to the area surrounding the blister. Although the tape has its own adhesive backing, using an additional tape adhesive will ensure a better stick.
  7. Place the tape down on the skin from one edge of the tape to the other. Be careful to avoid folds and creases. If you do get a fold or a crease, start over.
  8. Lightly press down on the patch to ensure the adhesive completely sticks to 
the skin.
  9. Put your socks on, lace up your shoes, and run!

If you are particularly blister prone, practice various techniques at home. Cutting and placing the patch on the surface of the skin can be the most frustrating part of the process during a race. The tape is sticky and adheres to itself and to your fingers. You’re in a hurry. You’re sweaty and dirty. And you’re working in a dirty, dusty environment. Finding a routine and learning some simple skills goes a long way to making the process smoother and faster in race conditions. As with any other skill, practice makes perfect!

Hoffman, M. D., & Fogard, K. (2011). Factors Related to Successful Completion of a 161-km Ultramarathon. International Journal of Sports Physiology and Performance, 6(1), 25-37.

 

5 Responses to “Blisters: 9-Step Plan for Treating Blisters on the Run”

  1. Steven on

    Switched to altura zero drop shoes. No more blisters,giant 30 year old calluses gone!

    Allow your feet to spread out and work like they are supposed to. I thought blisters were normal, use to get them all the time. Feet feel like they were at 19. Not affiliated with altura. 30 miles a week with a 12-15 mile trail run

    Reply
  2. Pablo Pereira on

    Hi there, very useful article, thanks! I will be running my first 100k ultra in two weeks and during my training I found out that blisters are my weakest point, using the same shoes I will use in the race I know exactly where are my hot spots, after trying vaseline, or talcum powder the best strategy is to prevent the blister using patchs in the sensitive areas. Anyway I will carry my needle and patchs as you recomended

    Reply
  3. David Roberts on

    Once I tape a blister, I leave the tape on until it falls off by itself. That includes showering with the tape on. Sometimes it takes a week.

    Reply
  4. Wayne Ingram on

    I have found two additional pieces of this puzzle that can be very helful.

    1. When you drain the blister, puncture it on an edge away from any point of impact. Opening up the blister is necessary for draining, but puncturing it at or near the leading edge of impact can cause it to open up further as you continue to run.

    2. Once it’s open, squirt some Neosporin ointment up into the opening and under the blister roof. This will spread out as you continue to run and provide some comfort, but it also provides protection against infection, which is of primary importance.

    Regards,
    Wayne

    Reply
    • J. Kevin Poitras, MD on

      DON’T DO THIS. Indiscriminate use of antibiotics is the reason for the current problems we see with antibiotic resistant bacteria such as MRSA. Throwing antibiotics at a wound that is not infected only ensures that if that wound becomes infected it will do so with bacteria resistant to the drug you have used. Additionally, Neosporin allergy is one of the most common and the likelihood is only increased by occluding the drug under a blister roof and/or bandage.

      Reply

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