Planning your bucket-list multi-day hiking expedition is an exciting prospect, filled with the promise of breathtaking views, fresh air, and the thrill of conquering challenging trails. However, even the most carefully planned adventure can be marred by a persistent foe that haunts many a multiday hiker: foot blisters. This common affliction has the power to transform a dream hike into an agonizing ordeal.
Thankfully, we have blister expert Rebecca Rushton here to tell us all about what’s new with this seemingly basic, but vastly misunderstood injury. Rebecca is a podiatrist with 30 years experience who lives in Esperance, Western Australia. She has a special interest in the cause, prevention and treatment of foot friction blisters which stemmed from her own persistent blister struggles, and culminated many years ago in the popular Blister Prevention website. Rebecca is considered a leader in the field, authoring journal articles and educating podiatrists and sports medicine professionals on blister management. She provides foot care at 6-day ultramarathons, and loves to help people of all active pursuits to understand their blisters better to find effective solutions they can rely on.
Rebecca Rushton
Founder of Blister Prevention, podiatrist
The complete guide to foot blister management for hikers, walkers and trekkers
1) What really causes blisters?
To conquer blisters, it's essential to understand their origin. Blisters are often thought to form due to repetitive rubbing. However, rubbing is rarely the problem. Blisters are actually caused by skin stretching back and forth (called shear deformation). Shear is the “give” in your skin, and it originates from the fact that your bones move back and forth within your foot, every single step you take. Shear is normal, and your feet can put up with a lot of it. But when shear becomes excessive and repetitive, like it can do in multiday hiking, a tear occurs under the skin surface. This is the initiation of the blister injury. Fluid slowly fills the injured site, and within 2 hours, you have a blister.
2) Aren’t blisters more or less inevitable in multiday hiking?
Blisters are common, but they are certainly not inevitable. To successfully get on top of blisters issues, you need to focus on shear, not rubbing; nor some combination of heat, moisture and friction. Sure, your feet are going to get hot and sweaty as you progress through the day, regardless of the conditions. And this means friction levels will increase. But the heat, moisture, friction paradigm is not an accurate formula for the formation of friction blisters.
When hikers find their best efforts at blister prevention fail, whether it be wider shoes, moisture-wicking socks, special taping techniques, powders, lubricants or something else, they surrender to the inevitability of blisters, and just deal with the damage. But I’m here to assure you, with a renewed focus on minimising shear distortion in the skin, blisters can soon become a thing of the past. No matter how steep your inclines and declines, no matter how rocky and uneven your trail is, and no matter how hot and sweaty your feet become, it’s easier than you think!
3) Why the first few days are the most important
The initial days of a hiking trip are crucial in preventing blisters. Research shows the majority of blisters occur on day two of a hike. If you can help your blister prone areas through the first 3-4 days, chances are you’ll get to your destination with happy, healthy, blister-free feet.
Choi et al, 2013. The number of blisters experienced per day of a multiday road hike.
At the very least, pay very close attention to your feet over these first few days. Be aware of any hotspots and take action on them straight away. The hotspot stage can be subtle and often doesn’t last that long. If you continue until you feel a sting, you’re too late - a blister is on the way. The better approach is to have the very best preventions in place for your blister prone areas, before you even start.
4) The value of your blister history
The most likely blister you’ll have is the one you’ve had before. This is invaluable blister intel. My advice is, don’t just ignore this fact and hope for the best. Identify every area you’ve had blisters before, assume they will rear their ugly heads again, and get the very best prevention in place for that blister site before you even start on day 1. Don’t wait for a hotspot. Start with your best preventions in place!
Where do you get blisters?
5) Are callouses good or bad?
Callouses, those thickened patches of skin, are often considered protective barriers against blisters. However, blisters are not a superficial-to-deep wear injury. So, not only do they not protect against blisters, they can make dealing with them more difficult and painful.
However, here’s a piece of inside information that you can use to your advantage. Callouses and blisters are caused by the same thing - repetitive shear. Callouses are the chronic manifestation, where the skin has time to adapt; blisters are the acute manifestation, where it doesn’t have time to adapt. The pearl of wisdom here is, anywhere you have a callous, you should expect this area to blister on your multiday hike. Expect it, and get the very best prevention for this location in place before you even start.
It’s not enough to exfoliate the callous or see a podiatrist before you go to remove the callous. It’s not the callous that’s the problem; the callous is simply a sign that this patch of skin undergoes a lot of shear in your normal day to day. Expect blisters to develop here with the sudden increase in activity, and take proactive preventive action to stop that from happening.
6) How to prevent blisters
I wish I could tell you there’s a single solution to every blister. If only it were that simple! What I can tell you is, there are a lot of blister prevention products, techniques and strategies out there. The trick is finding the best one, for each area of your foot.
As a serious hiker, you’re understandably looking for a single blister solution specifically for hikers. However, you’ll get better results if you start with the anatomical site of the blister, and then nuance it to the specifics of your hike.
For example, one of the best preventions for most toe blisters is gel toe protectors. I especially like them for pinch blisters of the pinky toe. This material absorbs tremendous amounts of shear so your skin doesn’t have to. Really, it doesn’t matter if you hike, run, or play tennis; if you want to prevent 5th toe pinch blisters, I would recommend gel toe caps for this blister. However, for the 6-day continuous ultramarathons I provide foot care at each year, swelling can become a big issue and there’s just no room in the toebox for these protectors. In this case, we use the gel toe protectors for as long as we can get away with it, then pivot perhaps to a lubricant, being sure to reapply it every couple of hours as it disperses into the sock.
7) What your blister roof tells you about how to treat it
Not all blisters are created equal, and their appearance can provide valuable insights into effective treatment. Essentially, the integrity of the blister roof helps you decide if you need antiseptic, and what dressing to apply.
There are 3 stages of blisters. Blisters can present with their roof intact, torn, or deroofed. Watch the video below to understand the nuances of blister treatment to each blister stage to prevent infection and facilitate rapid healing.
8) Blister first aid versus meaningful blister treatment
Applying an antiseptic (topical antibiotic) and a dressing (bandage) is basic blister first aid. Unfortunately, most hikers stop there, and wonder why their blister continues to be painful and get worse over the remainder of the hike. Meaningful blister treatment, the type that takes the pain away and helps your blister heal while you continue to walk on it, requires a more comprehensive approach.
Simply, it should include something that stops the blister causing forces (shear). A dressing will stop the damaged skin from being rubbed, but it doesn’t stop shear. What stops shear? The prevention you ideally would have had in place to start with. Prevention is king!
9) Packing light without losing functionality
The weight of your pack matters. But sacrificing essential items to lighten your load isn't the solution. You need to have some blister management items in your first aid kit, or a dedicated blister kit, to ensure you can stop hotspots from becoming blisters, and to treat blisters safely and effectively. Striking the right balance ensures you can enjoy a lighter load without compromising your hiking experience.
My advice is to expect those blisters we’ve talked about and have the very best prevention in place before you start. That way, you don’t have to carry anything extra for your most likely blisters. It makes so much sense, doesn’t it. And the better you are at prevention, the less stuff you need to carry for treatment.
10) Items to add to your packing list
There are a few blister care items that pack a punch in terms of utility and value for money.
Engo Blister Patches are thin blue “stickers” that you put on your shoe, not your foot. They take friction levels out of the equation, no matter how hot and sweaty your feet get. And best of all, they last for days, weeks, months, and sometimes even longer. They’re handy for lots of blister sites, including the back of the heel, under the ball of the foot, the arch and the edges of your feet (edge blisters) - so if these blisters are in your blister history, get your patches in place before you set off. Engo Patches aren’t available in most stores but you can pick them up online. They need to be applied to a clean and dry surface, and they don’t like waterlogging - it can make them start to peel off. But they are low bulk and weight and should make it into your pack list for long lasting relief from painful friction and prevention of blisters. Learn more about how Engo Patches work, and their pros and cons here.
Gel toe protectors, which come in the form of sleeves, caps and interdigital wedges. The gel material absorbs huge amounts of blister-causing shear, so your skin doesn’t have to. I particularly like gel toe caps for pinch blisters. You can pick these up at most pharmacies and online. Ours are a little thicker than other brands, which means they give better protection, but it also means you’re less likely to fit more than one into the toebox of your shoe. I don’t recommend them for already-damaged or blistered skin as the gel can cause maceration. So use them for prevention only. Learn more about when to use them, and their pros and cons here.
Thirdly, have dressings and plasters of various shapes and sizes at your disposal in case you get a blister. You’ll probably want standard size bandaids, some bigger dressings, and consider some “finger” and joint dressings for those awkward parts of your foot, like toe tips. Hydrocolloid blister plasters (like Compeed) are a great addition to your kit. They’re waterproof and accelerate the healing of shallow raw weepy wounds, like deroofed blisters. BlisterPod hydrocolloids are worth a look as they have a couple of advantages over Compeed, particularly when it comes to remote multiday adventures. BlisterPod hydrocolloid blister plasters are:
Sterile and individually-wrapped: You should only ever use sterile products on open skin to prevent infection.
Includes the fixation tape that should go around the edges of your plaster: Hydrocolloid plasters can peel at the corners in active and sweaty situations. Not only does this invite infection, the plaster can also stick like glue to your sock and be difficult to get out. The fixation tape really helps your plaster stay in place for days, like it should.
Conclusion
Preventing and treating foot blisters is equal parts art and science. While reliable prevention alludes many, with an eye on the real cause, and by honing in to what works best for specific blister locations, it can be quick and easy to arrive at a winning strategy. This is the approach I use to help endurance athletes and active people of all persuasions to find the best blister solutions for their feet. If you seem to be blister prone, or if you feel like you’ve tried everything, see below for resources and next steps that can help you bid farewell to blisters in your multiday hikes, and stride confidently along the trails. Here’s to your happy hiking feet!
WEBINAR: PREVENT BLISTERS SPOILING YOUR NEXT HIKE
When travelling to the Alps for your bucket list hiking trip, the last thing you want is blisters to ruin your trip. You have back-to-back days, big elevation changes per day and often a heavy pack. Blisters aren't just an annoyance, but can cause further injury.
Join Rebecca Rushton, Podiatrist and owner of Blister Prevention, and Susan Perry, Co-Founder of The Hiking Club, for a free 45 minute webinar on blister prevention for multi-day hikers.
What we covered:
What causes blisters while mutli-day hiking?
What can I do to prevent blisters?
Eeeek I got a blister….how do I treat my blister and keep hiking?
Items to add to your packing list
The Hiking club blister bundle
SPECIAL OFFER FOR THE HIKING CLUB COMMUNITY
For a limited time, Rebecca is offering a massive discount on the Blister Prevention’s “Blister Bundle”. Get lifetime access to the Fix My Foot Blisters Fast program and their best blister kit called the ULTRA Blister Kit all for just $245 USD (normally $425 USD). That’s a huge saving of $180 USD. You can only access this bundle using the below link and its only available for a limited time.
Resources
Blister Prevention website: Tonnes of freely available information on lots of blister topics.
Blister Prevention Store: On the same site is the online store where you can find lots of blister products so you can implement the perfect prevention during your training, or to add to your packing list so you can deal with blisters on the go. They ship worldwide from both Sydney (AUS), and New Jersey (USA).
Fix My Foot Blisters FAST: This online course is a guided program that helps you get straight to the information you need to prevent and treat your blisters, in the fastest possible time. It takes the same approach as Rebecca’s outlined in this article, supporting you as you change your mindset about how to deal with blisters effectively, every single time.