September 14th, 2021

Today's post is about blisters in the Wilderness!

By Coach Nick
Happy Wednesday everyone, it’s time for another installation of Wilderness Medicine Wednesday! Today we are going to be talking about something much lighter and more common than last week’s topic of shock. This post is going to be about blisters which I’m sure all of us have been plagued with at some point. As a reminder today’s post is going to be in the specific context of Wilderness medicine so we are going to approach this from the context of being on a long hiking trip, far away from the car or emergency services.
I think it’s always important to start these posts by talking about causes and prevention. Obviously, the ideal circumstance is that we can prevent all of these occurrences and never have to get to the evacuation or treatment steps. A blister occurs when friction causes the layers of your skin to rub against each other. After a while these layers of skin will separate and fluid will fill the gap, giving blisters their raised appearance. Blister prevention is relatively straightforward, eliminate friction. The most important part of prevention is knowing your footwear. The first time you wear a new pair of hiking boots should not be when you decide to hike the Beaten Path over the course of 4 days. When you buy new boots/shoes wear them around the house and do a few short hikes to break them in. If nothing else this will alert you to some friction points that you can tape over in advance of a long hike. The best way to eliminate friction is by wearing two pairs of socks. By this I mean an extremely thin sock (think ankle socks or liners) underneath your normal hiking sock. This simple technique will virtually eliminate all of your issues. I did this during my time in the Marines and never got any blisters. Keeping your feet dry is vitally important. Always carry multiple pairs of socks especially on long hikes, change your socks as soon as your feet get wet, sweat, or at least once a day. These two tips combined will make you never get a blister again, I guarantee it. If you are hiking and start to feel what we call a “hot spot” this is your last chance to prevent a blister. If you have never felt a hot spot before it feels well, hot, and it will hurt a little bit. Basically, you will feel like a blister is forming. All you have to do is put some athletic tape over it and this will stop the progression towards a blister. Hopefully through this paragraph I have conveyed the point that blisters are preventable. If you are prepared and use prevention techniques these do not have to be an issue. Any pictures you see or stories you have heard about blisters covering the entire bottom of someone’s foot or ruining a trip are the result of poor planning or lack of understanding and prevention. With this information I’m confident you can all prevent this from happening to you.
Let’s imagine that someone in your trip who does not know this information develops a large blister on their foot in the middle of a long hike and you are not within a day’s walk of the car. There’s a few schools of thought on how to go about treating this, I will give you the thought process and arm you with the information to make your own decision because no situation is the same. Here we are presented with the dilemma of to “pop” or “not to pop” and each has its pros and cons. Let’s start with the “pop” course of action. To pop a blister you need a needle or a knife that is STERILE, you can kind of do this by rubbing it with alcohol and exposing it to flame for a few seconds. From here you make a few holes at the base of the blister, squeeze the fluid out, LEAVE THE SKIN ON, and apply Moleskine. Moleskine is an adhesive, raised band-aid that needs to be part of your first aid kit. To apply this, cut a hole in the middle the size of the blister and place the ring around the blister, fill the middle of the hole with Neosporin, and cover the while thing with a bandage. Popping a blister needs to be a very deliberate decision because we introduce the risk of infection. A blister will not kill you, infection could. Whenever we make a hole in the protective layer of our skin we open the door to infection, especially in dirty environments like the middle of the woods. My recommendation is that a blister should only be popped in the case of an emergency or if the person can not walk at all, otherwise I would recommend just taking the extra time to walk out in a little more pain and discomfort over risking severe infection (this is where we should analyze how far away from “civilization” we are and weight it against the risk). If you decide not to pop the blister you can still use the same dressing technique with Moleskine. As I already alluded to, the patient will be in pain when they step on the blister and will move slow but I would recommend this if you are very far from help and don’t have experience keeping wounds clean.
As always, I hope this post was helpful and that you don’t have to experience what I’m writing about. Unfortunately, with blisters we will all encounter them at some point in time. Hopefully this is enough to prepare you to prevent them yourself, teach others about it, and treat them in others. Have a great week everyone!

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