Blisters due to minor trauma

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Blisters due to minor trauma

Very common – often just a minor annoyance – but can lead to cellulitis or sepsis.

Due to frictional forces between skin and external object. They are not a thermal injury,

Frictional forces  slight exfoliation of stratum corneum and erythema – the “hot spot”  burning pain/stinging – pale area forms around red area  pale area enlarges inwards  becomes elevated and fills with fluid.

Risk factors:
• High frictional forces – from shoes, orthoses
• Moisture – increased risk in moist skin
• Lubricating agents – some agents initially decrease friction, but later increase it (eg mineral oil, petrolatum)
• Thick area of stratum corneum more prone
• Female > male
• Previous history of blisters at greater risk

Prevention:
• Moisture reducing agents –
• Insoles – eg Spenco™ (closed cell neoprene) – absorbs shear stresses
• Socks – can reduce moisture and shear stress
• Good fitting footwear
• Adaptation – blisters less likely if area has been previously exposed to some friction below threshold for blister formation
• Adhesive fabrics (eg Moleskin®) and viscoelastics (eg Spenco Second Skin®)
• Lubricants – eg petroleum jelly – but may increase friction after time
• Debridement of callus

The skin does appear to adapt to increase stress like the musculoskeletal system if small increasing loads are applied

Treatment:
• Drainage of blister – best results have been shown if leave top in place if possible and drain blister 3 times over first 12 hours
• remove top if infected or if edges loose
• Hydrocolloid dressing if top removed
• Accommodative padding to relieve pressure
• Adjusting of foot orthoses if a factor
• Antibiotics only if serious signs of infection
• Implement preventative measures
• Good fitting footwear
• lubricant to reduce friction
• taping or moleskin on prone areas if using new shoes to during competition if prone

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