Blisters:

In the blister literature there are particular groups of people who are studied: military recruits, endurance athletes and wilderness adventurers. These people get blisters, but I generally see them in patients who have taken meth and then walk around the city all day or all night. This is essentially an urban ultra-marathon.  

The blister discussion is broken up into two realms: prevention and treatment. We will talk about prevention for staffs’ personal lives (hiking, running skiing) and then treatment for our patients.

Prevention is all about lowering friction at the skin surface:

• Moisture increases friction at the skin, so keeping feet dry can limit blister formation.
• Military studies have looked at sock fabric composition, and according to a meta-analysis on the topic there is no clear data on what type of socks work best. (This is a big deal to the military because they loose millions and millions of $ and a plethora of training days because to foot blisters.)  
• There may be some benefit to wearing two pairs of socks, which theoretically shifts some of the friction to the interface between the socks and off of the foot.
• The most effective treatment (for both cost and blister prevention) is applying paper tape over the areas that are likely to get blisters.
• There have been studies looking at fancy/proprietary tapes vs regular old paper tape, and the paper tape looks to be more effective in preventing blisters. (In my experience K-tape, or its generic cousins, is easier to apply and gives similar results to paper tape.)
• The paper tape is applied to the heel, ball of the foot and toes based off of the participant's history of where they get blisters. A spray adhesive can be used to help the tape adhere to the skin.

Treatment: the goal is to leave the skin roofing in place over the blister so that is acts as a natural bandage. If there is fluid in the blister, it is reasonable to either perforate an edge and then squeeze the fluid out or to needle aspirate the fluid.  If the "roofing" skin comes off the chance for infection increases, but once the protective skin has ripped and is not a clear protective barrier, then it can be trimmed off.

To take pressure off the blister once it has been drained, you can make a doughnut of supporting material that sits around the blister with moleskin (or in the urgent care we have been using layers of Coban sandwiched between elasticon tape). Once that support is established, another layer of tape is placed over the top to create a full barrier. The goal of this is to off-load the skin that has blistered.

Finally, if there are hot-spots or deep blisters with no skin “bubbling,” I think it is reasonable to try paper tape directly over these areas to reduce friction, but I am not sure this has literature to back it up.

Pre-TAPED II study, Lipman, G, Krabak, B et al. Clini J Sports Med, Sept 2016
Frist-Aid Treatment for Friction Blisters. Janssen, L, Hopman, M et al. Clinic journal Sports MEd. Jan 2018

Prevention of Friction Blisters in Outdoor Pursuits. Worthing, R, Joslin, J. Wilderness and Environmental MEd. 2017.

https://www.thebmc.co.uk/friction-blisters-prevention-and-treatment