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Saturday, December 31, 2016

Blister Care: An Exerpt from my Book

Here is an exerpt from Dr. Blake's Book "Secrets to Keep Moving: A Guide from a Podiatrist"

8. Blisters/Calluses

    The top 20 treatment tips for blisters are:

  1. Always drain blisters as soon as possible and use a sterile pin or needle.
  2. Sterilize the needle or pin with rubbing alcohol or passing it through a flame, when letting it cool for 30 seconds.
  3. Before performing the procedure, and try to make Marcus Welby MD proud, make sure you have topical antibiotic, bandaids big enough to cover completely, gauze to collect the fluid, and moleskin or athletic tape to cover the band aid.
  4. Push the fluid towards one side of the blister and puncture the dead top layer of skin keeping the needle/pin parallel with the skin, sort of above the fluid.
  5. Do not push the needle/pin into the live, deep layers of skin below the fluid.
  6. You must puncture the skin 3 to 5 times in different places to ensure that the top will not just reseal over and allow a new blister to form.
  7. Even with the best intentions, 30% of all blisters have to be popped again.
  8. After popping the blister, soak in warm water in a basin with two tablespoons of any type of salt for 30 to 60 minutes (the longer the better) to pull out the fluid. I do like the sound of the SALTS from the DEAD SEA.
  9. After soaking, dry off the blister well, apply topical antibiotic over the holes made by the needle/pin, or any other exposed, open skin, and cover with a band aid(s) bigger than the size of the blister.
  10. Place with firm pressure tape or moleskin over the band aid(s) to give an added push on the roof of the blister to re-seal with the underlying skin.
  11. Take off the dressing twice daily to soak for 30 minutes until all the soreness is gone. It is so important to continue soaking until the soreness is gone to pull out extra fluid and inflammation. This can take 1 to 7 days based on the size and depth of the blister.
  12. Once the soreness is gone, the dressing can be removed except when you are in a situation that a re-blister may occur (perhaps that next hike!).
  13. Keep moleskin or tape over the old blister area for 2 weeks more to protect against re-blister. It is extremely important to massage softening creams or moisturizers into the area for these 2 weeks to re-soften the skin. Massage twice daily for 2 minutes. All the soaking you do in the first week dries the skin and deep tissues.
  14. The goal is to get the skin soft again and the deep tissue not inflamed.
  15. When the blistering process is severe with skin breakdown and exposed deep tissue (loss of the roof), use one of the over the counter medicines in the water while you soak. See if your pharmacy has any one of these powders or liquids: Domboros, Pediboros, Bluboros, and Burrows Solution. Follow the directions for concentrations.
  16. The medicated powders or solutions listed above are so powerful drying agents that you immediately have to twice daily use the softening/moisturizing creams on the skin.
  17. With the severe blistering, more skin protection is also needed like big squares of moleskin attached only to good skin, Silvadene-like silver tainted ointments, and perhaps some padding. The silver ointments are anti-bacterial as well as great for the skin. Ask the pharmacy.
  18. What if the blister is possibly infected? So you pop the blister and pus comes out, immediately see a doctor.
  19. What if the blister has blood? Blood is the food of infection. Blood blisters must be taken a lot more seriously, and drained as quickly as possible. If you think it is getting or is infected, see above and see a doctor.
  20. Every year I have to have an infected blister hospitalized or, at least, see an infectious disease specialist. I hate infections!!


Calluses: Treatment for when they become Painful

Hi Dr. Blake,


I have come to see you in the past at the Sports Center for an ankle sprain. I have a question unrelated to the sprain and would like your advise. When I sprained my ankle I was training for my first half marathon. I started to get a callus on the ball of my left foot and that has now developed a corn on top of it. At first it would not bother me too much but as I continued to train it got worse and worse. Now after my training is over and, I admit, wearing not cushioned enough shoes it has gotten MUCH worse and has become very painful. For the past four weeks I have tried self medicating it with those pad treatments from the drugstore. I think I have tried them all at this point, the Dr Scholls brands, and it is still there and still painful. Now even with no pressure on it, there is still a lingering pain. Is there anything else I could do/try myself or is it time to come in?


I appreciate your time,




Dear Jessica, Thanks for your email.


    Usually calluses and corns only become painful when they have grown too deep into your foot and are now irritating the soft tissue under the skin. It is the corn on top of the callus which is usually the most painful and bores deep into the skin, normally called "seed corns".


    As the picture above notes, these calluses can be like "gluing rocks to your foot", and can be multi-layered with variable depths with each layer. The hardness of the corn irritates the soft tissue under the skin which contains a rich supply of nerves. You can get a deep blister, very painful, underneath the callus, and so deep that it is difficult to reduce. But the blister part is irritated with massage, even gentle massage with a pumice stone.

    It is best to approach these very sore calluses with softening creams (ask the pharmacist for a great hydrator) three times a day, avoid skin irritants like the Dr Scholl's plasters with acid, lay the sore area on an reusable ice pack 15 minutes 3 times daily to reduce soft tissue swelling, try 1 session of 30 minutes cool water soak daily (the longer the better), and gentle removal with a callus scraper (like Ped-Egg) daily for 2-3 minutes to gradually reduce the callus.


    A trip to a Podiatrist would help make the diagnosis of callus, blister, or wart (since many of these painful calluses are actually warts under the callus), and speed up the callus removal by weeks since they can use very sharp instruments, plus place appropriate padding in your athletic shoes to off-weight the painful area.


    No matter what, the callus has become something else, since calluses (which are dead skin) do not hurt. It is how the skin around them reacts that produces the pain. Or is there a wart or deep blister needing other treatments. I hope this helps. Rich



  1. Those blisters are bad news, just ask any camper who has to hike for hours! That's why I often wear socks, especially when shoes are new and had to be broken-in. If you find any blister on your foot, make sure not to dilly-dally and do something about it. Don't think that "it's just a blister" since this can also lead to infection when not taken cared of right away. Make sure to see a doctor if it worsens or an infection is in the works. Here's a good site that gives adequate information on how to care for a blister. See


Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.