PLEASE! read the following post (search under David and blisters for whole thing)
I attended a pilgrim day with David there giving advice and he is SO right! Since I have kept my boots laced as he suggests and taken them off at every break during a day's hiking - I have never had another blister.....
So - get the right boots, lace them properly and let your feet breathe (and shrink!) while you have lunch/siesta/coffee....
Do not suffer when you don't need to!
'Hi. I am recently back from doing seven weeks first aid. I am usually alone and having the comradeship, help, and support from JennyH94 really enhanced the whole experience for me (especially her wildly irreverent sense of humour that matches mine!). We met many injured pilgrims; Puenta La Reina was a great stop, being just a few days from St Jean, with many pilgrims beginning to fail there - at times the first aid would go on for over four hours non-stop, with Jenny using the torch on her phone as we worked into the late evening.
Anyway ... I have some thoughts about some of the problems I/we met with. These are personal opinions from repeated observation and hands-on experience in the field. Your thoughts may differ from mine but I am not trying to force my point of view, only offering it.
Boots - most foot problems were blisters and mainly to do with the wrong size or ill-fitting boots, as well as ignoring hotspots until it was too late. Boots were frequently laced too tightly and/or were too small. I know this is gender specific but I would say that over 90% of those whose boots were too small were women .. now, I don’t know if this was to do with women wanting their feet to look the right size, or inexperience, but again and again frontally located blisters were women with the wrong size/width boots.
I rearranged the lacing on many boots .... loosening the front section of the laces, with my fist stuffed inside the boot to spread it out, from the front to the third eyelets and then tying a half knot, at those eyelets, and then showing them how to put them on. Kick the heel right back into the boots, tie up firmly so that the rear of the boot is held firmly with the foot, and, with the half hitches at those mid eyelets, the front of the boot never tightens up but stays more open, allowing the toes to move freely.
We also found that many would lace up tight in the morning and leave their boots untouched until they finished walking at the end of the day, ignoring the increasing pain - some did not even know that their feet became larger during the day. One should stop at least every two hours, take the boots and socks off and have a break, then put the socks back on alternate feet (so that seam pressure points are moved) - for many this was the end of their daily discomfort or pain.
Blisters - rascally things! we met pilgrims who were in denial, just hobbling along in pain with terrible blisters and doing nothing about them. We found those who had self-treated poorly and made their situation worse; those who had drained their blister and left cotton thread in there to wick away liquid and then left them uncovered. This is a terrible idea unless you know exactly what you are doing. That sweaty environment inside the socks is a perfect petrie dish for microbes to breed and many had become infected.
There are two points of view here - cover and allow to heal, and drain and cover and allow to heal. Here is the thing. A blister is a burn under the surface of the skin. The body produces the fluid as a cushion but walking on it every day forces the liquid, with each step, to press against the outer edges of the blister under the surface skin - which widens it every day .. the blister gets bigger and bigger.
So I drain them - always. They have to be drained. I use a scalpel to make two tiny V shaped cuts that allows the blister to be completely drained. I then spray antiseptic (to get into all crevices and inside the cut sections) and cover with fabric plasters that have sticky all the way round the edge. I then sometimes fabric plaster on top of that to give more cushioning (I give the pilgrim back-up plasters to keep them going until they get to a pharmacy).
This treatment works well, almost instant pain relief. Why fabric plasters? Because I find that waterproof ones are never sticky enough and they allow the wound to sweat beneath them - so I always use fabric, which sticks well and breathes.
What we found, again and again, were pilgrims who had stuck Compeeds over a growing blister. The Compeed sealed all the way round, the constant pressure of each step enlarged the blister and they ended up in considerable pressure pain - and there was no way I could get the Compeed off without the strong possibility of further harm.
I no longer use Compeeds now, will never use them again. Although I met pilgrims who had self-treated with them and had no problems, our view - remember, we were only seeing the feet of those who came to us for help - is that they cause too many problems. We met pilgrims who hadn’t put them on properly .. dirt had got in, the blister had burst, and they were getting infected.
A Swedish woman: - we had met her before and met her again "purely by chance" on the Camino, another one of those extraordinary Camino ‘coincidences’ - we met her as she was about to walk up onto the Meseta. She was feeling a little dizzy and had put it down to lack of water or the heat. She then said she had a blister problem. The moment I looked at it I said she had to go to hospital. It took us the rest of the afternoon to find a casualty dept (in a small town about 20 miles away).
Her problem was that she had put a Compeed onto a heel blister. The blister had grown over the days of walking until it burst and forced an edge of the Compeed open. Dirt got in and it became infected - what did she do? Just kept walking. When we saw her she had blood poisoning, her ankle had already started to swell. Had we not found her she may have died of that blood poisoning somewhere, going to bed with “just a little fever” and waking up dead. The doctor cleaned it all up, gave her horse-pill sized antibiotics and told her that her Camino was over, she had to go home. The doctor then took me aside and said we had to keep an eye on her overnight and that if she became more ill we must take her to an emergency dept immediately, she was really concerned for her. We did that but she started to become better and the next afternoon we drove her way over to Pamplona and put her on a train home.
This is what had us instantly throw her in the car in search of a doctor. '