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To lance or not to lance...

Striderc8

New Member
Time of past OR future Camino
Camino Frances (2013)
I have been reading the advice on blister prevention which is really useful but I am a bit confused about what to do once a blister appears. The general advice is to lance it but why would you do that? Doesn't it just make the area more painful and surely it fills with fluid again pretty quickly? Also, isn't the blister nature's own form of protection? If you don't lance though it can take a couple of weeks for a blister to go away. I would like to understand the logic for both courses of action because I really don't know what is best.
 
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The fluid in a blister will make it quite painful, and the blister is likely to break from fluid pressure with continued walking. So lancing it with a sanitary needle is helpful. After lancing, clean the surround skin with alcohol, and apply a Compeed. The Compeed with provide a completely sanitary environment until it comes off, and uses wet wound technology to absorb the fluid that will continue to be generated. The fluid will eventually cause the Compeed to come off, probably covering your sock with goo along the way, after which you should clean the area again, and put on another Compeed.

A thread left in the blister is an invitation to bacteria, so probably is not a good idea, although the thread will wick some moisture out, and infection can be prevented with regular cleaning with alcohol and covering it with your favorite bandage (my favorite is Compeed!).
 
Lancing makes for more comfortable walking. I cleanse with an alcohol wipe, lance the blister with a sterilised needle then apply Betadine and a piece of sterile gauze. Elastoplast (not bandaids) goes over the gauze to keep it in place.

I leave it be until the elastoplast is not holding properly. The Betadine doesn't take long to do its magic on blisters but don't use it if you have an allergic reaction to iodine antiseptic.
 
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Thank you. If blisters burst with continued walking then it does make sense to do it yourself in clean and hygienic conditions.
I have never heard of betadine so I shall look it up but would any antiseptic do, surgical spirits or tea tree oil for example? I am conscious that I will have to carry this kit so it would be useful to have one product that serves several uses.
Also, how to sterilise the needle. I know you can heat them in a flame but is that practical on the Camino?
Thank you for your advice, I do appreciate it.
Cate
 
I don't believe in lancing for many of the reasons listed in the OP, in addition to which lancing is another wound to treat to ensure it does not get infected. Reducing complications should be key to any treatment, and deliberately creating a wound in what could be far from hygienic conditions appears to me to be asking for trouble.

Sure, the blister might burst, when it will have to be treated, and good infection control measures used inasmuch as they are available. Until then, protect the blistered area as well as possible and try to keep it intact.
 
I take a 2 oz. bottle of isopropyl alcohol. It sterilizes needles and cleans the area around the wound. Almost all blisters will burst after a few more hours of walking. The open wound may be exposed to the bacteria and spores in your sock and shoe for hours. Knowing that you will have a wound to treat, it is worth considering whether it is best to have a controlled wound and treatment environment. A small blister between toes can probably be left alone. Since it is not bearing the weight of your body, it has a good chance of not breaking, which is the best condition. Reduce the friction with a covering or lubricant. It will reduce in size overnight.
 
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I was told by a doctor in Fromista that I should not put compeed on a blister. She said compeed was only for hotspots to prevent the formation of a blister. She told me to keep the popped blistwee clean and to cover with gauze when I was walking and keeping it uncovered when I wasn't so it could dry out and heal.

I think the most important thing is to keep it clean once it has been popped.
 
I was told by a doctor in Fromista that I should not put compeed on a blister
Not everyone is a fan of Compeed, but the instructions for use as approved in licensing this product are quite to the contrary. It is wet wound technology specifically for the purpose of absorbing blister fluid, not as a friction pad (which it also is). The adhesive is very strong and will remove healthy skin if removed prematurely. I suspect that is why the doctor does not like it. He probably uses similar wet wound coverings all the time for wounds much more severe than a blister. I have some up to 6"x6" from 3M for burns and cuts. Many pilgrims don't like it, and don't use it, which is an excellent choice for some.
 
The problem with not lancing a blister is that when you continue to walk on it the fluid within will regularly press against the inner edges - which means that the blister will get larger and larger, unless it bursts. That the skin has delaminated means that it is already a wound and needs early treatment.
If it bursts when you are walking you stand a good chance of it becoming infected as your sock will start to press in to the open wound.

Prevention is better than cure of course so the VERY MOMENT you feel a burning hotspot, stop, take your boots and socks off and really look at what is going one there. Putting a plaster over the hotspot before it becomes a blister can protect it from becoming one - also check if you have pressure edges caused by a fault inside the boot. Then put your socks on but on different feet (well, your feet of course but right on left and vica-verca, which will remove any pressure points caused by the sock.

So - it is lancing then. Cleanliness is absolutely everything here. Carry some alcohol wipes in your first aid kit and thoroughly clean the whole area - and your hands and the needle.
With a needle it is difficult to make a big enough hole - I use scalpels - but it will work. Make a hole at each end of the blister and gently press until all the fluid is out, it won't hurt. If necessary do the holes again to ensure all liquid has gone. The thing here is to get the blister skin flat against the inner skin so that healing can take place - it is still covered. This is why making sure it is empty is important.
Once this is done use a new alcohol wipe (yes, it will sting a bit) and clean the area again and allow to dry.
Now you have the 'compeed or not to compeed' choice. If it is a simple blister - not between the toes and so on - where a compeed will seal properly all the way round, then, ok, use one of those ... they do exactly what they say they do and are comfortable but only when put on well.
But do think about this - you will be walking for hours every day, sweating in those boots, a perfect incubator for microbes, then stepping into showers used by thousands of others ... so, you should be aware that if the compeed doesn't properly seal then you stand a high chance of getting some infection in there (also if it does seal properly and you introduced microbes in there before sealing) .... if so then a good plaster - the pad larger than the wound - would be a better bet as you can replace them as needed, alcohol cleaning the area each time (good reason for buying whiskey in a bar!). I always give a pilgrim replacement plasters/compeeds for future days.
Everything here is about cleanliness. When covered and you are ready to go again - well - is the problem that caused your blister in the first place still there? If so then you need to pad against further harm. There are two basic ways of doing this - either using padding, even folded toilet paper can work, or making things slick by putting such as gaffer tape (duck tape) on your skin over the plaster over that area (also works well as prevention before the blister starts).

If you are getting them between your toes - difficult place to work on and difficult to keep clean - then your boots may be too narrow at the front. Try removing the laces and replacing by missing the first two eyelets, which will allow the boots to open more at the front. Also - don't over-tighten your boots, they are living things, your feet, so don't crush them into a tight space - think of them as puppies if that helps. So, also, after walking for an hour or so you may feel your feet becoming cramped (they swell during the day), so stop and retie them looser so you are comfortable again.
My step-father told me that during the war, on marches, they regularly stopped for ten minute breaks and were told to take their boots and socks off to allow their feet to dry and breathe, then to put their socks back on on opposite feet - this really works. I do it every 90 minutes or so.
You do see pilgrims who lace up tight in the morning, walk all day in the heat and don't air their feet or rest them until they get to a refugio in the evening - why do they do this? Don't you do this! :wink:

Buen Camino peregrino
 
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falcon269 said:
Almost all blisters will burst after a few more hours of walking.
My experience is quite different, and I have successfully treated blisters that have survived several days of walking without bursting. Certainly enough time for skin to start healing beneath the blister so that when the top layer comes away, there isn't an open wound site.

This has included being the 'blister fixer' on a seven day group walk, where the less experienced walkers were not able to recognise a hot spot forming, and let quite large blisters form before seeking my help. The only person whose blister burst after being treated by me on that walk refused to heed my care advice.

Several others treated their own feet, including one whom I know drained a quite large blister. She got no better outcome than the people whose blisters I treated without draining them.

I also note that Compeed (http://www.compeed.co.uk/compeed-footcare/compeed-blister?nid=4400&tab1) clearly states to avoid deliberately bursting the blister. I suspect I would find similar advice from other manufacturers.

As a final point, if you are going to burst or lance a blister, make sure your hands and fingers are as clean as possible, and that you create as clean an area as possible on which to carry out the operation. These points seem to have been overlooked in earlier responses.

Regards,

Edit - David almost simultaneously has made this last point about cleanliness. I disagree with him that lancing is the only option - clearly it isn't. But his advice on cleanliness is sound.
 
"Edit - David almost simultaneously has made this last point about cleanliness. I disagree with him that lancing is the only option - clearly it isn't. But his advice on cleanliness is sound."

Thanks Doug and you write good sense ... - I find that I wasn't being too clear on the lancing thing. I prefer to lance where the blister is in constant pounding contact with the sole of the boot/the ground because of the chance of it extending, and they are painful to walk on. Where it is elsewhere, such as between toes - well, I see it as natures own padding! preferring to leave them whole, unless causing pain.
And, yes, cleanliness is so important.
 
Then put your socks on but on different feet (well, your feet of course but right on left and vica-verca, [/quote]

Ha ha, I love this humour. And now I shall never forget this piece of advice. Thank you David.
 
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I'm for lancing the blister as a personal choice because I just don't like the discomfort. But as has been said cleanliness is vital - alcohol or betadine are readily available in Spain. Both are useful to clean needles and skin - and also the thread which I always leave in to ensure the blister doesn't seal and fill up again. That with a light clean dressing and all is well. I've never found Compeed useful as I've never had blisters that fit the Compeed!
 
Homer-Dog said:
I was told by a doctor in Fromista that I should not put compeed on a blister. She said compeed was only for hotspots to prevent the formation of a blister.

This is my understanding too.
 
AJ said:
Homer-Dog said:
I was told by a doctor in Fromista that I should not put compeed on a blister. She said compeed was only for hotspots to prevent the formation of a blister.

This is my understanding too.
That's not what the manufacturers of these products claim. While they do suggest that their products can be used on hot spots, they clearly market to people who have both intact and burst blisters.

I find that even as a fairly experienced walker, it is often difficult to determine when a hot spot starts. My observation of inexperienced walkers is that they find it almost impossible to tell before the blister has formed, and some even walk through that before seeking treatment.

If one knows where one's feet will blister, it is possible to apply a product like Fixomull or Micropore as a preventative measure, as well as COMPEED, Scholls, moleskin or the like. That doesn't help inexperienced walkers who don't know where they will blister. So they are are still in limbo as to where to apply any of the products, other than perhaps to apply them everywhere. Not even the manufacturers are recommending that :?

Clearly prevention is better than treatment, no matter what treatment option is chosen, but that is another subject. There has already been plenty of discussion on the forum about that.

Regards,
 
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I am with Doug on this one.
THe skin is the largest organ in the body. One of it's functions is to stop infection.
If you can't walk and need to POP the blister, then you have to keep it very clean in order to stop a secondary infection. Compeed is more of a preventative once you feel a "hotspot"
I carry syringes and needles (My work) and flush with isotonic saline. If you do drain the blister, at some stage you will need to "debride" the dead skin to reduce infection from the sealed cavity under the blister.
I do put a cover such a compeed, fixamol flex, etc over a forming blister.

As a rule, i just take my shoes and socks off often just to let them dry out and cool down.
A burn blister is not the same as a pressure blister. The internet confuses the treatment of the two.
If only chafing was as easy to fix :)
 
If only chafing was as easy to fix :D

Silk! like the oldtime mountain climbers :wink:

though I suppose it is gaffer (duck) tape now - which is like the force .. it has a light side, a dark side, and holds the universe together :lol:
 
David said:
though I suppose it is gaffer (duck) tape now - which is like the force .. it has a light side, a dark side, and holds the universe together

There are mixed views about the longer term use of duct tape or similar non-permeable tapes for blisters, either as a preventative measure or as treatment. I know that there are runner's blog sites that suggest this, but this would normally be for relatively short periods of time. I also think that what many of them are using is not duct tape, but the shiny, thin packing tape and not the thicker, fabric backed duct tape.

There are are suitable semi-permeable or permeable products available for preventative application or blister treatment. Two that I use are Fixomull for larger areas, and Micropore tape on my toes. The other option is zinc oxide or strapping tape. Fixomull and Micropore can be left in place for a few days. Zinc oxide tape needs to be replaced more regularly.

I think these are better for the longer term application required for longer pilgrimages.
 
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Sorry Doug, was going for humour again - I must watch that :?

I would never put gaffer tape on a blister - I should be more careful as text doesn't carry the way voice and face does :|
 
David said:
I would never put gaffer tape on a blister - I should be more careful as text doesn't carry the way voice and face does
I don't have a problem with using gaffer tape. If that is all that one has, then it can be used to make perfectly reasonable repairs. See, for example http://www.backpacker.com/slideshows/159 or http://www.backpacker.com/create-a-makeshift-blister-cure/slideshows/229.

A more complete list of tape alternatives is at http://www.fixingyourfeet.com/Taping-for-Blisters.html.

Regards,
 
Has anyone had experience with blisters on the sole of your feet. I have never had one there, and was wondering if you need any special treatment such as foam padding. If thinking along the lines of stopping one from getting worse. I was going to take fixamul stretch, competed for prevention or hot spots, and a few minor things.
 
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if you need any special treatment such as foam padding
If you can keep the corners from curling up, moleskin and foam work. I have never been successful with them. Good tape works, even duct tape! Compeed is great because it really adheres, and it absorbs moisture if a blister develops and drains. For me, the friction on the soles of my feet is handled by liner socks and silicone lubricant.
 
Johnny Walker best describes what to do. I would add that you can buy in any pharmacy in Spain a roll of Omnifix, a very thin, extendible plaster, which comes in a roll and can be cut to size. This should be placed over a piece of sterilized gauze and easily conforms to the shape of the foot. This can be removed after walking and and a fresh medication applied before walking the next morning. Aloha gel is also a fantastic skin healer and can be applied to the blister once lanced. Anne
 
max44 said:
Has anyone had experience with blisters on the sole of your feet. I have never had one there, and was wondering if you need any special treatment such as foam padding. If thinking along the lines of stopping one from getting worse. I was going to take fixamul stretch, competed for prevention or hot spots, and a few minor things.

We met an Irishman who swore by the use of ladies sanitary towels :shock: the ones with wings. He put the over his insoles and tucked the adhesive wings under to hold them in place. He said they absorbed the sweat, and he never had a blister :?
 
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