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Hi,

I was wondering if anyone has found a particular top cover material that is especially good for preventing blisters on the heels and MLA? I have a client who is 15 years old and has been training to walk the Kokoda Track in September.

I have been providing him with orthoses for heel pain and shin splints. They have been an effective treatment, but since really upping his Kms walked( sometimes 46k, building to 96Kms for the actual track) he has been developing blisters on his heels and in the MLA.

I was initally using multiform and have changed to spenco with no improvement, and was wanting to get the right formula as quickly as possible for him.

Any suggestions?

Regards,
Matt

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Matt Hayter
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If the heel cup of the orthotic is too narrow then more padding won't help. If the medial arch of the orthotic is too high, more padding won't help. Check the orthotic plate with foot on top of it. Insufficient lateral expansion plaster will cause blisters right at the top of the heel cup. Is that where the blister is?

Eric

Thanks Eric,

No, those parameters seem fine, it is only when his feet become sufficiently damp from sweating after walking more than 30kms that the blisters start to arise. So I need something that will either absorb and "wick" away the sweat, or that will reduce the friction.
Regards,
Matt

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Matt Hayter
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Friction will be the issue.

Does he need a top cover ?

2 pairs of shocks and Hyperfix/fixamull on the skin before he walks might be a good alternative

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Mike Weber.



Crazy Mary

Try Engo http://www.goengo.com/

I love the stuff, I use on the inside of the heel counter of my joggers, I can't for the life of me stop the movement. But with these, no blisters: something about the material's low coefficient of friction.

Rebecca

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Check the material of his socks. natural materials will wick moisture, while synthetic will increase sweating and therefore friction.
Also encourage that, if he has hyperhidrosis, he change his socks half-way through the walk/day and obviously have clean ones each time.

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I also find 2 pairs of socks can increase friction as one pair moves within the other.
He can try specialist walking socks which are especially padded to reduce friction on the pressure areas and are a cotton/wool mix.
Using hyperfix or sensitive bandaid directly on clean skin before walking also reduces the build-up of blisters in pressure areas.

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Duct tape is like The Force. It has a light side, a dark side, and it holds the universe together.

Reduce the moisture levels with something like perspirex. Could also use vaseline to lower friction at foot-sock interface. I've also had patients use gel socks with good success.

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Just a thought: Compeed blister plasters

Very good as a preventative on areas prone to shearing. Stay on well providing applied when skin is dry.

Regards,

Mandy.

Compeed Australia

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Mandy Brooks
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Matt,

I see quite a lot of competitive race walkers. The people that I see compete in an annual 85 miles in 24 hours walk. I have even had a stab at it myself(did 45 miles in 11hrs30mins)

The one thing that I can say is that blister prevention is sooo subject specific. All of the above comments are valid and unfortunately, many walkers need to go through the whole list of prophylactic treatments before they find something that works. I'll PM you the info sheet I give to most of the walkers except the really top level guys who are doing the 85 miles in 14 hours
There are a couple of things that I would say. When you say you are treating shin splints, are you talking about tibialis anterior overusage or MTSS? If the patient is suffering from tib ant problems and you are using varus FF wedges, you may be increasing the dorsiflexion stiffness at the 1st MPJ. The resulting abductory twist can sometimes be the cause of medial heel blisters(totally anecdotal based on n=2) So I would say to make sure that you are entirely happy with the orthotic prescription.

As far as socks go, 1000mile socks/twin skin/walking specific padded socks are all worth trying but there are 100's on the market and your man will just have to find one that is suitable

On occasion, I advise box taping the heel - you can find something on youtube - gives adequate protection - if they are not allergic to zinc oxide tape. As someone has already suggested, a gel heel moisturising sock can work. In my opinion, in someone who sweats, wearing it turned inside out works better.

With regards to a top cover with low friction, the cover that has consistently seemed to give the lowest friction anecdotally from the patients is white(for some reason) vinyl. However, this is only the issue if the area that is blistering is within the heel cup of the device. Otherwise it is a trimline or trainer issue.

Check there is not too much pistoning(heel moving up and down inside the shoe). This can be because the long heel measure of the shoe is too big(add padding under the tongue), the heel is too narrow for the shoe(difficult to treat) or that the orthosis is making the heel of the shoe gape as the heel cup is too wide. It can also be caused by a shoe that has a rigid sole but not enough rocker to compensate.

Hope this helps

Robin

PS - Sometimes there is no way of stopping it. Some people will blister no matter what. Sorry

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Also though of this today if you want to see if it a sweat thing or an orthotic friction thing - a strip of Gaffa tape on the top cover where the blister occurs and a test.

Just an idea.

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Mike Weber.



Crazy Mary

I had a football player i was recently treating who had a lot of trouble with blistering in the MLA region of both feet. We tried absolutely everything, natural fibre socks, taping his skin, grinding down the MLA region of the orthotic. The thing that finally worked was friar's bolsom and then three layers of hypafix with fleecy web on top in the area he was blistering and then sticking 2 gel silicone gel dots on the MLA part of the orthotic. He hasn't had a blister since. I've now started using the gel dots in a few other patients who had trouble with MLA blistering and every single one of them has not had another problem with blistering since adding the dots.