From the Guidelines
To properly manage a foot vesicle (blister), it is essential to keep it clean and protected, allowing it to heal naturally, and following the most recent guidelines from the British Association of Dermatologists' guidelines for the management of pemphigus vulgaris 2017 1. When dealing with a foot blister, the primary goal is to prevent infection and promote healing.
- For small, unbroken blisters, leave them intact as the skin provides natural protection against infection.
- For large or painful blisters, gently cleanse the blister with an antimicrobial solution, pierce the blister at the base with a sterile needle, and apply gentle pressure to facilitate drainage, without deroofing the blister, as recommended by the British Association of Dermatologists' guidelines for the management of pemphigus vulgaris 2017 1.
- After drainage, cleanse the area again with an antimicrobial solution and apply a non-adherent dressing if necessary.
- It is crucial to monitor for signs of infection, such as increasing pain, redness, warmth, swelling, or pus drainage, and seek medical attention if any of these symptoms occur, especially in individuals with diabetes or poor circulation.
- Additionally, consider the guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2023 update) 1, which emphasize the importance of proper foot care, including daily washing and drying, moisturizing dry skin, and examining feet daily for any signs of ulcers or pre-ulcerative lesions.
- Pain control is also essential, and patients may require analgesia prior to blister care, as well as maintenance and breakthrough pain management, as suggested by the British Association of Dermatologists' guidelines for the management of pemphigus vulgaris 2017 1.
From the Research
Proper Management of a Foot Vesicle (Blister)
- The proper management of a foot vesicle (blister) involves early aspiration of the fluid and protecting the blister roof 2, 3, 4.
- Preventive measures include properly fitting shoes, protective padding over potential sites of blister formation, and using drying foot powders and nonslip insoles 2.
- Clinical experience suggests that draining intact blisters and maintaining the blister roof results in the least patient discomfort and may reduce the possibility of secondary infection 3.
- Treating deroofed blisters with hydrocolloid dressings provides pain relief and may allow patients to continue physical activity if necessary 3.
- There is no evidence that antibiotics influence blister healing 3.
Treatment Options
- A study comparing the effect of two different friction blister treatment regimens, wide area fixation dressing versus adhesive tape, found that adhesive tape was more effective and had higher patient satisfaction 5.
- The use of wide area fixation dressing is not recommended over adhesive tape in routine first-aid treatment for friction blisters due to lower effectiveness and patient satisfaction 5.
- Another study highlighted the importance of considering factors such as whether to aspirate the blister, how to protect it from further pressure, friction, and shear, and which dressing to choose 6.
Prevention Strategies
- Preventive measures such as properly fitted shoes, socks, and athletic equipment, together with the judicious use of lubricants, can help prevent the formation of friction blisters 4.
- The use of closed cell neoprene insoles and wearing foot socks composed of acrylic may reduce the incidence of foot blisters 3.
- Recent exposure of the skin to repeated low intensity frictional forces results in adaptations including cellular proliferation and epidermal thickening, which may reduce the likelihood of blisters 3.