What is the best course of treatment for a 59-year-old male patient with blisters and bruises on both feet caused by poorly fitting medical boots?

Treatment of Blisters and Bruises Caused by Poorly Fitting Medical Boots

The most effective treatment for blisters and bruises caused by poorly fitting medical boots includes immediate discontinuation of the ill-fitting footwear, proper wound care of existing blisters, and prescription of properly fitting therapeutic footwear to prevent recurrence. 1

Initial Assessment and Management

• Examine the blisters and bruises on both feet to determine their location, depth, and severity 1
• Document the relationship between the areas of injury and the specific parts of the boots that caused the friction or pressure 1
• Discontinue use of the problematic boots immediately to prevent further skin damage 1
• Inspect inside the returned boots for rough edges, uneven seams, or design flaws that contributed to the injuries 1

Treatment of Existing Blisters

• For intact blisters:

  • Gently clean the area with mild soap and water 1
  • Aspirate fluid from large, intact blisters using sterile technique while preserving the blister roof as a natural protective covering 2
  • Apply antiseptic solution to prevent infection 1

• For open/deroofed blisters:

  • Clean the area thoroughly with mild antiseptic solution 1
  • Apply appropriate dressing such as hydrocolloid dressings which provide pain relief and allow continued activity 2
  • Consider 2-octyl cyanoacrylate (medical adhesive) for hand blisters, though this approach may be adapted for foot blisters in select cases 3

• For bruised areas:

  • Apply cold compresses intermittently during the first 24-48 hours to reduce inflammation 1
  • Elevate the feet when possible to reduce swelling 1

Prevention of Further Injury

• Prescribe properly fitting footwear that meets these criteria:

  • Inside of shoe should be 1-2 cm longer than the foot 1
  • Internal width should equal the width of the foot at the metatarsal phalangeal joints 1
  • Height should allow enough room for all toes 1
  • Evaluate fit with patient in standing position, preferably at end of day 1

• For patients with foot deformities or recurrent issues, consider:

  • Therapeutic shoes with custom-made insoles 1
  • Digital silicone orthoses if toe areas are affected 1
  • Referral to podiatry or foot care specialist for comprehensive assessment 1

Patient Education

• Instruct the patient to:
  • Inspect feet daily, including between toes 1
  • Wash feet daily with careful drying, especially between toes 1
  • Apply emollients to lubricate dry skin (but not between toes) 1
  • Avoid walking barefoot, in socks without footwear, or in thin-soled slippers 1
  • Inspect inside all shoes before wearing them 1
  • Report any new blisters, cuts, or abnormal foot symptoms promptly 1

Follow-up Care

• Schedule follow-up within 1-2 weeks to:
  • Assess healing of blisters and bruises 1
  • Evaluate the fit of any new footwear prescribed 1
  • Address any persistent issues or complications 1
  • Document resolution or complications for quality improvement purposes 1

Special Considerations

• Report the issue with the specific boot model to prevent similar injuries in other patients 1
• Consider using closed cell neoprene insoles in replacement footwear to reduce friction blister incidence 2
• For patients with diabetes or peripheral neuropathy, more frequent follow-up is essential as they may not feel pain from ill-fitting footwear 1
• Be vigilant for signs of infection in open blisters, especially in patients with compromised immune systems or diabetes 1