What treatment options are available for blisters on a stump caused by a prosthetic leg?

Management of Prosthetic-Induced Stump Blisters

The primary approach is to lance intact blisters with a sterile needle at the lowest point to facilitate drainage while leaving the blister roof intact, combined with immediate prosthetic modifications using lightweight materials and soft padding to reduce friction and trauma. 1

Immediate Blister Management

Burst all intact blisters promptly to prevent enlargement under pressure, as the plane of weakness in the skin allows blisters to easily expand with continued prosthetic use. 1

• Lance blisters with a sterile needle at the lowest point to facilitate fluid drainage by gravity and prevent refilling 1
• Leave the blister roof in place as a biological dressing to prevent secondary infection 1, 2
• Use gauze or absorbent material to wick fluid from the blister 1
• Apply low-adhesion dressings (such as Mepitel or Atrauman) over painful eroded areas, held in place with soft elasticated viscose 1

Infection Prevention

• Consider saline soaks, nonmedicated or medicated dressings, and topical antiseptics or antibiotics until the skin heals 1
• For extensive erosions, use antiseptics such as potassium permanganate baths or antiseptic-containing bath oils (e.g., Dermol Plus or Oilatum) for a few days to dry lesions and prevent infection 1

Prosthetic Modifications to Prevent Recurrence

Use lightweight prosthetic materials and soft padding (silicone inserts or pads) to reduce trauma to the stump and facilitate weight bearing. 1

• Implement shock-absorbing insoles and custom orthotics, which have been shown to reduce blister numbers and severity while improving mobility 1
• Ensure proper socket fit with adequate cushioning to minimize friction and mechanical trauma 1
• Consider silver-lined socks to reduce moisture and friction 1

Continued Prosthetic Use During Healing

Controlled continued prosthetic use does not adversely affect healing and may be beneficial. 3

• Studies show that 64% of stump ulcers healed completely within 6 weeks despite continued prosthetic use, with only 9% showing deterioration 3
• Temporary discontinuation is not routinely necessary unless deterioration occurs 3
• Monitor ulcer size and clinical appearance every 6 weeks to ensure improvement 3

Prevention Strategy

Prevention requires addressing the root cause of friction through biomechanical assessment and proper equipment. 1, 2

• Ensure properly fitting prosthesis that is broken in slowly 2
• Use protective padding over potential blister sites 2
• Apply drying foot powders and nonslip insoles to reduce moisture 2
• Maintain a cool, dry environment as heat and sweating promote blister formation 1, 2

Key Clinical Pitfalls

• Do not leave large blisters intact, especially on weight-bearing surfaces like the stump, as they will enlarge and worsen with prosthetic use 1
• Do not routinely discontinue prosthetic use for healing unless clear deterioration occurs, as this limits activity unnecessarily 3
• Do not ignore biomechanical factors—assess weight distribution and gait patterns to identify the source of excessive friction 1