Treatment of Blister on 5th Digit of Foot
For a friction blister on the 5th toe, drain the blister with a sterile needle at its lowest point while preserving the blister roof, then apply protective dressing and address the underlying cause of friction. 1
Immediate Blister Management
Drainage Technique
- Clean the blister gently with antimicrobial solution without rupturing it 1
- Pierce the blister at its base with a sterile needle, bevel up, selecting a site that allows gravity drainage 1, 2
- Apply gentle pressure with sterile gauze to facilitate drainage and absorb fluid 1
- Leave the blister roof intact—it serves as a natural biological dressing 3, 1, 4
The evidence strongly supports early drainage rather than leaving blisters intact, particularly on weight-bearing areas like the 5th toe where continued pressure will enlarge the blister due to the plane of weakness in the skin 3, 4. Draining within the first 24 hours minimizes patient discomfort and allows continuation of activity 4, 5.
Post-Drainage Care
- Apply an emollient such as 50% white petrolatum and 50% liquid paraffin to support barrier function 1
- Cover with low-adhesion dressing (such as Mepitel or Atrauman) secured with soft elastic bandage 3
- Alternatively, use adhesive tape for fixation, which shows better effectiveness than wide-area fixation dressings 6
A critical pitfall: adhesive tape demonstrates significantly lower drop-out rates (4.0% vs 11.7%) and faster healing (35.3% vs 51.9% delayed healing) compared to wide-area fixation dressings, despite only 2 minutes longer application time 6.
Infection Prevention
- Monitor for signs of infection including increased erythema, purulent drainage, or systemic symptoms 1
- Perform daily washing with antibacterial products to reduce colonization 1
- Change dressings using aseptic technique 1
- Take bacterial and viral cultures if clinical signs of infection develop 1
- Apply topical antimicrobials for short periods only when infection is suspected 1
Note that antibiotics do not influence blister healing in uncomplicated cases and should be reserved for documented infection 4.
Address Underlying Friction Causes
Footwear Assessment
- Ensure properly fitted shoes that are gradually broken in 2, 5
- Consider closed-cell neoprene insoles, which reduce blister incidence 4
- Use non-slip insoles to decrease shear forces 2
Sock Selection
- Recommend acrylic socks for runners, which reduce blister formation 4
- For high-risk activities, use a thin polyester sock under a thick wool or polypropylene sock that maintains bulk when compressed 4
Biomechanical Factors
- Evaluate for foot deformities that may predispose to friction on the 5th digit 2
- For diabetic patients with toe deformities causing recurrent blisters, consider digital flexor tenotomy 3
- Use toe spacers or orthotic devices to reduce pressure on the 5th toe 3
Special Considerations
Diabetic Patients
If the patient has diabetes, this blister represents a pre-ulcerative lesion requiring immediate attention by a trained healthcare professional 3. Treat pre-ulcerative lesions aggressively to prevent progression to diabetic foot ulcer 3. Consider removable offloading devices, footwear modifications, or toe spacers depending on the specific location and cause 3.
Prevention of Recurrence
- Apply drying foot powders to reduce moisture, which increases frictional forces 2, 4
- Use protective padding over the 5th digit if anatomical factors persist 2, 5
- Gradual skin conditioning through repeated low-intensity friction promotes epidermal thickening and reduces future blister risk 4
The key to successful management is not just treating the current blister but identifying and correcting the biomechanical or footwear issue causing friction on the 5th digit to prevent recurrence 2, 4.