Treatment of Toe Blisters
For small, asymptomatic toe blisters, leave them intact with a nonadherent dressing; for large or symptomatic blisters, perform aseptic drainage while preserving the blister roof, then apply petrolatum-based ointment and cover with a nonadherent dressing. 1
Initial Management Decision
The treatment approach depends on blister size and symptoms:
- Small, asymptomatic blisters: Leave intact and observe, as the blister roof provides natural protection against infection 1
- Large or symptomatic blisters (especially those interfering with walking or on weight-bearing surfaces like the sole): Drain aseptically while preserving the roof for optimal pain relief and reduced infection risk 1, 2
Drainage Technique (When Indicated)
When draining is necessary:
- Use sterile needle to pierce the blister and release fluid 2
- Critically important: Leave the blister roof in place—do not remove it 1, 2
- Apply petrolatum-based ointment to the area 1
- Cover with nonadherent dressing (such as Mepitel or Atrauman) 2
- Change dressing as needed to maintain cleanliness 1
The preserved blister roof acts as a biological dressing that reduces pain and protects against secondary bacterial infection 2, 3.
Offloading and Activity Modification
Strict offloading is essential for healing:
- Limit weight-bearing activities immediately 1
- Avoid barefoot walking entirely 1
- Reduce intensity or duration of activity until healed 1
- For plantar (sole) blisters, consider this particularly critical as continued pressure will delay healing 1
Footwear Assessment
Address the underlying cause to prevent recurrence:
- Ensure shoes are 1-2 cm longer than the foot with adequate width and height 1
- Assess for biomechanical abnormalities, foot deformities, or abnormal gait patterns that may require orthotic intervention 1
- Consider protective padding over blister-prone areas 4
- Use properly fitted socks; evidence suggests acrylic or layered sock systems (thin polyester with thick wool/polypropylene) reduce blister incidence 3
Follow-Up and Monitoring
- Reassess within 3 days to check for healing progression and signs of infection 1
- Watch for complications: increased erythema, warmth, purulent drainage, or fever 1
- Document reduction in blister size, re-epithelialization, and pain improvement 1
Critical Pitfall: Diabetic Patients
If the patient has diabetes, treat any toe blister as a pre-ulcerative lesion requiring immediate professional attention 1. This population requires:
- Assessment of vascular status (pedal pulses, consider ankle-brachial index) 1
- More aggressive offloading strategies 1
- Close follow-up every 1-3 months for high-risk patients 1
What NOT to Do
- Do not routinely use topical antiseptics or antimicrobial dressings—these do not enhance healing 2
- Do not use honey, collagen, or alginate dressings 2
- Avoid complete deroofing of intact blisters, as this increases pain and infection risk 3
- Do not allow continued friction or pressure on the affected area 1