06/19/2024    Doug Richie, DPM

OH Podiatrist Discusses How to Prevent Blisters

The advice given by Dr. Botek for prevention of
friction blisters on the feet has some value but
unfortunately also propagates several myths
regarding the pathomechanics of this common skin
injury. In short, ill-fitting shoes are not the
primary cause of friction blisters on the feet as
any active athlete can attest after changing or
modifying their own footwear and still suffering
from blisters.

Shoes do not "rub against the foot", rather the
foot rubs against the shoe. Friction blisters are
not an abrasion or external rubbing injury against
the skin of the foot. Instead the friction blister
is the result of shear distortion of the deeper
layers of the epidermis in response to underlying
bone movement beneath a fixed stratum corneum.
Prevention of friction blisters certainly includes
proper shoe fit, but addressing the pathomechanics
of the injury has been the missing component of
effective interventions.

Herein is the opportunity for any lower extremity
clinician who is versed in biomechanics and
understands abnormal bone movement, shear forces
and effects of friction at the multiple interfaces
located between the foot, the sock, footwear and
ground surface to implement a proper blister
prevention intervention tailored to the patient.

Rebecca Rushton, a podiatrist located in Australia
collaborated with me to recently publish two
manuscripts attempting to debunk common myths about
the cause and prevention of friction blisters on
the feet.

See:
Rushton R, Richie D. Friction blisters of the feet.
A new paradigm to explain causation. .J Athl Train.
2024 Jan 1;59(1):1-7. doi: 10.4085/1062-6050-
0309.22.

Rushton R, Richie D. Friction blisters of the feet.
A critical assessment of current prevention
strategies. .J Athl Train. 2024 Jan 1;59(1):8-21.
doi: 10.4085/1062-6050-0341.22.

Doug Richie, DPM, Long Beach, CA

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