Trail First Aid: Blister Prevention and Care

[Editor’s Note: Today we launch a new article series on iRunFar called First Aid on the Run.’ It’s a collaboration between long-time iRunFar columnist Liza Howard, who is a NOLS Wilderness Medicine instructor, and graphic artist Brendan Leonard, of Semi-Rad fame and a trail and ultrarunner himself. Over the next year or so, ‘First Aid on the Run’ will offer practical, witty how-tos for the first-aid issues and emergencies you may experience while trail running and ultrarunning. Please enjoy!]

Coach: So what are you going to put in your blister kits for the race?

Athlete: Yeah, you know, I don’t really get blisters. I’ve never gotten any in training. I didn’t have any during that 50k. I’m just not really worried about them. I…

Coach: STOP TALKING! STOP!! DO NOT SAY ANOTHER WORD!!! You know what ensures getting blisters during a race? Talking about how you never get blisters, that’s what! Lord almighty! Do you want to know what happened to the last 147 people who told me they never get blisters and didn’t make up a blister kit?

Athlete: They got blisters?

Coach: You’re darn right they got blisters! Missing-time-goal blisters! Missing-cutoffs blisters! DNF blisters! Scare-young-children blisters! Your only hope now that you’ve woken the blister gods is to do exactly what I say.

Make a Blister Amulet

Now, make a blister amulet and carry it with you during the race. It’s small and it’ll fit in your shorts pocket, your handheld water-bottle pocket, or your hydration vest. It must contain:

  • 3 pieces of precut KT tape or Hypafix tape

These tapes are thin and stretchy and conform to the shape of your foot. Both are breathable. Hypafix is also waterproof. Strengthtape is a waterproof form of KT tape. Cut pieces to cover areas where you’ve had hot spots or blisters before. If you’ve never had trouble, cut pieces to cover your big toe, little toe, and heel. Practice taping these areas so you can do it well. Lumps and creases will enrage the blister gods and almost ensure more hot spots and blisters.

  • 1 vial of tincture of benzoin

This stuff is basically a tree resin (so sticky!!) mixed with alcohol. It’ll keep the tape stuck to your foot. It’s worth its weight in gold.

  • 2 alcohol prep pads
  • 1 ENGO patch

Roll the tape around the benzoin vial, and then roll the alcohol pads and ENGO patch around that. Secure it all with a rubber band or a ponytail holder. At the first hint of a hot spot while running, grab your amulet, sit down, and make an offering to the blister gods.

Clean the hot spot and the area around it with the alcohol prep pad. Apply the tincture of benzoin to all the skin the tape will cover. Allow it to dry. You can wave your hand over it or blow on it to speed the drying up. Then apply the tape. Rub the tape for 20 seconds (or long enough to sing the first few versus of “Blister in the Sun”) to increase its stickiness. These two videos show how to tape a hot spot on the foot and how to tape a toe with a hot spot.

Alternately, you could stick the ENGO patch to the inside of the shoe itself. These thin patches are particularly helpful at preventing blisters on the ball of the foot, an area that is hard to tape. Watch this video that demonstrates how to apply them.

Regardless of the method you choose, the offering is most powerful if it’s done as soon as you feel discomfort. Don’t wait to get to an aid station to make it!

Blister Amulet

Photo: Liza Howard

Make a Blister Kit for Each of Your Race Drop Bags

Next, build a small blister kit to keep in each of your race drop bags or with your crew. This blister kit contains the tools you need to address hot spots as well as both painless and painful blisters. Each kit should contain:

  • 1 blister amulet
  • 6 inches of KT or Hypafix tape
  • 1 pair of small scissors (Swiss Army knife size)
  • 1 large pin (or an individually packaged, sterile 18-gauge needle)
  • 2 gauze pads
  • 1 tiny tube of ointment containing zinc oxide (diaper-rash cream like Desitin)

If putting that all together seems overwhelming, go to the Trail Toes website. They sell great, tiny blister packets for about $10.

Buy a Copy of Jon Vonhof’s Fixing Your Feet

Jon Vonhof’s book Fixing Your Feet is the Blister Bible. The Torah of Taping Techniques. The Qur’an of… Well, you get the idea. Read the passages about prevention and taping techniques. Or visit his website and watch the blister-lancing videos and read the FAQs passages.

Share This Information with Three Friends

This is the real offering to the blister gods, right here, your main chance for penance. Teach your friends!

If You Get a Blister

Athlete: So all that will keep me blister-free at the race?

Coach: Maybe. Your blasphemy was pretty extreme. It might not be enough for absolution. So if you do end up with a blister, here’s what you should do:

  • If the blister’s not painful and doesn’t look like it’s going to rupture, just tape over the top of it like you would with a hot spot.
  • If the blister is painful:
    • Use the pin or needle to make four holes in it.
    • Move the pin or needle back and forth to make the holes nice and wide.
    • Use the gauze pad to press the fluid out.
    • Tape the blister flat.
  • If the skin covering the blister is partially or fully gone:
    • Put a dab of zinc oxide on the wound site before you tape it down.

This video shows how to lance and tape your blister.

One last thing, sometimes you think you’re dealing with an awful blister or hot spot, but when you take your socks off, all you see is wrinkly prune feet. There’s not much to be done once you have painfully waterlogged and macerated feet. If you know your feet are going to be wet during a race, try putting a very thin layer of Desitin or a similar barrier on them before you start. There are a lot of products out there, but I like Desitin because it’s hard to wipe off, it’s inexpensive, it’s easy to find, and it can substitute for sunscreen in a pinch. And change your socks often! The best resource for preventing macerated feet is podiatrist Rebecca Rushton’s website. It dives deep into the pros and cons of different methods.

Disclaimer: Blister care is an art. What works for you in one environment might not work for you in another environment. And what works for you might not work for someone else. It’s good to have a lot of tools in your blister-care toolbox.

[Author’s Note: Learn more about managing blisters and other wilderness first-aid skills with a two-day NOLS course. Thank you to Tod Schimelpfenig, NOLS Wilderness Medicine’s Curriculum Director and author of NOLS Wilderness Medicine, for his guidance and oversight of this series.]

Call for Comments (from Meghan)

  • Many of us have a nightmare blister story, that one time where it all went wrong on our feet. Leave a comment to share yours.
  • What have you found to be your tricks of the trade, for keeping your feet feeling good and blister-free over long distances or in difficult conditions like wet, heat, and when your shoes get filled with debris?
Liza Howard

is a long-time ultrarunner living in San Antonio, Texas. She divides her time between teaching for NOLS Wilderness Medicine, coaching for Sharman Ultra, directing the non-profit Band of Runners, wrangling two young kids, setting the bar low for house tidiness, staying happily married–and training for ultras. You can follow her chaos on her website.

There are 46 comments

  1. Joel anderson

    Great blister advice! I always simply carry about a 1.5”x4” piece of duct tape, rolled up in my pocket. The instant you begin to get a hot spot, put the duct tape on it. I’ve used this method in 100 mile races, wet races, training runs and the tape always stays in place and I’ve yet to form a blister if it’s applied in time.

    1. Liza

      Duck tape is awesome because it sticks and stays stuck — and it works for you!. One downside for some folks is that it can be really hard to make the tape conform to certain parts of the foot because it doesn’t stretch. Creases, lumps and raised areas can be sources of irritation and even cause blisters. It’s a good tool for the tool kit for sure!

    1. Liza

      Poor moles. (Kidding.) Like duct tape, it can be hard to get moleskin to really conform well to certain parts of the foot, but it works well when it does, for sure. There’s thinner mole skin out there (from thin-skinned, easily offended moles… ;)) that can conform a bit better than the thicker kind that comes with most first aid kits. And toe caps are great! Is there a particular brand you like?

      1. docreport

        Honestly I’ve only tried one brand of toe caps (cheapest..cough cough). Amazingly I am able to reuse them, just wash and dry :-)
        Amazon has many brands and they are inexpensive.

  2. Nick

    Leukotape is a great sports/medicine tape that has a zinc oxide adhesive side to it. Works quite well for blister management in my experience.

  3. Quigley

    I dropped out of a race once largely due to blisters at about mile 80 after very kind aid station staff at around mile 60 and 70 helped tape my blistered feet. My feet were wrecked by long stretches of standing water on the trail, and I find wet feet for extended periods of time tend to cause the most problems for me. I have found that thin wool socks are the best for minimizing blisters, especially in wet conditions. I am particularly fond of the defeet wooletator, although any thing wools sock will work. Andrew Skurka’s comments on blister care are definitely worth checking out as well: https://andrewskurka.com/2016/gear-list-backpacking-hiking-foot-care-kit-blisters-maceration/

      1. Ellie

        Most cringeworthy moment? When I met a runner I didn’t know a few months after a race and she eagerly said, ‘Oh, remember when you volunteered at that race and popped my blister with my safety pin for me’. Guess I should have had better supplies :) Great article – thanks Liza!

  4. Des

    I rarely get blisters anywhere on my feet except under my toenails/on the tips of my toes. Any specific advice on dealing with those? It’s a difficult spot to get any kind of tape to stick. To add to the complexity, I’m a no sock runner, partly because I hate them and partly because they seem to multiply my blister issues.

    1. Liza

      Sometimes getting a shoe with a bigger toe box can help — or switching to shoes that are a bit larger mid-race after your feet have started to swell. Taping the toes like I show in the video helps some people. If the nail is raised up at all, file it down, so it’s flatter. That’s what’s helped me the most with that problem.

  5. Qaireen

    I ran a 50K race in a humid and very wet condition for 12h, no blisters maybe a few mild hotspots. I ran a 100k race in hot and humid condition for 28h no hot spot or blisters. But i always carry my blisters kit. I guess u need to bomb proof your feet in training, i always train in hot condition so my feet sweat a lot amd probably get ised to it and makes my skin a bit bad ass i guess? And i wear Altras for tberoomier toe box and injinjis trail.

  6. John Vanderpot

    Dear iRunFar: I would like to thank you for injecting a bit of humor into the discussion, there are days when it seems we might be taking ourselves and the less-than-truly-consequential just a tad too seriously?

    May your next blister be your best blister,

    JV

    1. Liza

      John, my primary goal is always a chuckle. I have great plans for this series. Let me know if I’m successful each month.

      1. John Vanderpot

        Bless you!

        And me too…

        My students say I’m a tough grader, but I always figured fair?

        We’ve got SD 100 this weekend, and I’m looking forward to some really epic blisters!

        J

  7. Cody

    I’ve liked Howard’s writings on iRunFar, but can’t stand Leonard’s passive-aggressive, sarcastic, “look at me” writing style. When I saw he was credited as a “graphic artist,” I had hopes that he’d focus on creating amazing graphics. Alas, within the first paragraph, I see Leonard’s style shining through.
    To each their own.

    1. Bryon Powell

      Cody,
      To be clear here, Liza wrote the article and Brendan did the graphic. Sorry to hear that you didn’t like the opening. Other’s did like the humor, and it will continue to be mixed in to series.

  8. Reg

    2Toms blister powder shout out!!!

    It’s made of PTFE (teflon) like the ENCO pads. It’s hydrophobic so u can get ur feet wet and it will still protect you. Works good and is inexpensive to sprinkle into ur socks near your trouble spot areas. I’ve got bunions from wearing tight shoes as a kid and always get blisters on them and the big toe on 10mile+ runs. :< So ENCO pads near those spots in shoe, toe socks with the powder. For race day I'll probably throw moleskin on too. Gotta practice that. ^<^

    Don't let your crew mix up ur 2Toms powder with your maltodextrin ;)

    1. Liza

      “Don’t let your crew mix up ur 2Toms powder with your maltodextrin.” Words to live by. I haven’t tried 2Toms, but I’m going to. Thanks for the recommendation.

  9. Barth Zurbuchen

    Game changer. Randy Sun waterproof socks!!!!!!at Amazon. They run big so get the next size down. A special weave and fiber. Not Goretex or Storm Shield. They keep water and SILT out….no abrasives. They worked so well at Black Canyon 2017 (The Hard Way). Used again at mud fest Bighorn 2017 without a change…cut off still caught me. And again at BH in 2 weeks. Under these I use Injinji liners after I massage the foot with hand lotion. Everything gets put into La Sportiva Bushidos using the open tongue lacing method. Over 400 miles blister free.

  10. TeddyImReady

    The only product that helps with maceration is a cheap cliche (but what problem in ultrarunning isn’t solvable by a cliche?).

    ‘Maceration is of the mind.’

    There, you have your cure. Now go forth and suffer.

  11. Deb Burley

    I have found the hypafix best for toe taping and the k tape for larger areas. I followed the directions for taping like a religion from the book “Fix Your Feet” and thankfully have avoided my previous horrors so far, knock on wood! I tape the night before and then slide on my socks to keep it all together. Benzoin is a must, although KT makes an adhesive spray to use with their tape. More expensive, smells less, and seems to work pretty well. Amazon has it all. Loved the article and graphics, nothing like some humor to go with a serious subject. Can’t wait for future articles!

  12. Joe

    Thanks for the fun and informative take on blister avoidance and care! Trail running and allusions to paganism are such a natural fit. I wish the pie chart could have been depicted as a turgid blister, but may all your other critics be lanced and squished flat (metaphorically speaking).

  13. Chris

    During 100 mile i had decent blisters on both feet. Just for fun i lanced one foots blisters and left the other foots intact. Both sides i put a gel bandaid and duct tape over. Pain was the same during race. Time to healing maybe slightly better with lancing. Leaving blisters results in disgusting fluid after a few days which didnt go away anytime soon. So i guess my takeaway is lance if u can but dont get overly undone if you dont.

  14. Yusef

    I never have blisters…

    Ran Lavaredo a couple years ago and the stream crosses plus shoes that did not drain well led to total maceration, then separation of the tissues. Last few miles in the race were a death march.

    Thanks for all the recommendations. Also, wondering if pedicures, or rasping dead skin off before a race is beneficial or not.

    1. Liza

      Keeping the toenails in check will definitely help prevent blisters and sores. And blisters can often develop under thick callouses where it can be really difficult and painful to get the fluid out of them. I try to keep on top of my callouses, but I’ll definitely give them some attention with a rasp/file before a race — usually a few days beforehand. The real downside to professional pedicures is scaring the poor nail technician with your runner’s feet.

  15. bud

    Good article that covers many aspects of blister prevention and treatment. After years of messing with blisters and black toenails, I finally figured out the system that works for me – Injinji crew toe socks under Smartwool light hiking socks, with Brooks Cascadias sized to take the socks and my orthotics. This combination completed Hardrock and its many water crossings and ups and downs without a hot spot. Obviously, this system may only work for me (and I will not change a thing – it works!), but the point is figure out what works for you to prevent blisters, and then don’t mess with it, ever. I have gotten so confident in the system (or I have gotten so lazy?) that I do not worry about blister kits any more.

    1. Bryon Powell

      Hey Bud,
      This is fun to read as I approach Hardrock’s many stream crossings from the completely opposite side, with good effect. I wear a single pair of the lightest/thinnest socks I can stand* (with that much climbing) and a highly breathable, drainable road flat (with a small forefoot rockguard I add.

      Drymax Hotweathers were great in 2015. Drymax Hyperthins in combo with road flats left the balls of my feet sore due to lack of cushion in 2016. No blisters of note either year that I can remember.

      The experiments of one continue! :-D

    2. Liza

      Everything I wrote is pretty worthless if you’re wearing rotten socks. I love hearing people’s systems that work.

  16. Pete

    Thank you for the wonderful article! Your blister kit is great –I carry something similar and your advice on tincture of benzoin and on the conforming tapes (I like KT) is spot on. To prevent blisters I have had good luck using double layer socks (such as Wrightsocks) and by greasing my toes and the balls of my feet with Cramer Skin Lube, which just doesn’t break down even over the course of 100 miles. (The stuff is also gold to prevent chafing, er, elsewhere….)

  17. Dan from Australia

    Hi there Runners
    I’ve completed numerous Ultras and I’ve always used a silicon gel/cream called Gurney Goo (created by legendary kiwi Steve Gurney adventure racer). This Goo has tea tree oil in it for its antiseptic qualities and other goodies.
    I always apply night before and morning of race it’s a fantastic product. Never have issues, Its like shark skin protection for your feet and toes and any other area’s which may chafe

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