Update On Dr Doug Richie and Rebecca Rushton's Blister Research [Blister Prevention Office Hours]

Blister Prevention Office Hours✍An Update On Dr Doug Richie and Rebecca Rushton's Blister Researc✍
➡ A monthly Q&A hosted by podiatrist Rebecca Rushton (the BlisterPod) for Podiatrists, Physios, Athletic Trainers, Wilderness Medics, Race Medics and Event Directors, Educators, Footwear Designers, Footwear Retailers, and anyone who deals with foot blisters and their prevention in a professional capacity ⬅

0:00 Preamble
Both papers are now available pre-print at the following links:

▶ FRICTION BLISTERS OF THE FEET: A NEW PARADIGM TO EXPLAIN CAUSATION https://doi.org/10.4085/1062-6050-0309.22

▶ FRICTION BLISTERS ON THE FEET: A CRITICAL ASSESSMENT OF CURRENT PREVENTION STRATEGIES https://doi.org/10.4085/1062-6050-0341.22

0:51🎓Overview of the first paper – A New Paradigm🎓
- Repetitive shear deformation
- Skin and bone move out of synch
- Misuse of the term “friction”
- Repetitive shear deformation (not rubbing)
- Intraepidermal mechanical fatigue (not a wear injury)
- Caused by repetitive shear deformation
- Shear deformation is the “give” in the soft tissue
- Driven by bone movement, in the presence of high friction force
- Bones move, skin surface doesn’t, everything in between distorts
- When repetitive, can cause a mechanical fatigue
- Takes up to 2 hours to fill with fluid

Bone movement, high friction force and the resultant shear deformation is normal and necessary for efficient gait
- Shear deformation happens with every step we take
- It’s normal and our feet can handle a lot of it
- High in-shoe friction force is normal (needed for traction)
- Plantar epidermis is hairless, ridged, eccrine sweat glands
- Plantar dermis has a higher collagen content – to store, transmit and dissipate elastic energy during mechanical deformation

The 3 fundamental elements of blister formation include:
- motion of bone
- high friction force
- repetition of the resulting shear events

Minimising any of these 3 elements will reduce the risk of friction blisters

5:04 🎓Overview of the second paper – A critical review of current prevention strategies🎓
- How blister prevention strategies work
- Evidence base for preventions
- Evidence for: adaption, neoprene insoles, dense padded acrylic socks
- Evidence against: powders, antiperspirants
- Conflicting: paper tape, double socks
- No/insufficient: footwear fit, lubricants, other tapes, toesocks, other socks, PTFE patches, gel toe protectors, toeprops, biomechanical interventions

12:15 🚩Blister Prevention Office Hours Q&A🚩

12:34 QUESTION 1: When to open/lance and when not to (including if you have an autoimmune disorder)
- Blister size and location?
- What is your patient doing?
- What shoes can they wear?
- What gear do they have, do they have enough?
- Can they see/reach their blister?
- General health, susceptibility to infection

14:29 QUESTION 2: Best blister prevention?
- Depends on the blister location!

14:58 QUESTION 3: Posterior heel blisters in hiking boots?
- ENGO Blister Patches

18:15 QUESTION 4: Should a hiker tape before the walk “just in case”
- Be purposeful!
- Have the best prevention strategy in place for:
- blister history
- calloused areas
- structural or functional predispositions
- Give them a Blister Plan

20:39 QUESTION 5: What are the latest products to treat & prevent blisters
- PelliTec Blister Prevention Pads
- ArmaSkin toesocks

22:28 QUESTION 6: What role do compressive forces play in blister formation vs shearing forces?

24:29 QUESTION 7: Common causative factors of blisters
The three fundamental elements of blister formation include:
- motion of bone
- high friction force
- repetition of the resulting shear events

25:22 QUESTION 7: Hosiery recommendations / Advice on toesocks

28:05 QUESTION 8: What are the main causes of blisters with orthotic therapy?

30:24 QUESTION 9) Roof management; volume concern & location

32:40 WRAPPING UP

Learn more with Rebecca and Doug at Blister Prevention University
🎓 https://pro.blister-prevention.com/blister-prevention-university/

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