Rebecca Rushton graduated from Podiatry in 1993 and has since developed a key interest in blister management & prevention. We dive straight into the common misconceptions around blisters and how the definition of 'friction' can be very misleading. We uncover why blisters occur from an anatomy stand-point and if some runners are more susceptible than others. Once knowing what actually causes blisters, Rebecca delves into her top treatment tips and answers your patron questions, including: What can we do to prevent blisters during wet conditions? What is the best way to treat/prevent blisters between toes? What should we do for blisters mid-event? Check out Rebecca's blister prevention website at https://www.blister-prevention.com/ Also check out the blister prevention youtube channel (Apple users: Click 'Episode Website' for links to..) Become a patron! Receive Run Smarter Emails Book a FREE Injury chat with Brodie Run Smarter App IOS or Android Podcast Facebook group Run Smarter Course with code 'PODCAST' for 3-day free trial.
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On today's episode, Blister Mythbusting with Rebecca Rushton. But more often than not, injuries disrupt this lifestyle. And once you are injured, you're looking for answers and met with bad advice and conflicting messages circulating the running community. The world shouldn't be like this. You deserve to run injury free and have access to the right information. That's why I've made it my mission, to bring clarity and control to every runner. My name is Brodie Sharp, I am a physiotherapist, a former chronic injury sufferer, and your podcast host. I am excited that you have found this podcast and by default, become the Run Smarter Scholar. So let's work together to overcome your injury, restore your confidence, and start spreading the right information back into your running community. So let's begin today's lesson. I wanted to call this episode blister busting but I think after listening to Rebecca Rushden we probably shouldn't be busting our blisters depending on the circumstances so I'll let her talk about that in a second. I hope you enjoyed our success story with Danny last episode it is the last success story of our series so I've been getting a lot of positive feedback. And so if I stumble across a really nice success story in the future, it might just be a one-off, but yeah, that's, that's it for those series. Um, I have plenty more ideas in the works of future episodes coming up and future guests to have on. So look forward to delivering more and exciting things, keeping the variety going. So Rebecca Rushton is a podiatrist and I heard her on the Shoephoria podcast and to spark the idea, how come we haven't talked about blisters yet? So I reached out to her and she was grateful enough to come onto the podcast. And I am truly grateful that I can speak to podiatrist who has almost specialized in blister management, understanding it, prevention, um, treating. So it was good to bust her brain and talk about all things blisters. I haven't had much experience with it, which you'll see in a second, but I know it is a big issue and there are a lot of misconceptions around blisters. And so I thought it'd be great to. dive into like the understanding, the prevention treatment management, all that good stuff. She does have a website blis that was what I was most familiar with and the one that I checked out, but she mentioned after the recording that there is actually blis because she does ship out all these lovely blister kits and other podiatry products. You can have a go. You can have a I'm a browse but she has the US distribution as well hence the second website and I thought fantastic because most of the people that listen to this podcast either in Australia or there in the US and so. Her website distributes the her products to both of those countries and so check it out there are some useful things in there if you do have blisters or you want to prevent blisters check out the website and see if you can find a product that suits your unique. Area of blisters that sort of thing we also ask some questions from the patrons as I do with most of the guests that I have on the opportunity to ask a question if you do want to become patron and contribute five dollars per month to. Receive these benefits the link is always in every episode in the show notes of every episode so you can just click on that and join the family okay let's get on with it and I hope you enjoy. Rebecca welcome to the run smarter podcast how are you today. Brody, how are you? It's lovely to be here. Thank you. Thank you for coming on. I have like the podcast itself is into like more than a hundred episodes. And I constantly think like, do I have enough content? Do I have enough ideas of episodes? Am I going to get to a point where I've already talked about everything and I'm just repeating myself? But as soon as hearing you on Shoophoria podcast, I'm like, how have I not even thought about having an episode on blisters and It's a thing that runners are constantly, especially like marathoners and ultra runners are constantly complaining about. So I thought what better person to have on? So I'm excited to dive into today's content, but before we do, can you maybe just give an introduction to who you are and how you've found yourself in this particular special interest? Yeah, sure. My name is Rebecca Rushton. I'm a podiatrist in Esperance WA. I've been here 20 years. I've been a podiatrist for, oh gosh, I don't know, since 1993. And yeah, I guess I've always had relatively blister-prone feet. I've been rather susceptible, particularly the back of my heels. And then when I play hockey, sort of medial, plantar medial first MPJ. And you know, there were times when my feet were just in a perpetual state of blister recovery. it was kind of frustrating if you think that I'm a podiatrist and I can't even handle my own foot problem. I can't get on top of it. So yeah, that's pretty much what spurred me on to really knuckle down and figure out this whole blister thing because it's in a terrible state of misinformation and mismanagement. So yeah, that's what I've been doing for the last, really concentrating on it since I think about 2008 or nine or something. when you've managed to play hockey and start developing blisters, did you notice during a particular part of the season or did you notice during any type of training that you were more prone to it? Well, it would be pre-season and start of the season. So that speaks to, you know, the adaptive process and how you can kind of toughen your skin to be a little bit more resistant to blisters. But certainly, You know, a lot of people put a lot of weight on the, on the toughening of the skin or the conditioning, but it's, it's important for sure, but it can only go so far. So I'd, yeah, I mean, I'd have, it'd be worse pre-season, but I'd pretty much be, you know, blister recovering or a new blister all year, all season. Okay. How- You know, walking was my worst one. And, and really what tipped the balance was, I was walking one day and in eight minutes, I had a blister on the back of my heel. And that was the day that I decided this is ridiculous. So things out. So what caused that? Was it a change in footwear or something? Nothing, nothing. Okay. You know, walking for eight minutes, given I live in Esperance and it was a bit hilly and all that, but that was my normal morning walk with my dog. And I don't know, maybe I had my heels taped. So, you know, you put tape on your heels, you think, well, there's nothing rubbing. So there's no friction. and yet heal blister after eight minutes. Okay. I think, how about we, you just mentioned before that there's a lot of misinformation out there and mismanagement out there. Can we maybe delve into exactly what causes a blister and what a lot of that misinformation is circulating out there? What sort of things are you seeing? The misinformation starts right from the very beginning with the definition of what causes blisters. So, Most people would think blisters are caused by heat, moisture and friction. And it certainly makes intuitive sense. Your feet get hot in your shoes, especially when you're exercising. That causes your skin to sweat more. That's the moisture, which increases the friction on your feet. But we've got the hot, we've got the wrong end of the stick when it comes to friction. And the problem is friction has two meanings and those meanings are opposite to one another. Now, When most of us think about friction, because friction is definitely involved in blister causation, we think rubbing. So rubbing is one definition of friction. The other definition is the resistance to rubbing or the resistance to movement between two surfaces. And it's this definition that we've really got to think about when we're talking about blisters. So essentially blisters are a tear under the skin surface. caused by the skin and the bone moving out of sync. Now that probably sounds a little bit weird and it certainly sounded weird when I first read it. And this is from Doug Ritchie from 2010. And I think that he summed it up best and no one summed it up better since. So it's the skin and the bone moving out of sync. Now when you walk or run, there's a mismatch between the bone and skin movement. So you strike with your foot, The skin relative to the sock and the shoes stays in the same spot, but the bones move forward. And then when you propel, they move back. So skin stays still, bones moving back and forth. And you can imagine what's happening to everything in between. They're kind of stretching back and forth. And that's what's called sheer distortion. So blisters are caused by repetitive sheer distortions. And it's because of this mismatch between the bone and the skin. Most people can kind of have a feel of their body and kind of rub their, the skin over the bone and can see that the skin can move while the bone stays completely still. And what you're saying is once we're encased in a shoe, the opposite happens. So the bone actually moves while the skin stays the same. Hence why with your experience before talking about you had a blister after walking for eight minutes, you had it taped up. So the, the the skin itself in relation to the shoe might not have been moving at all, but we can't stop bone moving underneath skin. And so you're saying that's what caused your blister in eight minutes. That's right. Yep. Okay. Wow. Okay. And you mentioned that heat moisture might have a role to play, but isn't the primary cause? No. And if you get hooked up on thinking heat and moisture, you will never get anywhere because you can't stop your feet getting hot and sweating in your shoe. We know that skin friction is lower when it's very dry. But when you're exercising, and really probably just any time of the day, your feet, the skin of your feet is never in a very dry situation. It's always a bit clammy, bit moist. Certainly if you're running, especially when it's hot, there's moisture there to mean that there is a high friction level. Okay. And would, knowing what we know about blissness now, Is there someone that might be more prone? Is there a type of person that's more prone to getting blisters than others? There's not really a type of person, but there has been a little bit of research. So there's conflicting information about age. There's been a couple of studies that have gone either way. Gender is conflicting as well. There were two studies that showed females were more prone and three studies that showed that there was no difference. Ethnicity, interestingly. There's been two studies that show Caucasians are more susceptible than African American. And there was another study that showed no difference between Caucasian, Asian, Hispanic and other group, whatever that was. So ethnicity has got a little bit to do with it. Body mass has got nothing to do with it, or at least it's conflicting evidence, fitness, conflicting evidence. And the other things that we do know that make us more susceptible are having either a foot deformity, injury or flat feet. If we've had no previous experience in the activity, that will definitely make us more susceptible to blisters. And if we have literally just had blisters before, that makes us more likely to get blisters. Okay, let's write those down. If you- I think from all of that, you can say that anyone can get blisters. Yeah, and- with anyone in particular becoming more susceptible, you sort of alluded to maybe the skin might not having the, be adapted or be resilient enough to undergo a certain type of friction, which would be all rubbing. So if they were to do a new activity or do something, maybe new shoes or something where there is a change in environment, they increase their likelihood of getting a blister. Yes, just because the skin hasn't been subjected to those blister causing forces and hasn't built up any resilience. Okay. And so when we're talking about the skin adapting and building up resilience, because it is a break underneath the surface, like you're explaining, do the skin just gets tougher? Does it just, is there any physical properties? When we subject the skin to blister causing forces or these shear distortions, things like cell turnover becomes quicker. Now, and it happens relatively soon. Like it's not like, you know, three weeks later after you subject your skin to sheer distortion, does it start to get tougher? It actually happens kind of quickly. So it's important to, you know, not just go out and run a marathon, but that's the same with everything like musculoskeletal injuries, you're setting yourself up. So it kind of makes sense. think if I look back on my experience, I don't think I've had a blister from running except when I used to play basketball and it was pre-season, almost every season if I would spend the summer walking around in bare feet, walking, like spending time at the beach, not wearing shoes a lot and then going back to wearing shoes and especially when I'd go back to basketball training and put on my running shoes. within the first training session to have a blister. But then after that it was, I would tape edit heal relatively quickly. And then I was just fine after that, which kind of fits the pattern of what you're telling us now that the turnover and adaption is relatively quick. Have you found that, like I was a lot younger then, have you found that the adaption process is slower with age? Oh, look, the- the research in regard to blisters isn't there. And I certainly haven't noticed anything. Okay, it's good to know. And I think that's reassuring for a lot of people. The next question I had written down was something that we could do if there is anything in a general sense that someone can do to reduce their risk. Based on what you've told us now, it might just be if you were doing something or if you're planning on doing something new, if you're planning on wearing a new type of shoe or going from being a runner up to playing a team sports and changing direction and changing your environment, you just make sure you'd be sensible and like, you know, just start slow and build your way back up. Other than that, is there any other prevention tips that you might have? Oh, there's plenty of prevention tips. But as far as, you know, without implementing a strategy like taping or, you know, that sort of thing, it's not that, you can't... can only train the skin to cope with the forces so much. So you exhaust that and that happens relatively soon as you've mentioned. And by the way what we're not trying to do when we adapt the skin is we're not trying to build calluses. Certainly there might be a bit of a callus, like a bit of a thickening of the skin present but when we've got the I guess the perfect amount of skin adaption and skin toughening, it's not like you've got a callus. So the idea is not to build calluses because calluses, what they do is they just act like a big lump of something stuck to your foot and the sheer happens under the skin or within the skin layers, regardless of whether there's a callus. So calluses are not the idea when we're adapting the skin. But what can we do for prevention? Plenty of things that we can do prevention. And if we think about the cause of blisters, we just have to remove the blister causing forces. So we can do that either by reducing pressure. Now, how would we do that? Really depends on the blister location, but let's say donut pads, donut pads reduce pressure. Not ideal because they're pretty bulky, but there's other ways of reducing pressure. We can cushion with some Spenco insoles for blisters under the ball of the foot. we can, let's say we've got a blister under the big toe joint, the interphalangeal joint. One thing that we look straight for is functional helix limiters. So we really want to facilitate the windless mechanism. So we can get the first MPJ taking the weight that it should and not just dorsi flexing and letting it all happen under the IPJ of the helix. So definitely reducing pressure is the go, reducing friction is the go. And we can do that by one way. One way we can do it is obviously moisture management, but it's a mistake to just put all your hopes on moisture management, like I said, because you can wear moisture wicking socks, you can take your socks off every hour and let them air out, et cetera, but your skin's never gonna be the very, very dry that we need it to be to exhibit low friction. So friction reducing mechanisms, we've got lubricants. powders like two Toms, blister shield powder, Ango patches, which are things that stick to the shoe. We've got Armour Skin socks, they're double socks. They're quite good at reducing friction level. So anything, when we're talking about friction, we're trying to make it more slippery. Okay, so the lubricants make it more slippery, the Ango patches make it more slippery. When we wear the Armour Skin double socks, we're encouraging slip between the two sock layers. So this is the aim of friction management is to reduce friction levels, which encourages an early slide, an early slip between one of the interfaces, which means the skin can then move against the sock or the shoe to allow it to move more in sync with the bone. Takes a little bit of getting your head around because you think, well, I don't really want my feet slipping around in my shoe. We don't want the whole foot slipping around the shoe. We just need that blister prone area to slip. easier back and forth with the bone movement. Well, it goes back to what you were saying before. It's like the, we want to disrupt that discrepancy of the skin, the bone moving underneath the skin. And so if we get that skin moving, then that kind of interface, the skin and the bone kind of start moving more in sync. So it makes sense based on what you're saying. So we're either removing the blister causing forces, which be either reducing the pressure or reducing friction or essentially where, or we're gonna adapt to said pressure or the friction. And sometimes the- Hang on, let me just frame that a little bit better. So when we're talking about preventing blisters, we want to reduce the blister causing forces. So if I just list them off, it's basically reduce pressure, reduce friction levels, reduce the bone movement. We can absorb sheer with a intelligent selection of materials. We can spread the sheer load, which is what taping does. We can reduce the repetitions, which basically means not run so far. So that's not so good. And we can increase the skin resilience. And as I said, that happens pretty soon. So generally with runners, they run a lot, you know, it's not like they run once every fortnight. They're generally running kind of frequently. So we've already maximized skin resilience. Okay, let's say we don't wanna reduce the repetitions because we wanna run as far as we wanna run. But we can reduce pressure. The things that we talked about, we can reduce friction levels with the things that we've talked about. We can try and reduce bone movement. Reducing bone movement is about, you know, tight muscles, limited range of motion. So we can think about stretches, Tib fib mobs, your lower tib fib mobs, anything where we can increase range of motion, where if that tight, let's say the Achilles tendon, for example, inserts into the back of the calcaneus, and we think about my heel blisters, so if that's tight, if the Achilles and calf is tight, there's a higher magnitude of pull and an earlier pull on the back of the calcaneus to lift that heel bone up. Thinking about friction levels is keeping the skin still or in stationary contact with the shoe and the sock. So you can see the heel bone is kind of moving up and down relative to the skin. So if we stretch the calf, use heel lifts to get away with the tightness in the calf, lower tib-fib mobs, those sorts of things are how we can address the bone movement to minimize that. All right. And then all depending on where it is on the foot, there's all different things that you can do. We can absorb shear. As I said, we need to use materials that do that. So if you think about a Spenco Insole, there's a bit of give in it. Yeah, so when you're standing on the Spenco Insole, you plant your heel, let's say, it kind of moves forward a little bit. So the- The heel will move forward in the shoe. but the give is happening in the sphenco, not in your skin. So if there's a bit that's going on in the sphenco, there's less that has to happen in the skin. And with regard to toe blisters, the gel toe protectors just absorb shea like nothing else. They're unbelievable. Do you know the things that I'm talking about like silipos, gel toe, sleeves, et cetera? Are they on your website? I think I saw something like that. Yes, yeah, we do have some on there. So they absorb shea really, really well, plus they cushion. Cushioning is how we reduce pressure. So, yeah, there's things that we can do to absorb shear. And finally, the other one is spread shear load. Now this is how taping works. In my opinion, this isn't sort of well known about or really well thought about because we're still hooked up on thinking that if we put tape on the skin, nothing's gonna rub it as in friction, but we know that there's still shear distortions happening under the skin. So if we... But by putting, you know, tape does help some people, like it's helped you with your blisters at the start of basketball season. So if you tape around the back of your heel, say, it just means that as the bone is moving up, it's kind of pulling on a larger area of skin. So there's less shear distortion per unit area because we're spreading it over across a bigger area rather than let's say, on a Haglund's deformity, you know, that bony thing at the back of your heel. Sometimes it's just that very location that's getting all the shear. Put a bit of tape on there, we're spreading it a bit. Yeah, we're distributing it over a larger area. Yeah, makes sense. So particularly if you're getting blisters in a really focal area, just a little rubbing over a bone, then tape could be quite effective. Well, essentially we only ever get blisters over a very small area. At least that's where it starts. And if you... allow them to go on unabated. Certainly your blister will get bigger, but we tend to get blisters in discreet locations over a bony prominence because that's the bone. There's pressure holding it against the skin and the bone, but friction levels and bone movement create the sheer distortion. So taping, try not to pin all your hopes on taping because taping only does a small amount to... reduced blisters for the vast majority of people, it does enough. But for people like me with more blister susceptibility or reduced capacity for my skin to manage the sheer distortions, I need way more than that. I've got a few patron questions to ask you, but before I do, is there any other misconceptions, misguided information that you commonly see? talking to runners and talking to athletes? Probably in regard to blister treatment and Compede in particular. Do you know Compede? No. Compede is quite popular in hikers and in the UK especially. It's a hydrocolloid ulcer dressing. So we use it in podiatry. But this one's just kind of particularly for blisters. They're just little bits of compaid of this hydrocolloid. A lot of people think that you can use compaid or hydrocolloids for blister prevention. Is it just like a padding? Yeah, it's kind of a thickish material. There's a little bit of give in it, but not an awful lot. It's just like tape really. It's like a thick tape. And so people use it preventatively. Now, just like tape doesn't always prevent blisters, nor does Compade. And if you get a blister underneath your Compade, Compade sticks like anything, okay? And you go to take the Compade off and it just rips your whole blister roof off. So in fact, you just made your blister worse. And I also wouldn't use Compade on... Anything but a D roof blister so there's three stages of blister you've got a blister with an intact roof you've got a torn blister where there's a breach in the skin and the fluid the blister fluids leaking out. Or you've got a D roof blister where there's no roof there whatsoever don't put it on an intact blister for the same reason you don't want to put it. Use it for prevention and don't put it on torn blister because again, as you take it off it's going to take the whole roof off so you just use these on raw. weepy wounds basically, which is what your blister base is. So Compeed is just a blister treatment and it's only a blister treatment for deroofed blisters. Have you seen Stegian socks? They're quite popular for runners. They claim to prevent blisters. And I guess putting them on, cause I've got a couple of pairs, they do snug, like fit your foot like really well. It's very thin. And I guess knowing what I know now, it's sort of improving the friction, or it's reducing the friction of your skin on the shoe. Like your foot will be moving around a little bit more. Have you seen much of that? We don't know because we don't know the friction level of them, the coefficient of friction. So potentially they do, but there's not really any sock brand and there's not really any taping brand that we know. coefficient of friction of their materials. So potentially the Stegen socks have a lower friction level than others. And so just like when you use a double sock like the Armorskin, it allows for slip. Potentially that's what happens. Yeah, okay. And I know that a lot of people love those socks. So they just feel good. Yeah, questions. So Nathan asks, blister prevention when getting wet feet, if getting wet feet is unavoidable, if he's out in the trails, if there's wet weather, crossings like creek and river crossings, and if he's out there and the feet are destined to get wet, is there any blister prevention techniques that we can do to help them? When it comes to wet feet, we've already got wet feet or clammy, sticky skin because of the sweating that happens. But what happens when they get wet is they can get macerated and that just further weakens the skin to any shear load. So it's tricky with maceration because there's really, Prevention is everything. There's not really any treatment other than taking your shoes and socks off and just letting them air dry. That is effective. I've researched that quite a lot. I've got three blog posts on my website that goes into all the bits and pieces that people can use and the limitations of them, the pros and cons. So the key would be, some people would be happy to take their shoes off, do the river crossing, put them back on again. Others are happy to just leave them on the whole time, like let them get wet. Hopefully trust that the shoe is relatively free draining and hope like crazy that just dries things out. So at least even though we still got wet feet, they don't get macerated. You can use waterproof socks. They're a bit different. They will actually keep your feet dry. For example, Dex Shell rings a bell, is a brand of waterproof sock. But I would just have all your preventions in place, be it your Armour Skin Socks. In fact, Armour Skin Socks are probably a good choice if you know that your feet are gonna get wet because... Armour skin socks manage friction. So there are friction management strategy. We know when we've got wet skin, it's a higher friction level. It's better than ENGO patches because ENGO patches have the potential to fall off once they get wet, like waterlogged. And then when it comes to your lubricants and your powders, you'll just need to, you know, that's just gonna, they're just gonna disperse and become ineffective. So you'd have to be prepared to reapply them. But of all of those, I'd probably pick the armor skin socks. If you know your feet are gonna get wet. Is there anything to say for like better fitting shoes? Like are there types of shoes that can reduce the, I guess, yeah, reduce the movement of skin like once you start running? Um, with regard to shoes, shoe fit is important. There's no doubt, but if you can't get perfect shoe fit, let's say you've got a bunion or you know, whatever, hammerto let's say, it doesn't mean that you're destined to get blisters. So you just need to hone in on that blister location, figure out all the blister causing forces and the specific things that you can do for that blister location. So, No, there's no such thing as I'm pretty prone to blisters. I should go out and get a Nike, whatever. It's, it's far too, far too difficult. And a lot of people, most people should really choose shoes, definitely for fit. I mean, that goes without saying, but for other reasons, like, you know, their, their activity, so it's going to be a good match for the purpose. Um, and you know, how comfortable they are. So yeah, it's not as easy as a certain shoe. Thinking about Nathan's question, I was thinking of one, either those, like I'm not a massive advocate for barefoot running, but like those five finger Vibram shoes that kind of have the webbing individual toes. Like that could potentially like, if you find a shoe that fits like a sock, then it's kind of limiting bone movement or that skin interface. Or you have like a trail shoe has a really big kind of toe box. So the toes aren't really close together, it allows them to splay out a bit more, which could affect the skin on bone, that sort of discrepancy there. Have you found much with shoes like that? A deep and wide toe box comes into shoe fit. Okay. So if your toe box isn't deep or wide enough, then you don't have a very good shoe fit. So again, if your feet are require that, then they require it. And it's very tricky to prevent and treat blisters if the toe box of your shoe just doesn't have enough space for your toes. Now, when I go to the six day ultra marathons, they'll have several pairs of shoes. And the shoes that they start off with are probably not the ones they're going to end up with because as their feet swell and the toe, but the toe box becomes less roomy, they need to switch to a shoe with more toe box room. So yeah, certainly a deeper and wider toe box is never going to be a bad thing. But it's only going to be necessary if your current shoes and the activity that you're doing and the amount of swelling that you get is inadequate. Uh, if your shoes are inadequate for that already. Right. And with regard to the vibrams, no, I wouldn't, I would doubt it. I mean, there's no research to back that up, but I doubt that they're going to be any better off of blister prevention. In fact, they'll be probably worse for blisters at the ball or the foot. Yeah. Okay. Good to know. Uh, Erin asks the best way to mend slash prevent. blisters that gather in between the toes. What can we do for that specific type of blister? They're definitely tricky. First of all, we need the toe box room and we need to have that the whole way through. So with the ultra runners, they'll need to change their shoes so that they've got that room. And in fact, some of the ultra runners at the six day events, they just, in the end, none of their shoes have enough room and they just cut the whole toe box out so that there is enough room. It's a bit extreme, but ultra runners do extreme things. So definitely room in the shoe. You can tape, definitely. It's not always gonna prevent the blisters, but by all means tape and spread a bit of sheer load so it's not concentrated at that, you know, bone on bone spot between the toes. The interdigital, or sorry, the toe, gel toe sleeves and caps, they can be fabulous. As I said, they absorb sheer. That literally sheer, the skin, the sheer doesn't have to happen in your toes at all when you wear those. The problem with them is they take up a fair bit of room in your shoe and you certainly can't wear them on every toe or you know even two toes sometimes is pushing it a bit. So I've seen these on your website they're just like a little sleeve, kind of like a little bandage thing that goes over an individual toe. Yes and a very conformable gel on the inside. you can get them from Chemist, they're available all over the shop. Silipos is a good brand. Then there's toe socks. Toe socks can be good, a lot of runners wear toe socks. Again, they take up a bit of room in the shoe when you think about, normally there's no anything, there's no material between the two toe, between two toes. Now all of a sudden you've got one sock layer there and one sock layer there and then you've got that all the way around. So it does bulk things up a little bit, but rather than having no cushioning between the toes, now you've got a little bit of cushioning from the two sock layers. And you've also got an additional movement interface because normally it's just the skin on the skin and now there's two sock layers in between and the socks can move against one another rather than the toes move against one another. And other than that, what have we got? If you've got a particularly clawed toe or hammered toe, a podiatrist might make a particular toe wedge or toe prop. That can be good to make toes kind of move less in the shoe or at least normally when we get like an interdigital corn, for example, or a callus, it's because there's a concentration of pressure on the two adjacent bones and all the rest of the interdigital pressure is kind of negligible. But when we mold something to that hole into digital space, rather than it being very pinpoint pressure, we even the pressure along that hole into digital space and that can go a long way to preventing blisters between the toes. But my pick would be the gel toe sleeve, especially for pinch blisters. Do you know the ones where your little toe kind of gets like a ridge on it? They're quite common. So a lot of people have- Like near the bed of the nail. No, on the underside of the night, it's kind of on the underside slash in between the toes. Often that little toe is curly and you kind of kinks in under like that a bit. Essentially your fourth toe is like treading on your fifth toe with each step that you take. You can't do any toe. Yeah. And over time, the pulp of that toe gets pinched and then it just becomes that shape. Oh, I see. Kind of triangular. Yeah. Well, if you've got a pinch callus like that, then you are just waiting for a pinch blister to happen. And for those, the gel toe sleeves are gonna be your best bet. So just because we're an audio former, I'm just gonna explain that a bit more. So what you're saying is the adjacent toe is kind of tucking under the toe next to it just subtly. And so it's pushing the skin differently. It's pinching the skin. And if that's done over, you know, the number of repetitions of running, then a blister could form. Yep. Great. One more question I have, which is right up here, Ali. Tracy asks, what should we do for blisters mid event, say for an ultra race? Should we pop them, cover them, leave them, cry, stop running crazy distances? What do we say? Stop running crazy distances. No, no. It depends on how crazy the distance is. So in my experience, anything up to a 24 hour ultra people aren't gonna wanna stop for blisters. So I don't even bother going to those events. They're just rather tough it out because the time pressure is so immense. And they're crazy people. Of course. And, but if you want to stop and do something, absolutely. It becomes more significant sort of the 48 hour, 72 hour and definitely the sixth day. You can't just tough a blister out, generally. Some people do, but generally. the time pressure is a little bit less. And so you've got the opportunity to stop and do something about it. First of all, you need to have gear with you. So you need to have thought about this in advance. So with regard to treatment, what you need is betadine or some sort of antiseptic, some island dressings which is a fancy way of saying band-aids and some hydrocolloids. So they're the two dressings antiseptic for... infection control and your band aids and or your ComPEDE for your different types of blisters. Now probably in a big ultramarathon I don't use much ComPEDE or hydrocolloids because the way they work best is to stay on for kind of days at a time and when you are in a six-day ultra there's still a lot of blister causing forces and generally we end up having you sort of losing the effect of the Compaid or the hydrocolloid. So I would maybe just stick to, if you really want to cut down, just stick to your island dressings or your band-aid. So it's better than a band-aid. So that's the basics of your blister treatment. But it's important to remember that blister treatment is not just looking after the injured skin, it's also implementing blister prevention, because if we don't want that blister to get bigger and we don't want it to hurt so much, we have to reduce or minimize the. blister causing forces, which is basically blister prevention. Of course, it always depends on where the blister is. So, so it's not as easy as saying blisters need this, this and this. It really depends. Like I said, toe props and things for toe blisters. Gel toe sleeves are good for toes, but obviously you can't, you can't use that gel material. There's just way too much give in it to use it under the ball of the foot. Because if you have it under the ball of the foot or under the heel. there's just way too much movement of the whole foot in the shoe. And you'll just end up with black toenails because your toes will hit up at the end of the shoe. So always be mindful of the blister location and hone in on that blister location and all the relevant factors. So you have a blister that has a roof on it. Are we popping it and then doing the bandadine and bandages, or are we just leaving it as is with, and then do the- That's a tricky one. Now I quite like- to pop a blister in an ultra marathon situation because you can pretty much guarantee it's gonna pop anyway. So I'd rather take the bull by the horns, be in control of the situation, lance that blister in a clean way, dress it up and so away you go and then you just need to know that you need to redress it and look after it, make sure it doesn't get infected. But there's certainly advantages to leaving a blister roof intact because as long as it's intact, it can't get infected. So in a way it depends on, you know, your environment. So if you are doing a trail ultra, you're doing water cross or river crossings, it's getting muddy, whatever, you'd be very reluctant to pop that blister. But at the races that I go to, people are generally running around a round a track, maybe. K, K and a half in distance. And so they're passing by the medical tent or their own tent pretty frequently. And you know, they have the opportunity to really look after that blister and plus it's clean because it's a track sort of an environment. Yeah, so it kind of... I guess the idea would be reducing the risk of infection as much as we can. So it's nice to know to say if someone finishes an event and then they find a blister and it's got a roof encased over the top of it, then we can say yes, let's leave it on because that's well in case it's not going to become infected. Would you still go with the benedine and the those bandages like you were talking about? I would, I'd put a bandaid or an island dressing on it just for a little bit of protection. So the important thing about an island dressing is there's a non-adhesive part and that goes over where the blister is. So nothing's gonna stick to the blister itself. So when you go to remove it, everything's cool. And plus that little bit of padding will pad, cushion a little bit, which reduces pressure. But also if it does pop itself, it's there to soak up a bit of blister fluid. Again, it will also depend on where it is. If it was at the back of your heel, you could easily just not do anything with it because, and wear thongs or scarfs. So there's nothing touching it. We know it's intact. It's unlikely to burst of its own accord. But if it's under the ball of your foot, little bit of a different story, I would do your island dressings and implement a really good blister prevention because you still got to walk around. It's hard to walk around and not be on the ball of your foot. Yeah, great tips. Anything else that we haven't covered when it comes to like misconceptions, blister prevention, blister treatment that we haven't talked about today that you think of run I might really benefit from. Not really. I think I've touched on all of them. Mainly very comprehensive. Yeah. I think, I think runners should look past taping, look past moisture management if they're still getting blisters in spite of those strategies and realize that there's more that they can do than they possibly think at this point in time. And That blister treatment is not just looking after the injured skin. You've got to implement your blister prevention. Otherwise the blister will keep getting, it'll get bigger and it'll hurt like hell. Yep. Great. I have gone to your website, which is blis Is that right? Yeah, we've had a bit of a change just recently. It's blis Yep. I saw that one too. It takes you to the same place though. Um, so do you want me just to, um, put that second one in the show notes. Yeah. Yes, please. Any other social media or any other websites or links that you want me to include within the show notes? I could just send you my links. Maybe the Facebook page is relatively popular. Great. Mr. Prevention. Yep, send me those across and I'll include those. Rebecca, thanks for coming on. This was, I learned heaps. almost silly to think that I do so much research into running and actually don't know anything about blisters. So it was, obviously you're a little bit more resistant than many of us. I just don't know. Good distances either. And I've kept the same. Um, yeah, but it's I've learned heaps and at least I can talk to other runners who might have listed about this information as well. And we've definitely broken into some key misconceptions with she's the ethos of the podcast. So once again, thanks for coming on. Right. It's a pleasure. Thank you. Thanks once again for listening. 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