Treating and Preventing Foot Blisters - Dr Gill

Hello and welcome back to the channel. My name is Dr James Gill and you've joined me for another clinical skills adjacent video. Today we're going to be looking at an aspect of expedition medicine how to correctly apply blister plasters. Now that might seem a very strange thing to apply but actually if done properly then blister plasters should be able to last for seven days according to manufacturer specifications potentially as long as 14 days and depending on the equipment that you're using may even last up to four weeks in duration. But as with so many things prevention is going to be better than cure and the first part of correctly applying blister plasters is to prevent a blister by being aware of what to do with regard to hot spots. So it's not unusual for people to buy new boots when they're going on expedition and find relatively quickly that they are aware of not discomfort but areas where their feet are feeling hotter there's a little bit of friction that there's some discomfort there and this is particularly important because of how a blister forms. We're dealing with sheer forces across the skin so for example your foot is pressed firmly against the edge of the boot the boot is moving that little bit as your foot gets hot and sweaty that skin is sticking to the boot and rather than the sock and the boot moving together actually it's the sock the skin and the boot moving steadily we get little bits of friction and sheer forces and we get fluid forming under the skin as that skin gets shorn off the underlying tissue developing that blister. So anybody on expedition anybody going on long distance hikes etc realistically as soon as you're wearing your boots go for a wander and see if there are any areas where you can feel that the shoe is relatively tight at which point we want to reach for the gaffer tape absolutely we're going to take the foot very lightly we're not looking to bind it but we're going to put the gaffer tape over those hot spots that could potentially reduce friction and actually stop a blister forming in the first place. So hello my name is Dr Vigil, can I please confirm your name and date of birth? I'm 12 August 1995 and it's Dr Vigil. Fantastic thank you very much. So can I clarify the problem at the moment? I'm hiking a lot and I'm getting some sore spots in my boot. Okay thank you, can I ask you to take your shoe off please? So again prevention being better than a cure, thank you. So what we're going to try and do we'll have a look at the foot and see if we can see any obvious issues. So you point towards the back of the foot so there's a little bit of redness underneath but nothing significant and if I can get you to lie back I'm going to lift the foot up so we're going to have a look all around the foot and I can just see here there's a little bit of erythema it's nothing very significant but nevertheless the patient is highlighting that here is a source of discomfort so we need to be very conscious about that but I'm also going to look around the heel over the base of the great toe and along the outside around the toes and across the arch of the foot as well all the areas that are prone for blisters to develop but we can see this one area so that's where we're going to start off applying the duct tape to try and reduce this friction and allow this erythema to settle down without causing any problems to the skin underlying it. So what we're going to try and do is we're going to go for prevention rather than cure in this case so if I can just get you to shuffle forwards so your heel is in space thank you and I'm going to go and pick up duct tape yes common or garden regular duct tape and I'm going to take the duct tape and I'm going to try and just use it to cup the base of the foot and I'm going to bring it up and around looking at that hot spot so I'm going around the back and then along the front here hopefully that will be sufficient to allow reduction in friction and prevent a blister forming however let's assume that that doesn't work then how are we going to deal with that what we're going to deal with that with Compede let me show you how to apply it properly so the crucial component to when you're trying to help somebody with Compede is we need to get it warmed first Compede is not actually massively flexible but we need to make it more flexible in order to be able to come around the area with the issue and get it to bond well with the skin so as a rule of thumb you can provide it to the patient and if you're on expedition something like that whilst you're preparing your other kit or even whilst the boots are on ask the patient to put it somebody somewhere warm for example under their armpit whilst we are going to be getting ready for things so once we have the Compede nicely warmed if I might thank you very much we're going to take the Compede and we're going to stretch it ever so slightly so just giving it a bit of a stretch I'm actually going to prepare it for what's going to happen then we're going to remove the backing so we've got the sticky side and once that's applied we're going to have this additional bit that we're going to pull off and you can see here the hydrocolloid just sat in the middle that's hopefully going to reduce the discomfort to the patient and at that point I'm then going to take off the first piece to expose the actual sticky underside given that we can see where the blister is here I'm going to apply again with a little bit of stretch down and round and finally I'm pulling off the piece and putting it over now this isn't actually the end of what we're doing here I'm then going to keep cupping to keep it warm and pulling along where I'm putting it down and hopefully my the heat from my hand and the pressure will help the Compede adhere to the skin as has that little bit of pressure and then I'm going to hold on firmly for a minute or so making sure it's nice and warm coming back and making sure that I'm giving it a really good smoothing round so it's sticking very firmly around the edges here and you can see where we've covered over the blister hopefully that heat from my fingers should help it stick down more effectively and mean we're less likely to have the edges coming up so I'm pressing down rubbing across those edges particularly where we think that there might be wear points so just on the edge where the shoe might be and over the cross of the of the top of the foot here again all the while I'm pulling across and down so stretching it at the same time and hopefully the heat of my fingers is improving that adherence as well we don't want to press directly too much over the blister because that could certainly cause some discomfort hopefully that will mean that a we're going to be able to protect the developed blister from worsening but we're going to be able to reduce the discomfort of the patient given the way that the compete works as a common dressing it's hopefully going to pull some of that fluid from the blister and is going to help the patient heal faster and hopefully be in less discomfort again I'm just checking those edges and making sure they're nicely smoothed down now what make the highlight with this I've applied that compete directly over the blister I haven't talked about de-roofing or anything like that as a rule of thumb I wouldn't go anywhere near de-roofing a blister unless there was evidence of infection if there was pus or if it was in other parts of the body was causing a problem functionally if however from an expedition medicine perspective your patient unfortunately has had that blister pierced and it's de-roofed one of the things that you can do is using sterile super glue you can put that into the wound and help stick that blister down yes it's going to be very uncomfortable as the glue is setting but that can again provide you a very good surface on which to apply the compete and allow that patient to complete their expedition keeping in mind that expedition medicine is about supporting the patient it's trying to help people safely achieve their goals and sometimes that's about how do we help somebody continue with something that perhaps in the regular world would be suggesting they avoid or go back to resting that's obviously not an issue when you're halfway up a mountain so hopefully that's been useful and we'll see you in the next one cheerio