Blister Prevention and Treatment
Foot blisters are a very common injury affecting soccer players along with many other athletes. Athletes who participate in high-intensity endurance sports are at increased risk for developing blisters due to increased sweating along with high friction forces at the bottom of the foot. Several studies have found the incidence of foot blisters in marathon runners and military cadets may be as high as 40%, and potentially even higher. Though there is not any direct research I am aware of, the incidence is likely similar in soccer players.
Blisters are typically caused by excessive heat, moisture, and friction. This leads to a tear under the skin or separation of skin layers, which allows plasma-like fluid to seep in.
https://www.flemingmedical.ie/news/footcare-blisters-and-hydrocolloid-technology
Moisture from sweat accumulation has been found to increase friction forces, and of course higher temperatures increase sweating. It is estimated that sweat production in the foot may be between 13 and 16 ounces/hour.
Activities involving repeated high intensity movements (cutting, sprinting, dribbling) also play a role in blister formation due to increased friction. Unsurprisingly, researchers have also found that faster walking/running speeds increase in-shoe temperatures and perspiration.
Location
The toes are the most commonly affected region for soccer players, followed by the ball of the foot and the heel. I’ve noticed my blisters almost always occur on the big toe, the side of the heel, and occasionally the ball of the foot.
Risk Factors
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Heat and foot moisture usually increase together
Hiking in wet socks has been found to double the risk of experiencing blisters.
Moist skin is more susceptible to blister due to a higher coefficient of friction on skin surface.
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Shoes that are not broken in.
Worn out socks and shoes.
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Can create new pressure points.
Some amount of callous formation is normal, however.
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Cumulative effect with increasing distance.
Performing unfamiliar activities.
Basically doing too much too soon.
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Does the playing surface matter?
There have been several high profile players noting an increase in blisters on artificial surfaces. This makes sense due to increased temperatures on artificial turf fields compared to grass.
Women's World Cup Artificial Turf
However, with moderate to cool weather I would expect minimal difference between artificial and natural surfaces, and that has been my personal experience. Debris that enters the shoe, such as dirt or rubber from synthetic turf fields, may also contribute to blisters.
Overuse injuries
Several studies have found an increased risk of overuse or other musculoskeletal injuries associated with blisters. This is likely due to the gait alterations blisters can cause.
(On a personal level, I’ve found having a bad blister on my big toe or heel definitely changes the way I kick and run, especially dribbling and cutting.
How do we prevent blister formation?
To prevent blisters, we want to reduce the combination of friction, heat, and moisture as much as possible. There are various ways to accomplish this, which we will cover in more detail below.
Sock material
Choosing the right pair of socks is one of the most important things you can do to prevent blisters.
It’s important to wear socks that:
Fit well
Have adequate cushioning/padding and are not worn out
Have moisture wicking properties
Cotton absorbs 3x as much moisture as synthetic socks
Once wet, cotton dries 10x slower
Synthetic socks also reduce skin heat better than cotton
Grip socks will likely help as well due to increased friction in less blister prone locations, dispersing shear forces throughout the whole foot rather than at one or two locations. (Nike Grip Socks & TruSox shown in picture)
Toe socks may help reduce blisters by adding more cushioning and pressure relief to the interdigital space (between your toes). Double socks may also help for some people. There is not much evidence for either of these, however.
Some studies show more blisters wearing double socks compared to more padded synthetic socks, though some athletes still prefer wearing 2 pairs of socks.
Changing socks at halftime
Due to the large amount of sweat produced in the feet, even the best socks may have trouble wicking all of the moisture away. On a practical level, changing socks at half time or part way through training can be an effective strategy to reduce excess foot moisture and blisters.
Cleat fit
Poor fitting cleats may contribute to blister formation.
Cleats that are too tight may increase friction at certain locations and cause pressure points.
Cleats that are too loose may cause the foot slide inside of the shoe, which could increase shear forces.
Cushioning, insoles, and orthotics
Wearing cushioned insoles can help reduce pressure and prevent blisters.
Rushton and colleagues describe friction force as “directly proportional to pressure (compression force) and the coefficient of friction between two surfaces.”
Cushioned insoles and orthotics can help spread out this pressure over a larger surface area to reduce friction forces.
Socks, insoles, or cleats that are overly worn out should be replaced.
Taping and skin lubricants
Taping
Pre-taping blister prone areas may help reduce blisters by spreading the shear load across a wider area.
However, there is not much evidence supporting this.
Blist-o-ban
May be beneficial for preventing blisters and hot spots by offloading specific areas.
Squirrels nut butter
I have not tried this, but I have heard it recommended by several ultra endurance runners.
Petroleum Jelly
This may actually increase blister formation according to a study by Lipman et al.
Powders
There is conflicting evidence, but overall antiperspirants and talcum powders appear to have minimal to no effect and may even increase blister risk and skin irritation, especially when the powder becomes wet.
Ultimately there is a lot of conflicting evidence when it comes to using powders, creams, or lubricants. It’s probably worth trying multiple products to see what works best for you.
Treatment
The main goals of blister treatment are to:
Minimize pain and discomfort
Limit the size and severity of the blisters
Prevent infection
Try not to tear the skin off smaller blisters. This will help minimize infection and promote healing. Instead, you may place a donut shaped pad (like the blist-o-ban) or moleskin over the blister to help relieve the pressure. Tape or second skin may also be applied. When the blister roof is almost torn off, you can remove it.
If the blisters are bad enough and running remains painful, you may need to cross train for awhile (biking, swimming, elliptical, etc) Once pain has improved, you may return to play, just continue to monitor if symptoms worsen. After you return to sport, you can use any of the prevention methods mentioned above.
Key Takeaways
Blisters are typically caused by excessive heat, moisture, and friction.
This leads to a tear under the skin which allows plasma-like fluid to seep in.
High-intensity endurance athletes are at increased risk for blisters due to increased sweating along with high friction forces at the bottom of the foot.
Toes, ball of the foot, and heels are the most commonly affected regions.
To prevent blisters, reduce friction, heat, and moisture.
Choose the right pair of socks, cleats, and insoles. They should not be worn out and changing to a dry pair of socks at half time may be helpful.
Don’t tear the skin off smaller blisters, but if the blister roof is almost torn off, you can remove it.
You can place a pad/moleskin/tape over the blister to help relieve the pressure.
References
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Brennan FH Jr. Managing blisters in competitive athletes. Curr Sports Med Rep. 2002 Dec;1(6):319-22.
Pujalte GGA, Costa LMC, Clapp AD, Presutti RJ, Sluzevich JC. More Than Skin Deep: Dermatologic Conditions in Athletes. Sports Health. 2023 Jan-Feb;15(1):74-85.
Yavuz M, Davis BL. Plantar shear stress distribution in athletic individuals with frictional foot blisters. J Am Podiatr Med Assoc. 2010 Mar-Apr;100(2):116-20.
Rushton R, Richie D. Friction blisters: A new paradigm to explain causation. J Athl Train. 2023 Jan 27.
Pérez Pico AM, Mingorance Álvarez E, Caballé Cervigón N, Mayordomo Acevedo R. Importance of Preexisting Physical Factors in the Development of Dermatological and Muscular Lesions During Hiking. Int J Low Extrem Wounds. 2019 Jun;18(2):161-170.
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Hoffman MD. Etiological Foundation for Practical Strategies to Prevent Exercise-Related Foot Blisters. Curr Sports Med Rep. 2016 Sep-Oct;15(5):330-5.
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