Treating Blisters When Hiking

Blisters are the most common foot injury in hikers, affecting beginners and experienced ultralight thru-hikers alike. A small hot spot ignored on the first mile of a 20-mile day can become a painful, hike-ending wound by afternoon. Understanding how to prevent, recognize, and treat blisters effectively is essential for anyone who spends serious time on the trail.

• Understanding How Blisters Form

A blister is the skin’s emergency response to repetitive friction. Heat, moisture, and movement combine to separate the epidermis (outer layer) from the dermis (inner layer). Fluid fills the space as protection. The three primary causes are:

1. Friction – poorly fitting boots, wrinkled socks, or debris inside the shoe
2. Moisture – sweat-soaked feet, stream crossings, or prolonged rain
3. Heat – generated by the foot sliding inside the boot

When any two of these factors increase, the third accelerates blister formation dramatically.

• Prevention: The Best Treatment

Experienced hikers repeat the mantra "blisters are preventable." The following measures, applied together, reduce incidence by 80-90 % in most studies of long-distance trails.

1. Footwear Fit and Break-In

Boots or shoes should have a thumb’s width of space between the longest toe and the end of the boot when standing. Try shoes on late in the day when feet are slightly swollen. Break in new footwear gradually—never take brand-new boots on a multi-day trip.

2. Socks and Liner Systems

A thin synthetic or wool liner sock (e.g., Injinji toe socks or Darn Tough liners) worn beneath a thicker cushioned hiking sock dramatically reduces shear forces. Change wet socks immediately. Carry at least two spare pairs.

3. Moisture Management

Apply an anti-friction product (BodyGlide, Trail Toes cream, or 2Toms BlisterShield powder) to susceptible areas before starting and reapply every 4-6 hours. Some hikers tape "hot-spot prone" areas prophylactically with Leukotape or kinesiology tape.

4. Foot Care Routine

At every major break, air feet for 10-15 minutes, dry them thoroughly, and dust with a moisture-absorbing powder (Gold Bond medicated or antifungal foot powder).

5. Early Intervention

A "hot spot" (tingling, burning, or redness) is the warning sign. Stop immediately. Apply tape or a blister plaster. Ignoring it almost guarantees a full blister within the hour.

• Field Treatment of Blisters

Despite best efforts, blisters still happen. The goal shifts from prevention to damage control: keep hiking if possible while preventing infection and deeper tissue damage.

• Step 1: Assess the Situation**
• Intact blister (fluid-filled bubble, skin roof still attached)
• Derroofed blister (skin torn off, raw dermis exposed)
• Blood blister (similar to intact but filled with blood)
• Step 2: Clean**

Wash hands and the blister area with soap and clean water or an alcohol wipe. In remote settings, potable water and a small amount of camp soap suffice.

• Step 3: Treat According to Type**

A. Intact Blisters (preferred: leave the roof on)

The skin roof is nature’s best dressing.

• Apply a hydrocolloid blister plaster (Compeed, Band-Aid Hydro Seal, or generic equivalents). These adhere strongly for days, absorb fluid, and turn it into a cushioning gel.
• Alternative: donut-shaped moleskin or Spenco 2nd Skin with an overlying piece of Leukotape to hold everything in place.
• Do NOT pop unless the blister is so large it will rupture anyway or is in a weight-bearing location that prevents walking.

B. Blisters That Must Be Drained

Only drain if the blister is painful, very large, or deroofing is inevitable.

1. Sterilize a needle (flame or alcohol).
2. Puncture near the edge (not the center) at two points so fluid can continue draining as pressure builds.
3. Press gently with clean gauze to expel fluid. Do NOT remove the roof.
4. Apply antibiotic ointment (Neosporin or triple-antibiotic).
5. Cover with a hydrocolloid plaster or Spenco 2nd Skin + Leukotape.

C. Derroofed Blisters (raw, painful)

These are essentially open wounds.

1. Clean thoroughly.
2. Apply an antiseptic (benzalkonium chloride wipes or povidone-iodine).
3. Cover with a moist wound-healing dressing: Spenco 2nd Skin, Tegaderm film, or a hydrocolloid.
4. Secure edges with Leukotape (it sticks even when wet and sweaty).
5. Change dressing daily or if it becomes soaked/dirty.

D. Blood Blisters

Treat like intact blisters unless they are extremely painful. Blood blisters often hurt more but follow the same drainage rules.

• Step 4: Taping Techniques**

Leukotape P or Hypafix applied smoothly (no wrinkles) directly to skin can stay on for days and prevents further damage. For heels, the "heel-lock" taping method (two anchor strips + diagonal tension strips) provides excellent stability.

• Infection Signs – When to Worry

Seek medical help if you see:

• Increasing redness spreading away from the blister
• Pus or cloudy fluid
• Red streaking up the foot/leg
• Fever or swollen lymph nodes

In remote areas, start oral antibiotics (carry a small emergency course if your physician agrees) and evacuate if symptoms worsen.

• Pain Management and Continued Hiking

Ibuprofen or acetaminophen help with pain and inflammation. Some hikers use Engo blister patches inside the shoe itself to reduce friction at the source rather than on the skin. Adjusting lacing (skip eyelets over painful areas) or adding an insole can redistribute pressure.

• Evening Foot Care Routine on Multi-Day Trips

1. Remove boots and socks; elevate feet for 15-20 minutes.
2. Wash feet (baby wipes if no water).
3. Inspect every inch for new hot spots.
4. Dry thoroughly, apply antiseptic to any open areas.
5. Re-tape or re-dress blisters.
6. Apply hydration cream (O’Keeffe’s Working Feet or Trail Toes) overnight to prevent cracking.

• Special Considerations
• Diabetes or poor circulation: Never drain blisters yourself; keep them intact and padded, seek medical care ASAP.
• Trench foot risk in cold/wet conditions: Prioritize keeping feet dry over mileage.
• Desert hiking: Talcum-free powders and frequent sock changes are critical.
• Conclusion

Blisters are rarely life-threatening but frequently hike-ending if mismanaged. The ounce of prevention—properly fitted boots, moisture control, and immediate attention to hot spots—is worth pounds of cure. When blisters do occur, modern materials (hydrocolloids, Leukotape, Spenco 2nd Skin) allow most hikers to continue with minimal pain. Treat early, keep clean, and stay vigilant. Your feet carry you the entire distance; treat them accordingly, and they will rarely let you down.

Craig Payne is a University lecturer, runner, cynic, researcher, skeptic, forum admin, woo basher, clinician, rabble-rouser, blogger and a dad.