Monday, July 10, 2017

About Those Blisters ...

In my last post, I mentioned having painful blisters on my heels after a long walk on Wednesday.  This is a follow-up post.

I seldom get blisters from running.  When I do, they’re usually on the tips of my toes or the side of my foot.  I puncture them and press the fluid out.  After that, they don’t bother me too much.  Within a week, they’re usually completely healed.

When I discovered these blisters, there wasn’t enough fluid to drain them.  The skin around my heels looked thicker, but if it wasn’t for the pain, I wouldn’t have recognized them as blisters.  There wasn’t much I could do to treat them.

By the time I did my next long walk on Friday, I was having difficulty walking fast because of the pain.  I managed to suppress the pain, but to do it I had to walk with a great deal of intensity.  I managed to do that for 10.5 miles, but I knew I was making the blisters worse.

After Friday’s walk, the blisters were thicker.  Now there was enough fluid to drain them.  At a glance, they looked slightly dark.  I wondered if they were blood blisters, but it was hard to tell because the skin was so thick.

That’s what makes heel blisters difficult to treat.  Instead of forming near the surface, they’re deep.  They form underneath thick layers of dead calloused skin that builds up around my heels.

I sanitized a pin and used it to poke holes in each blister.  Then I pressed out as much of the fluid as I could.  It wasn’t easy, and it hurt like hell.  They were definitely blood blisters.

Normal blisters are filled with clear liquid.  It’s mostly water, but with traces of salts.  It’s similar to your sweat.  The fluid in blood blisters is mostly the same watery liquid, but with a small amount of blood mixed in, which makes it look red.  The fluid I was draining out of these blisters didn’t seem watery.  It was just blood.  I saturated a tissue with the blood from the two blisters.

Both of these long walks were outside, in the afternoon heat.  I was walking fast enough to work up a sweat.  Even still, it was nothing like the way I used to sweat on long training runs in summer heat.  The hot conditions alone didn’t explain why I was getting such bad blisters.

I’ve had heel blisters before, but only after a long race, like a 24-hour run.  In those races, I do a combination of running and walking.  Maybe that was the common denominator.  Perhaps when I get heel blisters it’s always from the walking.  When I’m trying to walk fast, I lengthen my stride.  Perhaps that’s causing my foot to make contact with the ground in a way that puts more pressure on the back of my heel than running does.

I’ve been doing my long walks in the same shoes I would normally use for running.  I alternate between two pairs of shoes, but both of these long walks were in the same pair of shoes.  I noticed a problem with those shoes.

I have a history of plantar fasciitis.  As a preventative measure, I have rigid orthotics that I wear in my running shoes.  To make room for the orthotics, I have to remove the insoles.  Then I cover the orthotics with Spenco replacement insoles.  They’re basically flat foamy insoles that give me a little bit of cushioning.

The insoles aren’t an exact match to my shoe size.  I have to buy insoles in a larger size and trim them to fit my shoes.  Despite my best efforts to trim them just enough to fit, I sometimes cut them too small.  That’s what happened with this pair.  When I looked into the shoes, I could see that the insoles had ridden forward in my shoes, exposing the back edge of the orthotic.

Here’s a picture.  The insole is green.  The orthotic is red.  You shouldn’t be able to see the orthotic.

This was creating a pressure point where my heel rested on the back edge of the insole.  It might not be the cause of my blisters, but it certainly wasn’t helping.  After lunch on Saturday, Deb and I went shopping for more replacement insoles.  As I trimmed them, I was careful to make them large enough that I could just barely fit them into the shoes.

I have a short-term problem and a long-term problem.  My short-term problem is finding a way to cope with the pain, so I can continue training.  My long-term problem is reducing the friction that’s causing my blisters.  Before they can heal, I have to stop making them worse.

For the pain, I’ve tried Bio Freeze gel and a roll-on painkiller that we bought at CVS.  Neither of them made any dent in the pain.  I eventually realized why topical painkillers won’t help.  I can only apply them to the thick layer of dead skin on the outside of the blisters.  The pain is coming from the inflamed skin underneath.  Without cutting away the dead skin, I can’t reach that layer.

Cutting away the skin is a last resort.  I’ve done that with heel blisters before, but the skin is so thick, it forms a crater.  Along the bottom edge of the crater, it creates a new pressure point that’s even worse than before.  If I did that, I’d have to take a few weeks off to heal before I’d be able to walk again.  I don’t have time for that.

Ordinarily, I might consider taking ibuprofen.  It wouldn’t eliminate the pain, but it might make it slightly more tolerable.  There are two reasons why I don’t want to do that.  First, my long walks are getting close to three hours, and I’m doing them in summer heat.  I could easily get dehydrated.  Ibuprofen is hard on your kidneys to begin with.  It’s especially bad for your kidneys if you’re also dehydrated.

The second reason has to do with a discussion I had with the neurosurgery nurse at my follow-up appointment.  When I asked him about walking marathons, he said I needed to listen to my pain.  He gave me a few guidelines.  If walking causes discomfort in my back, I should stop.  If walking causes my back to feel fatigued at the end of the day, that means I’m overdoing it.  Finally, if I’m unable to wean myself off painkillers, that also might mean I’m overdoing it.

I stopped taking prescription painkillers that same day.  Since then, I’ve gradually weaned myself off ibuprofen.  Until the blisters, I wasn’t experiencing any discomfort.  I realize he wasn’t talking about blister pain, but if I’m taking ibuprofen for the blisters, it impairs my ability to gauge whether I’m having discomfort in other areas.  For now, I have to do without it.

Finally, I’ve tried soaking my feet in an Epsom salt solution.  Some people say that can relieve pain, while other says it reduces swelling.  There doesn’t seem to be any scientific evidence to support either of claims, but I figured it couldn’t hurt.  I’m not sure if it will do any good in the long run, but I’ll stick with it for a few days.  If nothing else, it feels soothing while my feet are soaking.

Finding a way to cope with the pain is important, because it’s starting to hold back my training.  On Saturday, when I tried to do a fast workout on the treadmill, I couldn’t bring myself to put weight on the back of my heels.  I had to shorten my stride until I was walking on the balls of my feet.  That felt too awkward, so I stopped after only a mile.  My pace for that workout was two minutes slower than the 10.5 mile walk I did on Friday.  My other walks that day were all casual walks outside.  I had to take small steps, resulting in a ridiculously slow pace.

On Sunday, I did another long walk.  This time I increased the distance to 12.25 miles.  I felt better than I did on Saturday, but my stride was still a bit shorter than before.  I did the best I could, but the shorter stride resulted in a slower pace.  I averaged 14:12 per mile.  That’s not awful, but it was disappointing compared to the 13:50 pace that I averaged for 10.5 miles on Friday.  In addition to building up to a marathon, I need to keep bringing my pace down.

One of the most obvious things I can do to keep the blisters from getting worse is to keep draining them.  The more they swell, the more it results in extra pressure.  On Saturday, there was good news and bad news.  The good news is that the fluid wasn’t as bloody.  There was a little blood, but mostly it was clear liquid.  The bad news is that I couldn’t get it all out.  No matter where I poked holes and where I applied pressure, some of the fluid wouldn’t come out.

I’ve had that problem with heel blisters before.  New blisters form underneath the old ones, creating layers of blisters.  The newest blisters are filled with fluid, while the ones on top are filled with air.  It’s hard to tell if you’re poking into the right compartment.  Even if you are, it can be tough to get the fluid out.  Sometimes it just moves from one compartment to another.

After my long walk yesterday, it seemed like there was only clear fluid, but I didn’t even try to get it out.  It was no longer worth inflaming the whole area just to get 10% of the fluid out.

Some people will protect their skin by applying bandages.  I have trouble getting anything to stick to my feet when they start getting sweaty.  Over the years, I’ve tried Band-Aids, sports tape, duct tape and expensive ortholetic tape.  Everything comes loose.  Sometimes tape will come loose as soon as I think about exercising.  That’s how much my feet sweat.

I bought some blister pads at CVS.  I was skeptical, but they’re supposed to be waterproof, and they seemed pretty sticky.  Yesterday morning, I put one on each heel before going for a one mile walk with Deb.  They stayed on for a short walk, so I was cautiously optimistic they might stay on through my long walk.  If they did, it would give me an extra layer to protect the skin underneath from friction.

After my walk, I took off my socks, and the pads weren’t there anymore.  They were sticking to the inside of my socks.  I’m not sure how long they stayed in place.

The latest thing I’ve tried is to lubricate my heels.  Some people apply Vaseline to areas that are prone to blistering.  I decided to use Aquaphor.  It’s designed as an ointment to sooth dry or irritated skin, but I use it like Vaseline to prevent chafing.  I’m applying it to each heel before putting my socks on.  So far, I’ve used it for two short walks on the treadmill.  I was able to walk fast, but I’m still altering my stride to minimize pressure on my heels.  I’ll use it again for my long walk tomorrow.

If I can keep from making the blisters worse, maybe they’ll eventually heal.  If I can’t, I’m going to have a hard time walking my summer marathons within the time limits.  Ideally, I should take a break to let my feet heal, but now isn’t a good time.

1 comment:

  1. Hey David, I have enjoyed reading your blog and hope you are able to get back to running soon.

    As a ~seven hour marathon walker, I understand blister pain. I use Superfeet Green inserts, and have had blister issues on my heel at the intersection of the insert and the shoe.

    A product which helped reduce the severity of my blisters were slick patches, applied to the shoe, which smooth the junction of the insert and the shoe --> To my way of thinking they are a little pricy, but I have found them to be very beneficial.