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First-Aid Treatment for Friction Blisters: “Walking Into the Right Direction?”

Lando Janssen, Nenltje A.E. Allard, Dominique S.M. ten Haaf, Cees P.P. van Romburgh, Thijs M.H. Eijsvogels, Maria T.E. Hopman. Clinical Journal of Sports Medicine, Vol 28, No. 1, January 2018.

Trauma-induced separation within the epidermis, or friction blisters, are frequently encountered by patients choosing to be physically active to improve their overall health and well-being. Although most blisters are benign entities, complications including antalgic gait patterns, exercise-related or overuse injuries, cellulitis or sepsis can result. Thus, from the primary care physician’s perspective, the goal of treatment remains to reduce pain, facilitate healing and prevent both infection and recurrence.

However, much of the advice provided to patients regarding this topic is not evidence-based. To date, very limited research has been conducted to examine different treatment regimens for friction blisters. Furthermore, each study on this topic is limited to studying a homogenous population (elite athletes, military personnel). The purpose of this study was to compare the efficacy of fixation dressing versus adhesive tape in the first-aid treatment of friction blisters. These 2 methods were evaluated based on 1) Time of treatment application, 2) effectiveness, 3) material satisfaction in a large group of participants of the Nijmegen Four Days Marches (4DM). In addition, this study included a 1 month follow-up period to evaluate blister healing and complications when comparing treatments with different blister-covering materials.

The major findings of this prospective observational cohort study were:

  • Time of treatment application was significantly lower in the wide area fixation dressing group (41.5min, SD = 21.6min) compared to the adhesive tape group (43.4min; SD = 25.5min; P = 0.02).
  • A significantly higher drop-out rate in the 4DM was observed in the fixation dressing group as compared with the adhesive tape group (11.7% vs. 4.0%, respectively, P = 0.048)
  • There was no difference in pain intensity scores, infection rates, and the need for additional medical treatments. However, there was delayed blister healing in fixation dressing group (51.9% vs. 35.3%; P = 0.02) and a trend towards decreased satisfaction (P = 0.054) when compared to the adhesive tape group.

The authors conclude that despite a small, but significant reduction in the time of treatment application with wide area fixation dressings, these dressings resulted in delayed blister healing, a trend towards lower satisfaction, and a higher drop-out rate of in the 4DM. For these reasons, they do not recommend the use of wide-area fixation dressings in routine first-aid treatment for friction blisters and rather support the use of adhesive tape for this purpose.

Sean Mindra, MD, CCFP                                                                                                                  PGY3 – Sport and Exercise Medicine, University of Ottawa                                                      Advisor: Dr. Taryn Taylor BKin, MSc, MD, CCFP (SEM), Dip Sport & Exercise Medicine

 

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