[[File:Blisters at Umstead 100.jpg|right|thumb|350px|I worked the aid station overnight at the Umstead 100, helping people with blisters. Here you can see me fixing up my friend Charles on his way to his first 100 mile finish. (Thanks to Laura for the picture).]]
When and how should you pop a blister? And how can you speed up the healing? The only reason to pop a blister is to prevent it spreading, otherwise leave it alone. Naturally, it's better to [[Blister Prevention|prevent the blister]] in the first place.
{{DISPLAYTITLE:Should you pop a blister? How can you speed up healing?}}
=Don't Pop the Blister=
The '''only''' reason to pop a blister is when pressure will cause the blister to spread; if the blister is not going to spread due to pressure, leave it alone. A wound heals faster in a moist environment than when dried out<ref name="FieldKerstein1994"/>. Likewise, popping a blister is a bad idea as a blister will heal faster and better when left intact. The idea of 'drying out' a wound is dated and wrong. Drying out a wound or bursting a blister can also increase the scar tissue that is left behind. The fluid inside a blister creates a good healing environment, far better than any dressing. The biggest problem with popping a blister is it introduces the possibility of infection. To make matters worse, a popped blister may refill with fluid, which is the worst of both worlds. Typically popping a blister will also make things more painful, so don't pop to reduce your discomfort. The fluid acts as a cushion to protect the raw flesh under the blister, so once the blister is popped, the two surfaces will then rub.
==Moleskin Doughnut==
The alternative to popping a blister due to pressure is to build up the area around the blister so that the pressure is relieved. Moleskin can be cut out in the shape of the blister, forming a doughnut shape that reduces pressure on the blister if it is small enough.
==Taping Blisters==
Putting tape over a blister on your foot can help reduce the pain. Care must be taken to ensure the tape does not peel up, causing further blistering. See [[Taping]] for more details.
If you get [[File:Blister - FInished.jpg|none|thumb|200px|An example of a taped blister, should you pop it? This is a question of finding the least bad option, as there is no ideal solution, other than preventing the blister in the first place (using Kineso-Tex and Micropore. See [[Blister PreventionTaping]])for a step by step guide.]] Popping =How to Pop a Blister=If you have to pop a blister , your biggest risk is a bad idea because it introduces the possibility of from infection. A popped blister may well refill, which is Bursting the worst of both worlds. Popping a blister may not reduce the discomfort in the way you expectwill impair healing, and can but an infection will obviously make it things far worse. The fluid can act as a cushion Follow these steps...* Clean your hands to protect make sure they are sterile. * Sterilize the raw flesh under the blisterarea first by wiping with an antiseptic wipe. Once Make sure you wipe the whole blister is popped, and the two surfaces will then rubsurrounding area. I * Ideally you should have also found that leaving the blister intact improves healing time. The only reason I would pop a blister is when pressure will cause sterile tool to burst the blister to spread. If you have to pop are using scissors, or anything else that is not in a blistersterile package, you should must sterilize the area firstit. I use hypodermic needles for bursting blisters as they are very sharp and quite long. (One caution: hypodermic needles can be considered 'drug paraphernalia' if you don't have a good medial reason for having them. ) * Puncture the blister at the edge, ideally at the edge that will be lowest most of the time so that gravity aids drainage. I use hypodermic needles for bursting blisters as they are very sharp. Multiple punctures may be needed to provide sufficient drainage. * Use a sterile dressing to push out the fluid, taking time to ensure you remove as much as possible. You can use an antiseptic wipe for this, but getting any of the antiseptic into the blister can be quite painful. * Cover the blister with a sterile dressing; I have found . An occlusive (waterproof) dressing will improve healing and reduce the chance of infection<ref name="Eaglstein-2001"/>.** Ideally, use a 'hydrocolloid' dressing, such as [http://go.fellrnr.com?id=35454X937677&xs=1&xcust=band&url=http%3A%2F%2Fwww.amazon.com%2FBand-Aid-Adhesive-Bandages-Multi-Day-Protection%2Fdp%2FB000Y8W50G Band-aid blister cushions work well for meAdvanced Healing Blister Cushions]. A hydrocolloid dressing is one that is water and air tight, with a gel that absorbs fluids. This can keep the wound moist without becoming saturated (macerated). ** You may need an adhesive promoter such as tincture of benzoin to help keep things in place. Be careful with tincture of benzoin. : If you put it near the punctures in the blister it can seep inside and be quite remarkably painful. Also, putting tincture of benzoin **Putting an adhesive promoter on the blister itself will mean that the blister and the dressing are bonded. When you then try to remove the dressing, making it will take the dressing harder to removeskin of the blister with it. If possible apply tincture of benzoin only to the surrounding skin. ** Putting a small amount of antibiotic ointment on the blister itself will help reduce the chance of infection. It will also stop the dressing sticking to the dead skin, but care must be taken to avoid spreading the ointment and preventing the dressing sticking. * If possible, leave the blister alone. Do not change the dressing unless it starts to come off or leaks. You can leave the blister covered for up to a week.* Do not let the blister dry out, but keep it moist to improve healing. =Other Techniques=There are two techniques I will mention, but would not recommend and have never tried. One is to thread * Threading a strand of cotton through a blister so that will make it continues more likely to continue to drain. I feel that However, this increases will also increase the risk of infection significantly, reducing the number of bacteria need to cause an infection by 10,000x<ref name="ELEK-1956"/>. The other technique is to inject * Injecting tincture of benzoin into the blister after it is emptied, which glues the detached skin to the underlying flesh. I hear that this Alternatively the blister can be cut open to apply the tincture of benzoin. This was a common practice in the US army in the 1980s, and while effective in the short term it caused issues with fissures and some cases of infection, and the practice has been abandoned<ref name="PersonalEmail"/>. The pain from the tincture of benzoin is amazingly painful intense, and I am the overall pain of the blister is not sure necessarily lessened, but it may allow continued movement. A similar practice is to use superglue. =Speeding up healing=There are several ways of speeding up the risks in doing thishealing process. ==Apply Heat==The alternative to popping Keeping the blister warm improves blood flow and healing. You can use a heating blanket like a blister due to pressure [[Theratherm]], but this requires power and is to build up inconvenient. Instead, using chemical hand warmers will keep the blister area around warm for hours. I like to use the blister larger sized 'hot hands' warmers which keep warm for over 12 hours so I can replace them twice a day. I've found the hand warmers will not get too hot but be careful as a burn will obviously not speed up healing! For foot blisters, placing the warmer inside a thick hiking sock works well. [[File:Hot Hands.jpg|none|thumb|150px|Chemical Hand Warmer.]]==Continuous Protein Intake==I have found that keeping a steady intake of [[Protein|protein]] speeds up the healing process. It's particularly important to take some protein before bed time, as a lot of healing occurs while you [[Zeo Sleep Monitor|sleep]]. If the body does not have a supply of protein available, it can't make repairs. Check out [[GOMAD Grazing]] for my approach to continuous protein intake.==Omega-3==''Main article: [[Omega 3]]'' Omega-3 oils are important for wound healing<ref name="GuoDiPietro2010"/>. I take both [http://go.fellrnr.com?id=35454X937677&xs=1&xcust=flax&url=http%3A%2F%2Fwww.amazon.com%2FNatures-Way-Super-Lignan-Ounce%2Fdp%2FB000F4WR16 Flax Seed Oil] and [http://go.fellrnr.com?id=35454X937677&xs=1&xcust=swirl&url=http%3A%2F%2Fwww.amazon.com%2FBarleans-Organic-Oils-16-Ounce-Bottle%2Fdp%2FB002VLZ8BW Fish Oil]. I blend the pressure Flax Seed Oil into a protein shake, but the fish oil I take tastes great on it's own. ==Calorie Intake==It's important to keep your calorie intake adequate. If you are dieting, then your body will slow down the healing process to conserve energy. ==Avoid NSAIDs==''Main article: [[NSAIDs and Running]]'' Ibuprofen, and possibly other NSAIDs, impair wound healing and should be avoided<ref name="StadelmannDigenis1998"/><ref name="GuoDiPietro2010"/>. (Tobacco usage also causes wound healing problems<ref name="StadelmannDigenis1998"/>.)==Take Vitamins==A number of vitamins and minerals are needed for wound healing, including<ref name="StadelmannDigenis1998"/>:* Vitamin C * Iron* Vitamin A* Zinc* Copper* CalciumOf these, Vitamin C is relievedarguably the most critical for wound healing. Moleskin can In addition, Vitamin E may improve the strength of the wound and deficiencies in B vitamins may impair the immune system. Getting these nutrients from wholesome foods is ideal, but supplementation may be cut out appropriate. ==Reduce Stress==Studies have shown that stress will delay wound healing<ref name="GuoDiPietro2010"/> so reduce stress if possible. ==Bioelectric Wound Dressings==There are some studies that have shown that a Bioelectric wound dressing improves healing<ref name="JAAD-2009"/>, with one study showing a 36% improvement in healing time compared with a semi-occlusive dressing<ref name="BlountFoster2010"/>. These Bioelectric wound dressings are not externally powered, but use embedded 'microcell batteries'. One provider is http://www.procellera.com/, but the dressings are not readily available and are expensive. (The use of electrical stimulation for healing wounds that do not respond to other treatments has been shown effective and is medically approved<ref name="Kloth-2005"/>, but that is outside of the shape scope of this article.)=Blister Color=The contents of the blisteris normally a yellowish clear liquid, blood or pus<ref name="Fitzpatrick"/>. The clear, forming a doughnut shape yellowish fluid is called serous and is similar to blood plasma. The difference between serous and blood is that the latter means that reduces pressure on some capillaries are damaged under the blister. The presence or absence of blood does not appear to be medically significant. If the blister if it is small enoughfilled with pus, this may indicate an infection, but this is not always the case. =References=<references><ref name="Kloth-2005"> LC. Kloth, Electrical stimulation for wound healing: a review of evidence from in vitro studies, animal experiments, and clinical trials., Int J Low Extrem Wounds, volume 4, issue 1, pages 23-44, Mar 2005, doi [http://dx.doi.org/10.1177/1534734605275733 10.1177/1534734605275733], PMID [http://www.ncbi.nlm.nih.gov/pubmed/15860450 15860450]</ref><ref name="JAAD-2009">Assessment of the effects on wound healing and gene expression of a bioelectric dressing using a porcine wound model and real time reverse transcriptase-polymerase chain reaction, Journal of the American Academy of Dermatology, volume 60, issue 3, 2009, pages AB200, ISSN [http://www.worldcat.org/issn/01909622 01909622], doi [http://dx.doi.org/10.1016/j.jaad.2008.11.868 10.1016/j.jaad.2008.11.868]</ref><ref name="BlountFoster2010">Andrew Blount, Sarah Foster, Richard Wilcox, Use of Bioelectric Dressings for Faster Wound Healing: A Prospective Case Series, Plastic and Reconstructive Surgery, volume 126, 2010, pages 97, ISSN [http://www.worldcat.org/issn/0032-1052 0032-1052], doi [http://dx.doi.org/10.1097/01.prs.0000388820.96542.6e 10.1097/01.prs.0000388820.96542.6e]</ref> <ref name="Eaglstein-2001"> WH. Eaglstein, Moist wound healing with occlusive dressings: a clinical focus., Dermatol Surg, volume 27, issue 2, pages 175-81, Feb 2001, PMID [http://www.ncbi.nlm.nih.gov/pubmed/11207694 11207694]</ref><ref name="FieldKerstein1994">Charles K. Field, Morris D. Kerstein, Overview of wound healing in a moist environment, The best place for blister care supplies I found is American Journal of Surgery, volume 167, issue 1, 1994, pages S2āS6, ISSN [http://www.worldcat.org/issn/00029610 00029610], doi [http://zombierunnerdx.doi.org/10.com1016/0002-9610(94)90002-7 10.1016/0002-9610(94)90002-7]</ref><ref name="StadelmannDigenis1998" target>Wayne K. Stadelmann, Alexander G. Digenis, Gordon R. Tobin, Impediments to wound healing, The American Journal of Surgery, volume 176, issue 2, 1998, pages 39Sā47S, ISSN [http://www.worldcat.org/issn/00029610 00029610], doi [http://dx.doi.org/10.1016/S0002-9610(98)00184-6 10.1016/S0002-9610(98)00184-6]</ref><ref name="_blank zombierunnerGuoDiPietro2010">S.comGuo, L. A. DiPietro, Factors Affecting Wound Healing, Journal of Dental Research, volume 89, issue 3, 2010, pages 219ā229, ISSN [http://www.worldcat.org/issn/0022-0345 0022-0345], doi [http://dx.doi.org/10.1177/0022034509359125 10.1177/0022034509359125]</ref><ref name="ELEK-1956"> SD. I would also recommend ELEK, Experimental staphylococcal infections in the book skin of man., Ann N Y Acad Sci, volume 65, issue 3, pages 85-90, Aug 1956, PMID [http://www.ncbi.nlm.nih.gov/pubmed/13363202 13363202]</ref><ref name="PersonalEmail"> Personal email communication with Army medic.</ref><ref name="Fitzpatrick">Fitzpatrick'fixing your feet' by John Vonhof.s Dermatology in General Medicine, ISBN 0071669043</ref></references>
