😟The 4 Key Challenges to the Advancement of Friction Blister Management | Blister Prevention

😟The 4 Key Challenges to the Advancement of Friction Blister Management😟 ➡ A monthly Q&A hosted by podiatrist Rebecca Rushton (the BlisterPod) for Podiatrists, Physios, Athletic Trainers, Wilderness Medics, Race Medics and Event Directors, Educators, Footwear Designers, Footwear Retailers, Pharmacists and anyone who deals with foot blisters and their prevention in a professional capacity ⬅

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Foot friction blisters are one of the most misunderstood foot and sports medicine issues. They’re not superficial wear injuries or burns—they’re intraepidermal tears caused by repetitive shear deformation. This difference isn’t just academic—it’s critical for both prevention and treatment.

Unfortunately, decades of misconceptions, confusing terminology, and a patchy evidence base continue to limit progress in blister care. In this presentation, we dig deep into The 4 Key Challenges to Advancing Friction Blister Management and how we can overcome them.

Here’s what we cover:
1️⃣ The Word “Friction”
The single most problematic term in blister science. In everyday use, friction means “rubbing.” In science, it means “resistance to rubbing.” This double meaning fuels myths—like blisters being caused by rubbing, heat, or wear—and keeps ineffective strategies like calluses and generic taping in circulation.

2️⃣ Misconceptions in Academic Literature
We’ve known since the 1950s (thanks to Naylor, Salsburg, Kamese, and later Comaish) that blisters are caused by repetitive shear deformation. Yet recent academic papers still describe them as abrasions from rubbing. In some ways, our understanding has gone backwards since the 1990s.

3️⃣ Inability to Measure Shear
Shear—the real cause—can’t yet be measured at specific anatomical locations the way pressure can. This limits research precision and the development of targeted solutions.

4️⃣ Limited Evidence Base
We do have solid support for a few strategies, like familiarity with footwear and activity, densely padded acrylic socks, and 3mm neoprene insoles. But others—antiperspirants, powders, paper tape, double socks—show mixed results, and popular options like lubricants, many tapes, and even optimised shoe fit haven’t been rigorously tested.

💡 Moving Beyond Heat, Moisture, and Friction
I share a prevention framework built around understanding shear: what it is, why it happens, and how to reduce it. We cover methods to reduce the number of shear repetitions, increase skin resilience, and reduce shear magnitude—whether through influencing bone movement, spreading load, absorbing shear, or adjusting friction force.

➡️ Real-World Case Applications
You’ll see how this framework applies to common problems, from blisters under the first MPJ with a plantarflexed first ray, to recurring blisters in children’s soccer boots, to ultramarathon toenail blisters caused by toe impact or digital clawing. Each case is unpacked with practical, evidence-informed solutions you can try.

🎓 Want to go deeper?
Blister Prevention University, developed with Doug Richie, is a resource for health professionals that provides a detailed look at prevention strategies, their mechanisms, and how to apply them to specific foot locations. With better understanding and targeted solutions, we can move past the myths and move blister management forward.
👉 https://lp.blister-prevention.com/bli...
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