Blisters at the back of the heel are the most common type of heel blister, by far. While there are two other types of heel blister (blisters under the heel and heel edge blisters) in this article, we’ll concentrate on back-of-heel blisters exclusively. You’ll learn how and why these are the 5 most effective prevention strategies, from lacing and taping to padding and patches.
Posterior heel blisters are more common in walking and hiking compared to running, and can be just plain debilitating. This email from Marcus (several years ago now) describes the struggle perfectly:
We completed the Overland Track around 10 days ago and I have been meaning to report back to you. In 30 years of bushwalking in Tasmania I have never completed a walk of any distance without some kind of heel blister – on this trip I survived 6 days and 70 kilometres of walking carrying a 25 kilo pack without ANY blister of ANY kind… The upshot of all of this is that I was able to enjoy the walk and that my wife and children were along for the trip with me. Under normal circumstances I would have been in quite serious discomfort after day three and basically become totally self-absorbed for the last 3 days enduring the pain.
Deroofed heel blisters
Heel blister anatomy and biomechanics
The heel bone (calcaneus) is pulled upwards by tension in the Achilles tendon when we walk, specifically, at heel lift. Then it moves down again at heel strike. This biomechanical function is normal and necessary. However, sometimes this can happen to excess. If the calf muscles are tight, extra tension in the tendon causes the calcaneus to lift sooner and higher. And with more force!
Back-of-heel blisters have a lot to do with high friction levels
The internal lining material of a shoe exhibits a relatively high friction level. So do socks. This is necessary to provide traction for the foot within the shoe. In other words, it’s a good and normal thing. But for some of us, this “normal” high friction can quickly lead to blister-causing levels of skin shear.
Heel blister research
Experimental Blister Studies: Time-To-Blister
In 2013, a team at the University of Salford produced blisters on the back of the heels of 30 people under very controlled conditions to measure temperature changes in the skin. Putting the temperature changes to the side – if you’ve ever wondered why you get heel blisters pretty easily while your friends don’t, the results give you an idea why. One participant blistered after 4 minutes while the last one to blister took 32 minutes! This gives great insight into how some of us blister much easier than others.
The same researchers also mentioned something interesting about the amount of heel movement in the shoe. A pilot study, previous to the 2013 research, used slow motion high speed video analysis to determine a 15mm displacement of the heel relative to the back of a shoe at heel strike. So, the heel moves downwards relative to the back of the shoe by around 15mm with each heel strike. And then moves up again during the remainder of the gait cycle. That’s a lot!
The 5 best heel blister healing and prevention strategies
Be sure to read all the way to the end. Some of these work better than others. Remember, you’re not limited to picking just one strategy. You could conceivably do all of these at the same time. In the past, I’ve done all of these at the same time while treating a heel blister. Nowadays, I only need one of these to remain blister-free – the last one!
You can reduce excessive tension in the Achilles tendon by stretching your calf muscles. This is almost always overlooked! Just like the famous shampoo ad says, “it won’t happen overnight, but it will happen”. So start now and benefit in the coming weeks from this strategy. I recommend to hold each stretch for at least 30 seconds and do it at least 3 times each day for 8 weeks. Technique is everything with this stretch, so ideally, see a podiatrist of physio for advice.
Spread shear load
A lot of people find taping to be all they need to stop heel blisters. I wished I was that lucky. While I always found that layer of tape saved me from the red raw deroofed blisters on the back of my heels (a big relief!), it didn’t always stop me from getting blisters. Here’s why. If you haven’t already and you’ve got some tape handy, give this a go. I’ve used Fixomull Stretch in this video but you can use any tape like paper tape, RockTape, Leukoplast or moleskin (moleskin is just a thick tape, in my book).
4) Donut pads
Cutting a hole in a piece of thick orthopedic felt (or thinner moleskin pictured below) creates what is affectionately known as a donut pad. Place it to the back of your heel so the blister is smack-bang in the middle of the cavity to reduce pressure and rubbing. A word of warning though: while a donut pad makes intuitive sense and can help blisters in lots of areas of your foot, I never found it gave enough relief to my poor heels. But in a pinch, I would certainly try it. Rather than moleskin, use podiatry felt which is much thicker, and Fixomull Stretch over the top. I’ve popped a video below so you can see how to make a donut pad from felt (albeit for the ball of the foot in the video).
5) Engo Blister Patches
Reduce friction levels
ENGO Blister Patches are the best form of heel protection I’ve found for even the worst heel blisters. In other words, if you just did one thing, this would be the one to do.
They will give you IMMEDIATE and SIGNIFICANT relief if you already have a blister.
And they will all but ENSURE complete blister prevention.
ENGO Blister Patches work by reducing friction levels at the back of the shoe. It may sound counter-intuitive, but they encourage a little rubbing at the back of your heel. But it’s a LOW FRICTION RUB instead of a HIGH FRICTION RUB and that makes all the difference to saving your skin. This way, your sock protects your skin rather than rubs against it, because your skin and sock remain in stationary contact. In the meantime, the little bit of low friction movement happens between your shoe and your sock. This saves your skin from the blister-causing trauma.
Like Marcus (at the top of this article), I think they’re heel blister prevention gold! These are the ones you’ll need – you get two patches in the ENGO Heel Pack. They’re shaped like a heel grip. Watch the video below to see how to apply them.
What’s next for your blistered heels?
Take your pick from the 5 strategies discussed. If you want my advice, the most effective preventative strategy for even the worst heel blisters is the ENGO Blister Patches, even if you have a Haglunds deformity. They’re the things that’ll keep you blister-free day in day out, without having to pad or tape all the time. The other strategies will help for sure, but the ENGO patches are best.
Hashmi, F, Richards, BS, Forghany, S, Hatton, AL and Nester, CJ. 2013. The Formation of Friction Blisters on the Foot: The Development of a Laboratory-Based Blister Creation Model. Skin Research and Technology. 19: e479-e489.