As explained in previous articles, friction blisters on the feet are quite predictable. Not only is it easy to identify the people with either current or imminent blister issues, it’s also easy to tell exactly where they’ll get blisters.
The problem is, we tend ignore the signs and belittle the injury.
Podiatrists possess all the skills to get their patients blister-free and keep them blister-free. But due to widespread longstanding misconceptions, we lack some understanding, and that makes us come at blisters from the wrong angle. We implement preventions (actually, usually just the one – taping) that don’t address the true cause of blisters in the best way possible. And so, when those interventions don’t work quite as well as anticipated, and we’re at a loss to explain why, we lose a bit of confidence. Sure, we can give a bit of general advice during the follow up consultation that gets us off the hook in that moment. And then hope those patients don’t come back if they continued to have trouble – I’m certainly guilty of this in years gone by. Is it any wonder our patients stop asking for help? We’ve just created our own Catch-22: no demand and the illusion of no problem to fix.
Sweeping It Under The Carpet
Unsurprisingly, this all leads to a semi-sweeping-under-the-carpet of the blister pathology. More surprisingly, our patients allow us to get away with this. But that doesn’t mean it’s acceptable. Especially for those patients that need it most, like:
- blister-prone patients
- patients who take part in competitive sport or endurance activities
- and those who can never truly achieve perfect shoe fit due to structural deformity
These patients come to accept blisters as inevitable.
The Good News Is, This Is Easy To Change
With a better understanding of blister causation, how preventions work and how to apply them to specific anatomical locations (you can learn this all in Blister Prevention University), effective and efficient blister education and management is all but guaranteed. After that, all that’s needed is a change of mindset – a conscious decision to stop ignoring the signs and start applying our skills.
Podiatrist Pete – Your Average Podiatrist
Podiatrist Pete works 5 days a week and sees 10 patients per day (a conservative estimation – I see about 14 patients per day).
With his new-found knowledge and understanding of blisters, instead of ignoring the signs, Pete decides to get the “blister conversation” started with 1 patient per day. Not just one random patient per day – he’s having this conversation with one relevant patient per day. Because he’s picking up on the signs and clues instead of ignoring them, out of habit and a lack of confidence in his ability to truly help.
From these 5 patients per week, patients that he’s already seeing, he advises on the best blister products for each anatomical location. These are products he already stocks or can provide, like:
- The gel toe protectors he sells for corns, callouses and “rubbing” – because he now sees how effective these gels are at absorbing blister-causing shear deformation.
- Or perhaps it’s custom-made (or off-the-shelf) toeprops to prevent toenail blisters – because the toes clawing is the far more common cause than the toes hitting the end of the shoe.
- Or ENGO Patches for posterior heel blisters or edge blisters – to reduce friction levels day in, day out.
- Or a replacement Spenco insole – because the proprietary insole is far too flimsy.
- Or heel lifts – you know, it’s not just posterior heel blisters they can be good for.
- Or maybe it’s a couple of hydrocolloids instead of simple bandaids or tape on his patient’s deroofed blisters
Not only that, now he understands the role of bone movement to blister formation, he gets one or two of these patients back to look further at the biomechanics behind their blisters. They might need a quick adjustment to their orthoses, a repress, new orthoses, a prefab for a certain shoe, or a Spenco recover.
One of these five patients might need some adjunct therapies like mobilisations or dry needling, let’s say for limited ankle joint dorsiflexion contributing to plantar forefoot blisters – because again, he recognises the role of bone movement and biomechanics to his patients’ blisters.
So, with very little effort or change to his day-to-day, with the patients he already had booked in, podiatrist Pete is now helping his current patients more, with skills he already has and products he already offers.
I’ll let you do the maths to see what this means for his bank balance.
All this took was a change in mindset – a conscious decision to have a quick blister conversation with one patient per day.
But podiatrist Pete wants to go further because he can see this is a common problem and an easy one to fix. So he implements the business building aspects of Blister Prevention Business. These resources result in his current patients asking him about blisters without any prompting. New patients start booking in specifically for help with blisters. And word starts getting around that his practice can really help beat blisters. People are dropping in to pick up blister supplies. And patients are referring friends and family, like:
- Their sister who got a nasty blister with a new pair of shoes last week
- Their mother who always seem to have damaged skin from her shoes “rubbing”
- Their son who’s got blistered heels from his soccer boots
- Their friend who suffered with blisters during last year’s fun run
- Their colleague who has diabetes and needs to walk every day to keep his blood sugar levels down and can’t afford to get blisters
- Their golfing partner who’s always complaining and limping around the golf course
- Their best friends who are leaving for a European sightseeing holiday in a few months
Pete gets so confident in his ability to help people with this often-overlooked foot problem, he accepts an invitation to talk to his local football team, netball association, walking club or army reserves. He offers to run an education session for this year’s Oxfam Trailwalker event participants to minimise the negative impact of blisters. Or he presents to a group of runners at his local sports shoe retailer who are training for their first half-marathon. (All of these presentations are available and ready for Pete’s unlimited use in Blister Prevention Business).
So, as you can imagine, Pete gets a flood of patients wanting their very own blister plan, and more people are popping in for supplies, and the word spreads further.
Before he knows it, Pete isn’t talking blisters to one patient per day – it’s 2 or 3 or 4 patients per day. And so are the other podiatrists in his practice.
I’ll let you do the maths on that!
Win – Win – Win
As a podiatrist, there are no downsides to being able to give better blister advice to your patients, helping prevent them, and providing meaningful pain relief to allow them to comfortably return to play.
- You’re better at your job – win!
- Your patients are happier and healthier – win!
- And so is your bank balance – win!
Be like podiatrist Pete. From the “rubbing” your patient has become all too accustomed to, to the painful plantar forefoot blisters your netballer never really gets on top of, use the skills you already possess to nail the problem.
Blisters are the most common injury in sport, and a very common problem in everyday life. A problem we can tend to minimise and ignore. A problem most of our patients aren’t telling us about, because they think they are inevitable, they think there’s nothing we can do (that they can’t do themselves), and they’re dealing with them on their own behind closed doors.
Did You Do The Maths?
Getting better at advising on, preventing and treating this common foot problem is not just worth it from a “helping your patients” standpoint, it’s worth it from a financial standpoint. Below are the resources you can use to become more knowledgeable and confident in helping your patients with blisters; and maximise the revenue potential for your practice.
There are several misconceptions about friction blisters. They pervade not just the mainstream reteric, but a concerning amount of the academic literature too. These misconceptions are intuitive and entrenched, and this perpetuates the situation.
Podiatrists have ALL the skills to dominate this problem. But we lack a little bit of understanding that will help us apply those skills appropriately. The science is not new, and it’s very clear, if you can separate the fact from fiction, which is what we’ve done in the resources below: