Wednesday, July 23, 2014


Richard Speights has an article for instruction on blister and foot care called "Blisters, Treatment and Prevention".   Within that article, he has offered a piece of  dangerous advice that will be discussed within this article near the end.    Due to some of the misinformation contained in his article,  I have decided to present the proper information.

"You do not really understand something unless you can explain it to your grandmother.”

        --- Albert Einstein                


Blisters are injuries in which a fluid filled bubble occurs.  The major causes of blisters include:









This article will focus on those blisters related to the  friction injury.  


Friction blisters are caused from a burn
This is not quite correct.  Studies show that due to friction,  there is only a slight increase in temperature.  There are stronger factors at play.  

Friction is breakdown from rubbing.
Not true.  Friction is not "breakdown".  The action is related to more of a shearing action.   As underlying tissue under the top layer of skin moves one way,  friction "grabs" onto the top layer of skin and prevents it from moving.  This causes the tissue between the layers of skin to stretch and tear apart from each other.

Cotton socks are appropriate for friction reduction

No.  Cotton socks are the WORST if used alone.  Cotton is a water-attracting substance (hydrophilic).   It traps in moisture and holds it against the skin.  Moisture increases friction levels - more friction,  more likely to blister.

Lubricants are the best way to stop friction
The use of lubricants will initially stop friction ---- then the friction increases.

Powder stops friction
BUT,  it is only for a short time.  As the powder absorbs the moisture,  it starts to clump.  In fact,  research has shown that US army servicemen who used powder ended up with MORE blisters: 

Pathophysiology of a Blister

As stated previously,  it is not the rubbing and 'breakdown' of skin from heat that causes blister formation. It is related to shearing of the skin and inflammation.

 Skin is made up of multiple layers that are connected together.  The friction "grabs" a portion of that top layer and prevents it from moving with the layers underneath.  The underlying skin moves in one direction,  while the top layer remains in place. This mechanical action separates the upper layer of the skin from the lower layer.   This separation,  or tear,  results in an open space.  Pressure in the body causes the fluid from  surrounding tissues to be pushed into the open area.    This collection of fluid, mainly plasma,  pushes the thinner top layer of skin out and the blister bubble forms.

This separation occurs at the level of the epidermis,  not the dermis as some claim.   The skin is made up of three main layers:
Epidermis (top layer)
Dermis (middle layer)
Hypodermis (bottom layer)

The Epidermis is composed of four to five layers:
Stratum corneum
Stratum lucideum (only in palms and soles)
Stratum granulosum
Stratum spinosa
Stratum basal

In a blister formation,  the skin at the level of the stratum granulosum is separated from the underlying layer.

It is not so simple as  "Fiction generates heat and heat breaks down the skin tissue, forming a blister."    In fact, that statement in blister formation is incorrect.  It demonstrates a lack of understanding as to the pathophysiology of blister formation.

 Blister formation occurs within the first layer of skin, not the second.    That fact makes statements such as "This heat, along with the abuse breaks down the tissue in the dermis, the second layer of skin" incorrect.  

It's very important that a person educating others on medical treatment understand the pathophysiology of the injury.   It's clear when  a person claims a blister occurs within the dermis they do not understand the process.


"True ignorance is not the absence of knowledge,  but the failure to acquire it"
--- Karl Popper

"Everyone you will ever met knows something you don't"
 --- Bill Nye                               
 Accurate research is the most important task to accomplish in writing an article on instruction.  It helps to prevent against relaying harmful information.   One person cannot know it all,  thus making them need to rely on others for factual information via research.  That research should be supported by links, and is what I  try to do.  But even so,  I remain open to the possibility that I could be wrong, and that is why I encourage people to present links if they want to claim I am.   I have not received those links related to medical fact to disprove what I have stated ---  only wild speculations and ad hominem arguments about grammar use.  Once again,  I encourage readers to please speak up, point out where I am incorrect,  provide a link to support it, and I shall happily address it.  

Medicine is always changing and keeping up with those changes via education, and research is pertinent for good and correct client care.   That is why educated medical professionals must renew their license at routine intervals after obtaining additional approved educational hours.  Something learned around 30 years ago and not practiced as a profession is not appropriate to do in the modern age.  In fact,  it can be downright dangerous.  

Some examples of those older medical beliefs once thought "safe"
Multiple miracle cures of the 1900's that ended up being made up of almost entirely morphine ...........

Heroin was once believed a safe treatment for coughing.......

The lobotomies of the 1940's as a "cure-all" for mental disease .................

Putting butter on a burn

Sticking an object in the mouth of a seizing person

Using powder for blister prevention

Using antibiotics in the lack of proven infection

At the time of their use in practice,  all of these examples were once thought to be in the best interest of the client.  However,  further research  proved otherwise.   Medicine will always be a forever changing practice,  and those who practice it know that fact.  One  cannot rely on old outdated medical information from the past when current research says it is no longer safe.

The same holds true for blister care and prevention.  Relying on outdated medical advice learned many years ago without doing research into changes does not promote the best care and prevention for blisters. There has been little research over the past 30 years in the prevention and care of friction blisters.   In fact, research into the prevention and treatment of blisters is just recently becoming more common.  It is being discovered that much of the preventative suggestions produced many years ago  can INCREASE friction and blister formation.   That is why researching facts before instructing is so important.


"Little insight or research into the prevention or treatment of the most common foot injury in sport has been produced in the past 30 years. Physicians, coaches and athletic trainers continue to advocate the use of petrolatum jelly and skin powders to prevent blisters while the scientific literature suggests these measures may actually increase the chance of blistering on the feet."

Dr. Douglas Richie is a podiatrist and belongs to a world renown practice of podiatry medicine and surgery.  He has done extensive, current research into blister care and is considered to be an expert on the subject.

He advises against the following acts:

"  Applying drying powders to the feet has been a popular remedy for preventing friction blisters yet there is no evidence to support this notion"" None of the studies showed a protective benefit of foot powders and one study actually showed that foot powders increased the rate of blister formation.15 " "Laboratory studies have shown that talcum powder will reduce frictional force on the surface of the foot. However, when moisture combines with this powder, frictional force and abrasiveness actually increase.16 I have observed this commonly in runners when application of a powder eventually leads to a sticky mess on the foot after sweating begins."

" a landmark study by Nacht and colleagues showed these measures may actually increase blister formation.17"
 after one hour of rubbing the skin surface, the coefficient of friction returned to baseline and after three hours of rubbing, it actually rose by 30 percent. This may have been due to a hydrating effect on the skin surface as the lubricant was absorbed over time."



Dr. Richie states that the BEST blister prevention is to focus on footwear.  Whereas proper fitting and conditioned shoes or boots reduces the risk of blisters,  it is not enough for adequate  blister prevention.   Dr. Richie encourages the use of an insole to help reduce the shearing force of friction.   One such liner he recommends is a neoprene liner called Spenco.  He adds that neoprene absorbs much of the shear force and has been noted to reduce the incidence of blisters by 25%.

In addition to insoles,  Dr. Richie recommends that the use of a friction absorbing material be used on the shoe or  the boot,  not on the skin.  Using the appropriate product on the shoe or boot has two great benefits.  First,  it absorbs the force of friction so that the skin is no longer "grabbed" and held in place, which allows the layers of skin to move in unison.  Second,  the risk of the adhesive coming loose due to moisture coming from the surface it is attached to is greatly reduced.  One such product that is used on the shoe for friction reduction is called Shearban.  For further information as to the product,  please see :

Dr Richie also discusses the effect of proper sock usage.  He states, "My colleague Kirk Herring, DPM, and I were among the first to study the effects of sock fiber and sock construction on the frequency of friction blisters in running athletes. Both of our studies were blinded, randomized, prospective trials.21,2"    

Dr. Richie's research shows that it is a good acrylic sock,  not a cotton sock,  that best prevents blister formation.  Studies of military troops support the use of synthetic fiber as well.  The best outcome of sock use was when a synthetic nylon or polyester sock was used NEXT to the skin and a wool sock placed over the top.  One current common method used to reduce blisters in the army is the use knee high nylons next to the skin with a wool sock over it.  Now,  a man might feel pretty silly about wearing women's knee high nylons,  but most will change their mind after the agony of walking for long periods of time with a blister in their shoe.   If you try this,  make sure the wool sock is high quality for cushion and is seamless.

For those men out there that still say "no way" to the nylons, there are socks out on the market that are specifically designed for hiking.  They are more expensive but well worth the avoidance of  pain and infection from a blister,  which can dampen the pleasure of a hiking trip.  These hiking socks are NOT made from cotton.  Some are made from a synthetic fiber blend: 

Others are made from a wool blend:
  • Fabric: 41% new wool, 37% Nylon, 21% polypropylene, 1% Lycra ® or, 42% new wool, 40% Nylon, 17% polypropylene, 1% Lycra ® '

 Earlier,  proper fitting and conditioned boots were mentioned.  It is an important part of blister prevention to condition boots if going on a hike.  New boots promote blisters.

Breaking in your boots:

Make sure you buy them as early as possible -  best at least a month in advance

Purchase a high quality, well fitting boot from a knowledgeable vendor

Wear the boot for short periods each day - ie to mow the grass, taking the dog for a walk, etc.

 Each day,  gradually increase the time you wear the boots. - use the correct socks when doing so.

After each use,  gently bend the sole of the boot back and forth - GENTLY.

During this breaking in period,  pay attention to your feet after wearing the boots.  Look for any reddened areas on your feet and apply a layer of  material such as Shearban to the corresponding area on the inside of the boot.


Purchase a high quality, well-fitting boot well in advance to break it in

Apply a product such as shearban to the inside of the boot at pressure points

Use the appropriate sock
A hiking sock

Use the sock-liner method
A nylon covered by a  seamless wool sock with adequate cushioning

Keep your feet dry with frequent sock changes - let the socks dry out in the air

Use a friction reducing insole

Healthy feet prior to the trip (discussed later)


Tincture of Benzoin (TB) is a solution of 10-% benzoin  and  90-% alcohol.  Both benzoin and alcohol are antiseptic agents.  In the health care setting, Tincture of benzoin is used for the treatment of open skin areas such as scrapes, cracked skin, and small superficial ulcers.  In the army, it is has been used to treat blisters.

Some state to use tincture of benzoin on pressure points for blister prevention.  However, there is a lack of support in studies to indicate a benefit from applying the tincture of benzoin to pressure points on the skin.   There is also a lack of evidence that shows it causes more harm,  such as powders, lubricants, and the incorrect sock material can.

However,  considering the property of tincture of benzoin,  independent use without a pressure absorbing agent may point to a problem.  Benzoin is a sticky substance that adheres to surfaces.   Thus,  when placed on the skin and a sock rolled over the surface,  it pretty much "glues" the sock to the upper layer of skin.  Some people have even suggested gluing the entire sock to the foot.   Moisture will still seep into the sock from the foot sweating, which promotes a greater frictional force between the shoe and sock.  This friction "grabs" on to the sock and  permits it from moving in a free manner.  AND,  since the sock is glued to the top layer of the skin,  the top layer of the skin is held fast in place as well.  The underlying layer continues to move,  resulting in the mechanical separation of skin as discussed previously.  The cushion of the sock can help to  reduce friction,  but that cushion is present whether the sock is glued or not.

I would suggest to NOT glue your entire sock to your foot. And,  if you must use the tincture of benzoin at a pressure point,  use it only if you put a product such as Shearban on the shoe in the corresponding area.


Military men put a lot of wear and tear on their feet.  They wear boots for much of the day, are frequently on their feet, and the nature of the job puts a lot of stress on the feet.   Because of this,  they often get blisters.  An intact blister is a seal that keeps out infection, but due to the nature of the job of a military man,  a blister on the foot from a boot has a huge potential to burst if friction continues.   This situation poses a huge threat for infection.  Boots are not known for air movement. Thus, the foot tends to sweat a little more in the boot,  turning that boot into a warm moist, dark environment. The result is a perfect breeding ground for infection causing bacteria.

Because of this issue,  it had become a practice via many army medics to deliver what is called a "Hotshot"  to a blister.  The fluid from a blister is drained aseptically with a needle, and a small amount of tincture of benzoin is injected into the blister onto the wound base.  Due to the alcohol in the tincture,  the process hurts like hell.  However, the hurt is short lived.    The theory is that the tincture of benzoin works as an aseptic seal over the wound and helps to "glue" the top layer of skin to the wound base.  This two-layer system method was thought to reduce the chance any bacteria would be able to reach the nourishing tissues of open skin. Pain from an infected wound lasts a long longer than the short-lived burning pain of the tincture of benzoin when first applied.

I haven't heard of the "hot shot" before, but I understand the effects of tincture of benzoin and the process of infection, so the theory of the army's manner of use is understood to me.   The theory is based on the fact that an infection in a foot wound can put a man off his feet for an extended period and has the risk of  long term serious outcomes. Blisters can break easily with continued friction, and the nature of the job causes continued friction on the blister.   Once that blister has broken,  the skin is no longer intact, and the first line of defense no longer remains.  Hence, the thought sealing it would be best.

The army did practice putting tincture of benzoin in a blister.  However, I do not know all the risks of putting tincture of benzoin INSIDE an enclosed wound such as a blister.  I do know that tincture of benzoin has been recommended to be used on minor OPEN wounds:

 Based on the fact it works as both an antiseptic and a sealant, the army has used the "Hotshot" method.   Speights suggested that the use of tincture of benzoin in the army could very possibly be not a true occurrence.   I did some research on this procedure and found research beyond Wikipedia does show that it was used for such a thing.  There have been articles written linking the fact and soldier specific sites show soldiers citing it as well.  For example,  this comment by verified SOF member surgical cric SOF 
(BTW,  yes - I know I made a typo via missing the "H" in "while" and the "F"in "from"  -- the idea was to make it larger for those with poor eyes can read it - it's a snip and I didn't save it so can't change it). 

This article shows it was done at some time as well

Even though there is evidence of this practice in the military,  my advice to you is not going to be to do the "Hotshot" treatment for a blister.  There is a lack of research to support benefits verse risks,  so I say don't do it.  There are not any medical sites that cite research on the effectiveness of the "Hotshot".  It is quite obvious that it is a shortly lived pain from the procedure.   Beyond the pain as a risk factor,  there are too many other factors to consider and more research must be done prior to it being considered beneficial in relation to the pain.

The point of addressing that it existed in army use is  that with good research,  facts can be verified. Research of facts is extremely important when discussing medical pathophysiology and treatment  It's an easy task to take on, such as I have displayed with the fact the "hot shot" blister treatment did exist in the army use.  Research shows it was a technique used in recent time.  It the "Hotshot" method is still used, I could not find the information beyond the listing of tincture of benzoin under the "minor wound treatment" area of an army medical kit.   However, that does not support that is is still used for an enclosed wound such as a blister.  It's possible the use in the kit is intended to seal small cuts and lesions as recommended on the package.   


It is a standard of practice,  not a personal view,  for an individual to not burst most blisters.  The skin is the first line of defense.  Thus, if you are able to keep the blister intact,  you should. It will take about 7-10 days for the fluid to be fully reabsorbed in most blisters.

Home remedy to encourage a blister to remain intact:
Make a raised surface using something as moleskin to surround the blister.
 Leave the top of the blister open to air.  


An intact blister is a situation that is very very tempting.  Even those who know that they shouldn't do it,  sometimes can't resist and pop that blister - even the tiny ones which are best left alone.  However,  there are other situations that warrant the need to pop a blister.   Those situations might be related to the location, pain,  or an extremely larger blister.  I have seen a blister so large it covered the entire width of the top portion of a gal's foot from the toe area to the dorsal pedal pulse.  A blister of that size only permitted the wearing of flip flops,  which is not the safest footwear in a camp.


If you must pop a blister,  there is a proper way to do it.    Follow these steps.

PROPERLY wash your hands to remove microbes (see hand washing article)

Put on a pair of gloves (they do not need to be sterile)

Clean the area with rubbing alcohol - a "spritz of antibiotic spray" is not sufficient cleaning of the area.  Medical professionals are taught to use an antiseptic to prep the skin.

Sterilize a needle with rubbing alcohol

Use the sterilized needle to make a few punctures in the thin skin near the edge of the blister

Allow the fluid to drain out

Apply a  non-adherent compressive dressing to the deflated blister to encourage the skin layers to adhere

This process may need to be completed every 6-8 hours during the first 24 because a blister will seal itself and refill.

Change the dressing at least daily and more often when soiled

Monitor for s/s of infection with each dressing change and as needed: Redness, drainage, warmth, increased pain

Begin antibiotic ointment at the first sign of infection

Some people may opt to use an antibiotic ointment immediately.  I would advise against that for one reason - the creation of superbugs.  Superbugs are strains of bacteria that have formed due to the overuse of antibiotics.  At one time it used to be if little Jimmy had a cough,  an antibiotic was given to Jimmy.  However,  some of those little Jimmy boys did not have an infection. Other little Jimmy boys did but instead of finishing all the antibiotic,  mom stopped giving them the antibiotic when they felt better.  These actions caused bacteria to mutate slightly and develop a resistance to the antibiotic.   The same outcome is at risk when a topical antibiotic is placed on a blister and other wounds that do not have an infection.

MRSA is one of those bacterial strains that developed a resistance to antibiotic ointments due to the overuse of them. Just like using oral antibiotics for the common cold (a virus)  have caused superbugs,  using antibiotic ointment on a non-infected wound encourages the same.  In the health care industry,  the medical world is pushing for an end to the overuse of antibiotics as preventative medicine.

    For more information on antibiotic ointments and resistance please see:


Starting off with healthy feet is a great preventative.  Ensuring the body is well hydrated is one method of encouraging healthy feet.  Another method is keeping those feet nourished with lotions to prevent calluses.  However,  if you do have a callus,  NO MATTER WHAT YOU READ ON SOME SURVIVALIST   SITE,  DO NOT CUT IT OFF!!!!!!!!!!!!!!!   There are many medical sites that say DO NOT DO IT.

A callus is a thickened portion of skin that has resulted from friction, pressure,  or other irritant.  It's the body's method of trying to protect AGAINST the skin being opened up.  One cannot see through the skin of a callus to determine hard skin from regular, and the edges of a callus are poorly defined.  Because of that reason,  ONLY a medical doctor should surgically remove a callus by cutting into it.

A callus is not usually painful and does not form overnight.  And,  like most conditions that take a long time to occur,  there is not a quick do-it-yourself method of treating it.

Most people have calluses on their hands and feet.  However,  some have larger ones, and all it takes is a simple examination of one's feet to be aware.  Examining the feet prior to a hiking trip allows a person to start to reduce the size of the callus in a safe manner.  Again,  this should NEVER be completed by cutting it off.

(diabetics and the immunocompromised should see their physician)

(tea, Epsom salt, vinegar, or baking soda may be added but not required)

(this slowly and safely removes the top layers of thick skin without the risk of cutting into the meat. Do not try to remove the entire callus on the first  try -- this takes time)


(try lots of lotion and the use of heavy socks overnight)

Should a callus become painful,  if could be a sign of other conditions and a physician should be consulted ASAP for appropriate care.


   As stated before, the skin is the number one line of defense against the entry of bacteria into the body.  As the extent of a callus cannot be determined,  cutting it off can risk opening up skin. Bacteria do best in an environment that is warm, moist, and dark.  An open area on the foot in a boot sets up the perfect situation for bacteria to multiply.    A person does not have to be diabetic or immunocompromised for bacteria to grow out of control in such an environment.

One such Jodi supporter,  Richard Speights,  has encouraged people to perform the dangerous act of callus cutting.  His claim is that his superior in the army instructed him that it was the correct thing to do.   Maybe  Mr. Speigths is gravely mistaken, or it was a long time ago when he was told this.  Perhaps,  he is leaving out the factor  that such an act was performed by a physician as a last resort and in a sterile environment.  No matter the reason,  it is not a safe thing to do and no recent man of medicine would instruct this action before trying other safer alternatives.  He definitely would not do or suggest doing it in a non-sterile environment.  If he does,  shame on him.

I do not know if it is illegal for a person to state the background of medicine and then advise someone to do such a thing.  However,  I do know that in almost all US states it is illegal for salons to cut off calluses during the pedicure because it is considered a form of surgery. They cannot even advise a person to do it on their own.  One would think the same would remain for someone claiming medicine credentials and offering medical advice.

Richard Speights has implied that any man who is not able to cut off his own callus is not a true man.  He is wrong.  Any man not willing to cut off his own callus is called smart and wise. A man who does cut away his own callus is foolish and irresponsible, as is a person of medicine advising one to do so.  Remember,  prevention is the best medicine, and this includes preventing infection.
Medical web pages that say DON'T DO BATHROOM SURGERY

Please ask Mr. Speights to show you  one medical site that will tell you that you can safely cut your own callus.

"stupidity is the DELIBERATE cultivation of ignorance"
--- William Gaddis

"mistakes are always forgivable, if one has the courage to admit them"
--- Bruce Lee


  1. In true cowardly fashion. RS wrote a failed rebuttal on his silly site. He claims you are not a doctor so you must not know better. It's called research Richard. You fail at that as well. You see what you want to see. The deceptive DB took his info from a daily news article and never provided it. He linked the whole paper. What a dummy 4 life he be.

  2. The narcissist pig just out did himself again by making a fool of himself & proved he has zero credibility and can't write his way out of his bunker. You're an epic fail Richard. Pssst, you will always be out numbered in the intelligence dept. You're so jealous of Debbie's blog you can't see straight. LMAO

  3. Oh, Pinky, Pinky, Pinky. I've said it before, and I'll say it again. Nobody writes snarky like you, little girl. Your hatred will eventually consume you.

    1. Oooh, look who's been stalking this page as I knew he would since he has no life and no profession. Geesh, Richard, you're like a broken record. You repeat your boring come backs. Buck up bunker boy! Say something original for once. Richard Speights, fraud & fool. This little girl is kicking your fraud azz. Oh wait, we all are. You've been sliced and diced! Illiterate DB, you already got your butt kicked after your wrote that garbage because you can't answer medical facts. Talk about deflecting which you suck at. Who you fooling fool? You blind or what? Hate you? You're not worthy of that. You're such an idiot that you don't see you're being mocked & laughed at. I'm having a blast doing so because you make it so easy. You want to play, you get played back even harder. How's that suing anyone who knows you're a liar, a fraud, a con-artist, a stalker, a creep not working out too well for you?


    1. Hey blind boy, you got your butt kicked after you wrote that illiterate tripe because you were never an army medic nor anything else that would allow you to give that horrific medical advice to anyone. You are no doctor. A fired bus driver, yes. Who you fooling fool? Why are you ignoring that response on purpose?

    2. Rich, it's nice that you have attempted to correct your blister article after I pointed out where you were incorrect. It shows that you do have the capacity to improve. However, your pathophysiology is still wrong as you have listed the incorrect layer of the skin in which a blister forms. You might want to do some research so you can correct it. Just google 'pathophysiology of a friction blister" and that will take you to multiple links. I am not going to tell you where your mistake was as I find people retain information the best when they have to find it on their own.

  5. Missing much RS? you deliberately ignored this:

    Consider yourself sliced & diced!

    1. No Pinky, he didn't miss it. In fact, he learned from it and made some corrections. Seems to be a strange thing that he had to learn from someone he implies is not as intelligent as he is, yes? In fact, since I have pointed out his errors, he has fixed a few on his site such as his calling an artery a vein, his calling the ear canal the "audio" canal, and his attempt to fix his description of the pathophysiology of blisters (BTW, he still has it wrong).

      It's interesting. He has made an attempt to correct at least three medical statement mistakes I pointed out to him, yet he still has posts to imply I don't know my medical fact. To some, that would seem to show that he is aware that I do know what I am talking about, which in turn makes his defamation even more malicious in nature. Oh well, just more ammunition for the fire, I guess.

  6. Dang, you owned him! Cut him up, put him in a frying pan! Lol.

  7. Also Debbie, that is their modeus operandi. Making stuff up and then when you call them on it, name calling, pointing out things that have nothing to do with actually proving their point, putting out fake stories, etc,etc. I have literally begged for proof, fact, or evidence and nothing. They just keep screaming at the top of their lungs fake, uncorroborated, made up stuff.

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