Why is this topic important?
 
Friction blisters are the most common injury sustained during long distance running, hiking, and military training. In those activities, friction blisters occur at a frequency 4 times that of any musculoskeletal injury.
 
Why are friction blisters so frequent?
 
They’re so frequent because we really do not understand the underlying pathomechanics and therefore cannot implement appropriate preventive interventions.
 
What are common misconceptions about friction blisters on the feet?
 
The most common myth about friction blisters is that the injury is caused by shoes rubbing against the skin of the foot. The second common misconception revolves around the concept of friction causing superficial skin abrasion.
 
What are the key components of the new paradigm for blister prevention?
 
Friction blisters are not caused by abrasion on the skin surface. Rather, blisters occur when high friction force traps the skin against the sock or shoe and bone movement beneath the skin causing shear distortion of the soft tissues beneath the skin surface. Thus, friction blisters are the result of bone movement against fixed or non-moving skin. The injury begins below the skin surface, moving from deep to superficial.
 
How does this causation mechanism change prevention strategies for friction blisters?
 
Podiatrists know how to control abnormal bone movement using padding, wedges and custom foot orthoses. There are new technologies which reduce coefficient of friction on the skin surface and/or between footwear interfaces such as the sock and insole.
 
Which research did you cite in your presentation?
 
I recently collaborated with Australian podiatrist, Rebecca Rushton to publish 2 manuscripts in the Journal of Athletic Training.^1,2 
 
Dr. Richie is an Adjunct Associate Professor within the Department of Applied Biomechanics at the California School of Podiatric Medicine at Samuel Merritt University in Oakland, Calif. He is a Fellow and Past President of the American Academy of Podiatric Sports Medicine. Dr. Richie is a Fellow of the American College of Foot and Ankle Surgeons, and the American Academy of Podiatric Sports Medicine.
 
References
1. Rushton R, Richie D. Friction blisters of the feet. A new paradigm to explain causation. J Athl Train. 2024 Jan 1;59(1):1-7. doi: 10.4085/1062-6050-0309.22.
 
2. Rushton R, Richie D. Friction blisters of the feet. A critical assessment of current prevention strategies. J Athl Train. 2024 Jan 1;59(1):8-21. doi: 10.4085/1062-6050-0341.22.