To lance or not to lance a blister...

I usually don't lance blisters, and let them pop on their own, but this last trip one got so big I felt I had to. Doing so was more painful than leaving the blister alone, and hobbled me until the following morning.

So, when should I lance a blister, and how do I do lance blisters to enhance my mobility rather than restrict it?

I understand the root causes of blisters, but I want to collect some opinions about how best to perform this first aid task.

I carry a sewing needle stuck into a piece of cardboard in my first aid kit. I use it to lance blisters, after sterilizing it briefly with a flame.

I've been fortunate enough to avoid blisters for the past six or seven years, so I am a bit rusty on the finer points, but my general procedure has been to lance with the needle, usually making several small punctures, because they are tiny! I remove what fluid I can, then I tape over the blister.

A thorough-going first aid maven could improve on that by several leaps and bounds, I am sure.

If I catch a blister forming, I lance it, dry it off, iodine it, and then cover it with moleskin if needed. Been doing this for years.

The only time I have used a snake bite kit, I somehow got a large spine of Spanish Bayonet stuck in my calf. Apparently it had been there for a couple days before I noticed it because it had festered. I borrowed someones snake bite kit, cut an X over the fester, then stuck the suction device over the wound and pulled out a large spine along with the clot of puss. Then I cleaned the wound inside and out, painted the outside with iodine and packed the inside with neosporin then covered it. I redressed it every half day to make sure it was getting better. Probably not the best way to do it, but it healed up fast.

PS I always sterilize the thing I am going to operate on myself with.

Probably should have mentioned this, but if I lance it right, the thing reattaches itself and forms a callus of sorts.

I find that if I can lance a blister, and then bandage it tightly so that the now loose flap of skin isn't rubbing back and forth on the raw area, then it is much more comfortable than the original blister. Proper bandaging is the key, and keeping the bandage in place. Chris Townsend's The Backpacker's Handbook has a detailed section on blister care. Maybe I will look it up when I get home and report back on his recommendations.

I don't know if this is generally accepted practice in normal life (and won't try to defend or argue the practice), but among long distance hikers a problem that sometimes occurs is a blister is 'lanced' and then it quickly reforms, refills. What folks do (and I have done) is to pull a bit of thread through when lancing it with a needle and leave a little thread sticking out on each side. Blister isn't able to re-fill.

A first blush it seems like it could get dirty/infected or something, but I did this on the PCT when there was just a ton of loose dirt, feet constantly dirty, and had no problem, and ditto other thru-hikers I've known have used this approach and FWIW I've not heard of any resulting problems.

Just haven't had that sort of blister since then, but if I ever do, I'll go that route again.

If the blister is noticed early, I use the needle/thread.drain method. I leave the thread and it falls off, or I can pull it out gently later. Never had any infection. I manage to do this in the evening so the blister has some time to dry a bit, and doesn't "shred" later.

Unless it's under a callus I pop and cover the area. But I have great socks and shoes these days and haven't had many issues. I did get a small blister under the callus on the ball of my foot - thought I had a pebble in the shoe. It didn't hurt, so I left it alone, and eventually it went away.

I had a small abrasion turn into a foot infection that was starting to be a blood infection - had to have IV antibiotics daily for a week outpatient. It was all frontcountry, I snagged a sandal on a crack in a sidewalk and did a spectacular fall, the only injury was a tiny skin flap on the back of my heel. I still have a bump of scar tissue years later for my trouble. Keep 'em clean, folks. Irrigate with clean (filtered or treated) water and leave no doubt, get all the grit out. Triple antibiotic cream, gauze, tape it up, put a donut of moleskin around it if it's in a high friction area and check frequently. At camp and on breaks let it get some air and dry out the wound before cleaning it again. If it's developing a greenish tinge around the wound and the area looks red, get the heck out of the wilderness and get medical treatment.

A trick I learned from I can 't remember where, but that I've used with success is a needle and thread. At night, spear through (in and out) of the the blister with a clean needle and thread. pull out the needle, but leave the thread sticking out both ends. I'd recommend covering it with a bandage while you sleep. This allows the blister to keep discharging over night and in the morning you can pull out the thread. A super fast recovery and no irritants the next day.

Here is a trick I learned from an Army buddy who was a Ranger medic and it is incredible.

For hot spots (before blister has formed) cut some moleskin larger than the hot spot. Then cut out a hole in the moleskin so that when lain over the hot spot, it fits within the hole. Then cover that with a whole layer of moleskin and tape in place if needed.

For full blown blisters, just lance that puppy first then follow the above directions.

What this does is prevent the hot spot or lanced blister from receiving any new friction.

I only lance if there is puss. Otherwise, no lance. But regardless of lance or not, I cover it with tape to prevent further blistering. I haven't had one in a very long time, but when I did this, I never had any pain afterwards.