Prevention and Treatment of Common Skin Injuries to the Feet

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Blisters can be common for anyone who regularly participates in sports. Blisters develop due to friction created on the skin. Therefore, the most common sites are the heel and soles of the feet due to the extreme rubbing between the shoes and socks and sports equipment. This type of friction, especially in warm, moist conditions is perfect for blister development. One warning sign a blister is about to develop, is redness and warmth on the skin called a “hot spot.” Next, fluid fills the space between the top two layers of skin to provide protection from continued rubbing. When this occurs, you will see a blister that looks like a little bubble on the skin.

To prevent blisters, minimize friction on the skin by wearing footwear that fits and keeping your feet as dry as possible by wearing moisture wicking socks. You can also tape blister prone toes or heels, as well as applying non-petroleum based jelly to reduce friction. Small unbroken blister, that do not cause pain, should be left alone to heel. The goal is to avoid the blister getting bigger and preventing infection. Signs of infection are pus from the blister, very red or warm skin around the blister and or red streaks leading away from the blister. Any infection should be treated immediately by your podiatrist.

Another skin injury is a contusion, which is a deep bruise that is caused by direct impact to the muscle, tendon or ligament, resulting in pooling of blood around the injured area that discolors the skin. The most severe type of contusion to the foot and ankle is a bone bruise. This is not an actual fracture to the bone, but can be extremely painful, and may inhibit movement just as a break would, lasting a long time. A suspected muscle or bone contusion should be brought to the attention of your podiatrist. While waiting to see a doctor, you should follow the RICE method of treatment: Rest, Ice, Compression, Elevation.

A subungual hematoma is another example of skin injury. These can occur by crushed type injury such as repetitive toe jamming or by dropping a heavy object on your toe. A subungual hematoma is the collection of blood that forms in the space between the nailbed and the toenail. You will notice a discoloration of red, maroon or any other color beneath the nail after the injury, along with pressure and pain. If the pain is mild and the hematoma is less than 25% of the area under the nail, then homecare is recommended that includes: ice, elevation, twice daily soak in antibacterial solution with oral anti-inflammatory medications to relieve pressure and pain followed by a topical antibiotic with a dry sterile bandage. If the injury that causes the subungual hematoma severe enough to cause intense pain and tenderness or if the blood collection occupies 25% or more of the nail area, you should seek the medical attention of your podiatrist.

Your podiatrist may take x-ray’s to rule out a fracture or laceration to the nail bed. In many cases, the blood from beneath the nail may need to be drained to relieve the pressure. Frequently, the toe is numbed with lidocaine which is injected at the bottom of your toe. Once numb, a device is used to burn or bore into the nail to create a hole, to allow the blood to drain out. In severe cases, the nail may need to be removed, but the toe nail will grow back over time with no lasting side effects.
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