Friction Blisters

Pathophysiology, Prevention and Treatment


Blisters occur frequently, especially in vigorously active populations. Studies using repetitive rubbing techniques show that blisters result from frictional forces that mechanically separate epidermal cells at the level of the stratum spinosum. Hydrostatic pressure causes the area of the separation to fill with a fluid that is similar in composition to plasma but has a lower protein level. About 6 hours after formation of the blister, cells in the blister base begin to take up amino acids and nucleosides; at 24 hours, there is high mitotic activity in the basal cells; at 48 and 120 hours, new stratum granulosum and stratum corneum, respectively, can be seen. The magnitude of frictional forces (Ff) and the number of times that an object cycles across the skin determine the probability of blister development — the higher the Ff, the fewer the cycles necessary to produce a blister. Moist skin increases Ff, but very dry or very wet skin decreases Ff. Blisters are more likely in skin areas that have a thick horny layer held tightly to underlying structures (e.g. palms of the hands or soles of the feet). More vigorous activity and the carrying of heavy loads during locomotion both appear to increase the likelihood of foot blisters.

Antiperspirants with emollients and drying powders applied to the foot do not appear to decrease the probability of friction blisters. There is some evidence that foot blister incidence can be reduced by closed cell neoprene insoles. Wearing foot socks composed of acrylic results in fewer foot blisters in runners. A thin polyester sock, combined with a thick wool or polypropylene sock that maintains its bulk when exposed to sweat and compression, reduces blister incidence in Marine recruits. Recent exposure of the skin to repeated low intensity Ff results in a number of adaptations including cellular proliferation and epidermal thickening, which may reduce the likelihood of blisters. More well-designed studies are necessary to determine which prevention strategies actually decrease blister probability.

Clinical experience suggests draining intact blisters and maintaining the blister roof results in the least patient discomfort and may reduce the possibility of secondary infection. Treating deroofed blisters with hydrocolloid dressings provides pain relief and may allow patients to continue physical activity if necessary. There is no evidence that antibiotics influence blister healing. Clinical trials are needed to determine the efficacy of various blister treatment methods.

Considering the pervasive nature of friction blisters, there is a substantial amount of basic and applied research that remains to be performed, especially in the areas of prevention and treatment.

This is a preview of subscription content, log in to check access.


  1. 1.

    Akers WA, Sulzberger MB. The friction blister. Mil Med 1972; 137: 1–7

    PubMed  CAS  Google Scholar 

  2. 2.

    Glick JM, Katch VL. Musculoskeletal injuries in jogging. Arch Phys Med Rehabil 1970; 51: 123–6

    PubMed  CAS  Google Scholar 

  3. 3.

    Curtis KA, Dillon DA. Survey of wheelchair athletic injuries: common patterns and prevention. Paraplegia 1985; 23: 170–5

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Cabrera JM, McCue FC. Nonosseous athletic injuries of the elbow, forearm and hand. Clin Sports Med 1986; 5: 681–700

    PubMed  CAS  Google Scholar 

  5. 5.

    Levine N. Friction blisters. Physician Sports Med 1982; 10: 84–92

    Google Scholar 

  6. 6.

    Hoeffler DF. Friction blisters and cellulitis in a Navy recruit population. Mil Med 1975; 140: 333–7

    PubMed  CAS  Google Scholar 

  7. 7.

    The soldier’s boot. BMJ 1895; 2: 1307–8

  8. 8.

    Ressman RJ. Epidemiology of friction blisters. J Assoc Mil Dermatol 1976; 2: 13–7

    Google Scholar 

  9. 9.

    Delany HM, Travis LO. A clinical evaluation of one hundred cases of infection of the lower leg and foot in military personnel. Mil Med 1965; 130: 1184–90

    PubMed  CAS  Google Scholar 

  10. 10.

    Knapik J, Reynolds K, Staab J, et al. Injuries associated with strenuous road marching. Mil Med 1992; 157: 64–7

    PubMed  CAS  Google Scholar 

  11. 11.

    Knapik JJ, Hamlet MP, Thompson KJ, et al. Influence of bootsock systems on frequency and severity of foot blisters. Mil Med. In Press

  12. 12.

    Naylor PFD. The skin surface and friction. Brit J Dermatol 1955; 67: 239–48

    Article  CAS  Google Scholar 

  13. 13.

    Comaish JS. Epidermal fatigue as a cause of friction blisters. Lancet 1973; 1:81–3

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Comaish S, Bottoms E. The skin and friction: deviations from amonton’s laws and the effect of hydration and lubrication. Brit J Dermatol 1971; 84: 37–43

    Article  CAS  Google Scholar 

  15. 15.

    Akers WA. Measurements of friction injuries in man. Am J Ind Med 1985; 8: 473–81

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Bueche F. Principles of physics. New York: McGraw-Hill Book Company, 1972

    Google Scholar 

  17. 17.

    Highley DR, Coomey M, DenBeste M, et al. Frictional properties of skin. J Invest Dermatol 1977; 69: 303–5

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Sulzberger MB, Cortese JA, Fishman L, et al. Studies on blisters produced by friction. I. Results of linear rubbing and twisting technics. J Invest Dermatol 1966; 47: 456–65

    PubMed  CAS  Google Scholar 

  19. 19.

    Naylor PFD. Experimental friction blisters. Brit J Dermatol 1955; 67: 327–42

    Article  CAS  Google Scholar 

  20. 20.

    MacDonald R. Physiotherapy management of marathon musculo-skeletal casualties. Br J Sports Med 1984; 18:283–5

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    Hunter JAA, McVittie E, Comaish JS. Light and electron microscopic studies of physical injury to the skin. II. Friction. Brit J Dermatol 1974; 90: 491–9

    Article  CAS  Google Scholar 

  22. 22.

    Cortese TA, Mitchell W, Sulzberger MB. Studies on blisters produced by friction. II. The blister fluid. J Invest Dermatol 1968; 50: 47–53

    PubMed  Google Scholar 

  23. 23.

    Schmidt P. Quantification of specific proteins in blister fluid. J Invest Dermatol 1970; 55: 244–8

    Article  Google Scholar 

  24. 24.

    Sulzerger MB, Cortese TA. Observations on the blister base. Br J Clin Pract 1968; 22: 249–50

    Google Scholar 

  25. 25.

    Epstein WL, Fukuyama K, Cortese TA. Autographic study of friction blisters. RNA, DNA, and protein synthesis. Arch Dermatol 1969; 99: 94–106

    PubMed  Article  CAS  Google Scholar 

  26. 26.

    Cortese TA, Fukuyama K, Epstein W, et al. Treatment of friction blisters. An experimental study. Arch Dermatol 1968; 97: 717–21

    PubMed  Article  Google Scholar 

  27. 27.

    Nacht S, Close J, Yeung D, et al. Skin friction coefficient: changes induced by skin hydration and emollient application and correlation with perceived skin feel. J Soc Cosmet Chem 1981; 32: 55–65

    Google Scholar 

  28. 28.

    Griffin TB, Cortese TA, Layton LL, et al. Inverse time and temperature relationship in experimental friction blisters. J Invest Dermatol 1969; 52: 391

    Google Scholar 

  29. 29.

    Akers WA. Sulzberger on friction blistering. Int J Dermatol 1977; 16: 369–72

    PubMed  Article  CAS  Google Scholar 

  30. 30.

    Burgess MC. Initial management of a patient with extensive burn injury. Crit Care Nur Clin North Am 1991; 3: 165–79

    CAS  Google Scholar 

  31. 31.

    DeCamara DL, Raine T, Robson MC. Ultrastructural aspects of cooled thermal injury. J Trauma 1981; 21: 911–9

    Article  CAS  Google Scholar 

  32. 32.

    Knapik J, Johnson R, Ang P, et al. Road march performance of special operations soldiers carrying various loads and load distributions. Natick (MA): U.S. Army Research Institute of Environmental Medicine Technical; 1993. Report no.: T14-93

    Google Scholar 

  33. 33.

    Reynolds KL, Kaszuba J, Mello RP, et al. Prolonged treadmill load carriage: acute injuries and changes in foot anthropometry. Natick (MA): U.S. Army Research Institute of Environmental Medicine Technical; 1990. Report No. T1/91

    Google Scholar 

  34. 34.

    Kinoshita H. Effects of different loads and carrying systems on selected biomechanical parameters describing walking gait. Ergonomics 1985; 28: 1347–62

    PubMed  Article  CAS  Google Scholar 

  35. 35.

    Sawka MN, Wenger CB. Physiological responses to acute exercise-heat stress. In: Pandolf KB, Sawaka MN, Gonzalez RR, editors. Human performance physiology and environmental medicine at terrestrial extremes. Indianapolis: Benchmark Press Inc., 1988: 97–151

    Google Scholar 

  36. 36.

    Spence WR, Shields MN. Insole to reduce shear forces on the sole of the feet. Arch Phys Med Rehabil 1968; 49: 476–9

    PubMed  CAS  Google Scholar 

  37. 37.

    Lord M, Hosein R, Williams RB. Method for in-shoe shear stress measurement. J Biomed Eng 1992; 14: 181–6

    PubMed  Article  CAS  Google Scholar 

  38. 38.

    Darrigrand A, Reynolds K, Jackson R, et al. Efficacy of antiperspirants on feet. Mil Med 1992; 157: 256–9

    PubMed  CAS  Google Scholar 

  39. 39.

    Juhlin L, Hansson H. Topical glutaraldehyde for plantar hyperhidrosis. Arch Dermatol 1968; 97: 327–330

    PubMed  Article  CAS  Google Scholar 

  40. 40.

    Tidman MJ, Wells RS. Control of plantar blisters in pachyonychia congenita with topical aluminium chloride. Brit J Dermatol 1988; 118: 451–2

    Article  CAS  Google Scholar 

  41. 41.

    Tkach JR. Treatment of recurrent bullous eruption of the hands and feet (Weber-Cockayne disease) with topical aluminum chloride. J Am Acad Dermatol 1982; 6: 1095–6

    PubMed  Article  CAS  Google Scholar 

  42. 42.

    Rook A, Wilkinson DS, Ebling FJG, Champion RH, Burton JL. Textbook of Dermatology. Boston: Blackwell Scientific Publications, 1986

    Google Scholar 

  43. 43.

    Reynolds KL, Derrigrand A, Roberts D, Knapik J, Pollard JA, Jones BH, Duplantis KL. Effects of an antiperspirants with emollients on foot sweat rates and blister formation while walking in the heat. J Am Acad Dermatol. In press

  44. 44.

    Younger IR, Priestley GC, Tidman MJ. Aluminum chloride hexahydrate and blistering in epidermolysis bullosa simplex. J Am Acad Dermatol 1990; 23: 930–1

    PubMed  Article  CAS  Google Scholar 

  45. 45.

    Quinn J. The effects of two new foot powders on the incidence of foot infection and blisters in recruits during basic training. Farnborough, United Kingdom: Army Personnel Research Establishment Research; 1967. Memorandum no. P/6

    Google Scholar 

  46. 46.

    Allan JR. A study of foot blisters. United Kingdom: Army Operational Research Establishment Research Memorandum; 1964. No. 1/64

    Google Scholar 

  47. 47.

    Allan JR, Macmillan AL. The immediate effects of heat on unacclimatized paratroops. Exercise ‘Tiger Brew II’. United Kingdom: Army Operational Research Establishment Research; 1963. Memorandum no. 16/62

    Google Scholar 

  48. 48.

    Benda C. Stepping into the right sock. Physician Sports Med 1991; 19: 125–8

    Google Scholar 

  49. 49.

    Subotnick SI. Foot injuries. In: Subotnick SI, editor. Sports medicine of the lower extremities, New York: Churchhill, 1989: 223–70

    Google Scholar 

  50. 50.

    Maiser T, Pietrocarlo T. The foot and footwear. Nurs Clin North Am 1991; 26: 223–31

    Google Scholar 

  51. 51.

    Sammarco GJ. Soft tissue injuries. In: Torg JS, Welch RP, Shephard RJ, editors. Current therapy in sports medicine-2. Toronto: B.C. Decker Inc., 1990: 189–98

    Google Scholar 

  52. 52.

    Spence WR, Shields MN. New insole for prevention of athletic blisters. J Sports Med 1968; 8: 177–80

    CAS  Google Scholar 

  53. 53.

    Smith W, Walter J, Bailey M. Effects of insoles in coast guard basic training footwear. J Am Podiatr Med Assoc 1985; 75: 644–7

    PubMed  CAS  Google Scholar 

  54. 54.

    Herring KM, Richie DH. Friction blisters and sock fiber composition. J Am Podiatr Med Assoc 1990; 80: 63–71

    PubMed  CAS  Google Scholar 

  55. 55.

    Euler RD. Creating ‘comfort’ socks for the U.S. consumer. Knitting Times 1985; 54: 47–50

    Google Scholar 

  56. 56.

    Farnworth B. A numerical model of the combined diffusion of heat and water vapor through clothing. Tex Res J 1986; 56: 653–65

    Article  Google Scholar 

  57. 57.

    Kosiyanon R. How coolmax keeps you cool and dry while the heat is on. Wilmington, DE: The DuPont Company Fibers Marketing Report 1990

    Google Scholar 

  58. 58.

    Jagoda A, Madden H, Hinson C. A friction blister prevention study in a population of Marines. Mil Med 1981; 146: 42–4

    PubMed  CAS  Google Scholar 

  59. 59.

    Stokes AW. Military footwear and the occurrence of foot blisters. Eighth Commonwealth Defense Conference on Clothing and General Stores, UK6; 1965: Melbourne, Australia

  60. 60.

    Cooper DS. Research into foot lesions among Canadian field forces. 13th Commonwealth Defence Conference on Operational Clothing and Combat Equipment; 1981: Malaysia. CDA-11

  61. 61.

    Cooper D. Footwear and blister incidence. In: Handbook on clothing. NATO Research Study Group 7, 1988: 7b2–7b5

    Google Scholar 

  62. 62.

    Patterson HS, Woolley TW, Lednar WM. Foot blister risk factors in an ROTC summer camp population. Mil Med 1994; 159: 130–5

    PubMed  CAS  Google Scholar 

  63. 63.

    Hodges GR, DuClose TW, Schitzer JS. Inflammatory foot lesions in naval recruits. Significance and lack of response to antibiotic therapy. Mil Med 1975; 140: 94–7

    PubMed  CAS  Google Scholar 

  64. 64.

    Rubin L. Hyperkeratosis in response to mechanical irritation. J Invest Dermatol 1949; 13: 313–5

    PubMed  CAS  Google Scholar 

  65. 65.

    Mackenzie IC, Miles AE. The effect of chronic frictional stimulation on hamster cheek pouch epithelium. Arch Oral Biol 1973; 18: 1341–9

    PubMed  Article  CAS  Google Scholar 

  66. 66.

    Mackenzie IC. The effects of frictional stimulation on mouse ear epidermis. I. Cell proliferation. J Invest Dermatol 1974; 62: 80–5

    PubMed  Article  CAS  Google Scholar 

  67. 67.

    Mackenzie IC. Effects of frictional stimulation on the structure of the stratum corneum. In: Marks R, Plewig G, editors, Stratum corneum. Berlin: Springer Verlag, 1983: 153–60

    Google Scholar 

  68. 68.

    O’Keefe KM. Outdoor health care. How not to be a babe in the woods or mountains. Am J Nurs 1977; 77: 974–9

    Google Scholar 

  69. 69.

    Fletcher C. The new complete walker. New York: Alfred Knopf, 1974

    Google Scholar 

  70. 70.

    Mirkin G, Hoffman M. Sportsmedicine book. Boston: Little, Brown and Company, 1978

    Google Scholar 

  71. 71.

    Moore M. Synthetic skin covers blisters, abrasions. Physician Sportsmed 1980; 8: 15

    Google Scholar 

  72. 72.

    Wheeland RG. The newer surgical dressings and wound healing. Dermatol Clin 1987; 5: 393–407

    PubMed  CAS  Google Scholar 

  73. 73.

    Ramsey ML. Managing friction blisters of the feet. Physician Sports Med 1992; 20: 117–24

    Google Scholar 

  74. 74.

    James WD, White SW, Yanklowitz B. Allergic contact dermitis to compound tincture of benzoin. J Am Acad Dermatol 1984; 5: 847–50

    Article  Google Scholar 

  75. 75.

    Katchis SD, Hershman EB. Broken nails to blistered heels. Managing foot lesions in the office. Physician Sports Med 1993; 21(5): 95–104

    Google Scholar 

  76. 76.

    Alvarez OM, Mertz PM, Eaglstein WH. The effect of occlusive dressings on collagen synthesis and re-epithelalization in superficial wounds. J Surg Res 1983; 35: 142–8

    PubMed  Article  CAS  Google Scholar 

  77. 77.

    Yarkony GM, Lukane C, Carle TV. Pressure sore management: efficacy of a moisture reactive occlusive dressing. Arch Phys Med Rehabil 1984; 65: 567–600

    Google Scholar 

  78. 78.

    Hedman LA. Effect of hydrocolloid dressing on the pain level from abrasions on the feet during intensive marching. Mil Med 1988; 153: 188–90

    PubMed  CAS  Google Scholar 

  79. 79.

    Akers WA, Leonard F, Ousterhout DK, Cortese TA. Treating friction blisters with alkyl-α-cyanoacrylates. Arch Dermatol 1973; 107: 544–7

    PubMed  Article  CAS  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Dr Joseph J. Knapik.

Additional information

The views, opinions, and findings contained in this report are those of the authors and should not be construed as official Department of the Army position, policy or decision, unless so designated by other official documentation.

Citations of commercial organisations and trade names in this review do not constitute an official Department of the Army endorsement or approval of the products or services of these organisations.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Knapik, J.J., Reynolds, K.L., Duplantis, K.L. et al. Friction Blisters. Sports Med 20, 136–147 (1995).

Download citation