5-7
or short 1st metatarsal) and treat with appropriate custom foot orthotics.
- Short term immobilization if necessary, especially with non-compliant individuals.
Alternative: Arch supports, padding to decrease weight on specific area. A metatarsal pad or doughnut
cutout will decrease weight on the metatarsal when correctly placed.
Primitive: For metatarsal stress fractures, duct tape two tongue blades transversely across boot just behind
the metatarsal heads, or use other substitute material to fill arch area to get some weight off the involved
metatarsal head.
Patient Education
General: Do alternate activities to maintain fitness. Return to running activities progressively after time off.
Start with a walking program for one week once pain free. If still symptom-free, start running short distances
the second week. Slowly increase distance and speed.
Diet: One Tums a day, and balanced diet with adequate calcium.
Medications: Be alert for gastritis with NSAIDs. Stay well hydrated.
Prevention: Perform proper warm up, stretching, warm down activities. Wear good-fitting, high-performance
athletic shoes. Change running shoes every 3 to 6 months depending on mileage. The midsole will wear
out long before the outer sole.
Follow-up Actions
Return evaluation: At 2 week intervals until released to full duty. Cannot resume full duty unless pain
free. Consider immobilization
Evacuation/Consultation Criteria: Evacuation not necessary unless mission requires heavy weight-bearing
or long hikes. Podiatry or orthopedic consultation recommended for stress fractures. Custom orthotics,
highly recommended, especially in recurrent case.
NOTES: If stress fracture incidence or any specific injury statistically increases in any one team or unit take
a closer look at the training program and cadre. Encourage troops to present early rather than suffering with
the “suck it up...No pain, no gain” attitude until disabled.
Podiatry: Friction Foot Blisters
CDR Raymond Fritz, MSC, USNR & MAJ Daniel Schissel, MC, USAIntroduction: Friction blisters are a common injury in the military. Training programs subject individuals
to high intensity activities, including high-mileage running and land navigation. Footwear is often new and
sometimes ill fitting. Swim fins may also cause blisters. Hyperhidrosis (excessive sweating) of the feet may
increase friction over pressure areas in the shoe. A high arch or cavus foot may be more susceptible to shoe
rub and blister formation on the top of the foot as well as over the metatarsal head area.
Subjective: Symptoms
Sore feet, blister, history of high-level training or running
Objective: Signs
Obvious blisters over involved areas.
Assessment: Diagnosis Is based on clinical presentation.
Differential Diagnosis - genetic blister disease, epidermolysis bullosa (inherited disease in which bullae
form from slight trauma), insect bite, or burn.
Plan:
Treatment:
Primary:
- Prevent additional and future blisters.
- Aspirate blister with a sterile needle.