Your Best Body: Blister 911

What to do when your toes start screaming
Published in the August/September 2012 issue.

Photo by Nathan Sayers

Sally Turkel never had a problem with her feet. Tape on her big and little toes was all she needed before slipping on her pointe shoes. But when she joined Colorado Ballet, the new demands of company life took a toll, and blisters became a constant enemy. “I wasn’t prepared for it,” Turkel says. “I became known as the one who always had terrible feet issues.” It took a few years of experience and tips passed down from senior company members to learn how to avoid blisters.

 “A blister is a sign from your body that it’s time to take a step back,” says Monara Dini, a podiatrist and assistant clinical professor at the University of California, San Francisco. “Ignoring it for too long can lead to infection, and a breakdown of the skin and wounds that ultimately take a long time to heal.” Fortunately, the right foot care can help dancers speed healing, minimize pain and even avoid blisters in the first place.

Find the Right Fit

Blisters are caused by a combination of friction, pressure and moisture. When the skin is subjected to repeated force, it creates tears in the second and third layers of the skin, while the uppermost layer remains intact. A serum-like fluid flows in to fill the space.

The culprit can be too-big or too-small shoes that create unnecessary friction and aggravate “hot spots,” such as bunions and hammertoes, says Diana Werner, also a podiatrist and assistant clinical professor at UCSF. Proper fit is essential. Keep in mind that feet evolve over time, sometimes growing in size or developing new pressure points. “Chronic blisters are a sign that your feet have changed,” says Werner. If blisters suddenly become a problem, consider getting refitted.

Avoid Chafing
Slightly damp skin blisters more easily than either very wet or very dry skin. A little petroleum jelly dabbed onto vulnerable spots just before dancing (and reapplied as frequently as possible during long rehearsals) can reduce friction to minimize chafing.
To keep skin dry, Werner recommends sprinkling foot powder inside pointe shoes just before dancing. Also, wear tights made of synthetic, “wicking” materials, such as polyester or microfibers; cotton tends to absorb sweat and exacerbate chafing. When it comes to padding, Werner says old-fashioned lambswool is still the best at wicking moisture away from skin.

And smokers, take note: Studies suggest blisters are more likely to develop among cigarette users, possibly because tobacco damages the skin and constricts blood vessels in a way that weakens the skin’s friction defenses.

Tape the Trouble Spots
For extra protection, Dini recommends taping any spots where your shoes rub. Look for a high-quality adhesive bandage that can survive sweat. Using a stretch of tape that’s about twice as long as the diameter of the toe you want to protect, fold one end of the tape so that you have a nonstick surface to place over the “danger zone,” and then wrap the rest around your toe. Keep in mind that your feet will likely swell throughout the day, so avoid wrapping too tightly.

Drain the Fluid

When a blister appears, Turkel lances it with a sterile needle as soon as possible. “You don’t want it to pop in your shoe,” she says. Lancing right away will help relieve pressure and pain. But the procedure—and the potential for infection—should not be taken lightly. It is only safe to lance if the fluid inside the blister is clear, says Werner.

First prepare your skin by washing it with soap and water or swabbing it with rubbing alcohol. (If it’s the end of the day, experts recommend soaking your feet in warm water and Epsom salts for 15 minutes beforehand.) Next, sterilize a needle by holding it in a flame until the tip turns red. Allow the needle to cool, then use it to gently make one small hole anywhere on the blister.

After draining the fluid, air the blister out overnight. Dress it with antibiotic ointment before wearing shoes in the morning. To relieve pressure, Werner recommends using a moleskin pad cut in the shape of a doughnut. (You can boost the pad’s adhesive power with a solution called compound tincture of benzoin, sold in medical supply stores.) Beware of any signs of infection: redness and pain extending up the ankle and leg, or pus in the blister.

There’s no need to drain a blister if you have some time off. “Blisters will heal on their own,” says Werner. But, “If you must dance and perform the next day, lance it.”
     
Rest and Pamper
Don’t forget the healing power of timely rest. “It’s hard to find time in a demanding schedule,” Werner admits, “but it can work miracles.” She advises dancers to soak their feet in warm water and Epsom salts every night before bed—or at least on the weekend. Even when your feet are feeling fine, this can help reduce swelling. During very busy periods, it’s also a good idea to minimize walking as much as possible after a long day of dancing.

Taking such precaution is worth it. As Turkel says, “You can’t take a day off because your feet hurt. It’s part of your job.”

TIP: X Marks the Spot
San Francisco Ballet corps member Alexandra McCullagh discovered a smart way to relieve pressure when a painful blister formed on her bunion during Nutcracker season. She cut an “x” with a box cutter on the bunion of her pointe shoe. She says, “This allows the satin to stretch and relieves pressure from the area. And no one can tell from the audience.”


Calibrate Your Cross-Training
Need to strengthen your upper body for partnering work? Then start your workout with push-ups, not pliés. A recent study from the Federal University of Rio de Janeiro in Brazil found that exercisers are most effective in the beginning of their session. As you tire, you lose form——and results. Begin any workout with the muscles you most want to target, and they’’ll get stronger faster.


The Divine DaVinci
Dancers’ muscles sometimes get so tight that a ball just doesn’t dig deep enough. The DaVinci Tool, a lightweight self-massage device, has a triangular shape to get into any spot you need. Each of the three edges has a different cut to offer varying types of pressure. “Some dancers find it a bit intense, but for me it’s necessary,” says longtime DaVinci fan Melissa Hough, a Houston Ballet first soloist. Hough lies on the DaVinci before class to relax the tight muscles in her upper back and open her chest. She also uses it on her lower back and hips. “It gets me through a workday when my body threatens to quit on me,” she says. “I found out about it when I was at Boston Ballet, and we’ve been in a serious relationship ever since.” The tool is available in soft or firm densities from bodyback.com.


Cramp!

You’ are balancing in passé, everything feels centered and strong, then——bam!——you get a cramp in your calf. These spasms occur when muscle fibers fail to lengthen again after contracting, causing tension and that awful squeezing sensation. To avoid cramps, stay hydrated and make sure you get enough electrolytes (sports drinks, milk and bananas are all great sources). Take the time to warm up (jump around!) before dancing to get your muscles ready to tackle those relevés and développés. If a cramp happens in the middle of class, stop and stretch the area to make the pain pass more quickly. And remember to cool down—: Cramps can occur up to six hours after exercise.


A for Apples
Fall is the season of back-to-school supplies, colorful leaves, Nutcracker auditions—and crisp, juicy apples. Why should you take a bite?
• Eating an apple before class can boost your stamina. The fruit has an antioxidant called quercetin that improves endurance by making oxygen more readily available to your lungs.
•One medium apple contains about 4 grams of soluble fiber for 95 calories, making it a filling yet waist-friendly snack.
•The natural sweetener in apples enters the bloodstream gradually, keeping your blood sugar level steady to deliver energy over time rather than setting you up to crash and burn.


Skip Stress Cravings

After a particularly bad rehearsal, sometimes you just want to wallow inside a pint of Ben & Jerry’s. The next time that happens, try to keep your spoon down for at least 20 minutes. Research shows that the changes in our hormones directly after a stressful episode leave us more vulnerable to temptation. If you can resist the craving for 20 minutes, your body will bounce back to normal and the urge will most likely pass.


Cross-Training: LINES’ Ashley Jackson
Alonzo King’s choreography for LINES Ballet stretches his dancers’ bodies beyond normal human limits. When Ashley Jackson joined the troupe in 2006, she had to revamp her fitness routine, adding new methods of strength training. “My body was being challenged differently than ever before,” she says. “It’s easy for dancers to only focus on flexibility, but having loose muscles without enough strength is a great way to get injured.”

Quirky Props: Before class, Jackson lies on top of a basketball. “Because it’s round it can go deeper than a foam roller,” she explains. She also rolls out her thighs and calves with a rolling pin: “the kind people use in the kitchen for dough!”
Step Up: To strengthen the muscles around her knees, Jackson stands on the bottom step of a staircase, facing sideways with one foot loosely hanging off. “She lifts her hip up and lowers it down 25 times, then switches sides.
For Her Upper Body: Jackson swims about once or twice a week. “I do the breast stroke and the doggy paddle. Then I get a kickboard to strengthen my back, and to think about my arms (the deltoids and triceps) pushing the board down into the water.”
Turn In: Jackson makes sure to stretch with her legs turned in as well as out. “If you always keep your legs turned out, it’s like only stretching your right side. The body needs balance.”