When a shoe rubs the heel, the resulting injury is most commonly known as a friction blister or, if the skin is broken, an abrasion. This painful experience is a side effect of poorly fitting footwear or intense activity. Understanding the exact nature of this injury, how to treat it immediately, and how to prevent it from happening again is the clearest path to relief.
The Cause and Name of Heel Rubbing
The physical mechanism behind this common foot injury is centered on repetitive shear force, not just simple rubbing. During walking or running, the foot’s internal bone structure moves within the shoe, but the shoe’s material tries to hold the outer skin layer stationary. This conflict creates a shear stress that pulls the skin layers in opposite directions.
This stress causes a mechanical separation within the epidermis. The resulting gap quickly fills with a clear, plasma-like fluid, creating the characteristic fluid-filled bubble known as a friction blister. The blister itself acts as a protective cushion for the underlying damaged tissue.
The primary factors that increase this harmful friction are ill-fitting shoes that are either too tight or too loose, leading to excessive heel movement, and socks made of non-wicking material like cotton. Moisture from sweat or external sources softens the skin, making it more vulnerable to shear forces and accelerating the rate at which the blister forms. If the outer skin layer is entirely scraped off, the result is an open wound called an abrasion or a “deroofed” blister.
Immediate Care for Heel Injuries
When a blister or abrasion has already formed, the immediate goal is to protect the area from further pressure and prevent infection. If the blister is small and intact, the best course of action is to leave it untouched, as the skin “roof” provides a natural, sterile covering. Covering the blister loosely with a specialized hydrocolloid dressing or a cushioned bandage will protect it from shoe contact and promote a moist healing environment.
For a large, painful blister that is likely to rupture on its own, controlled draining can provide relief. This involves washing the area and hands thoroughly with soap and water, then sterilizing a fine needle with rubbing alcohol. The blister should be carefully pierced at its edge in a few spots, allowing the fluid to drain while leaving the outer skin intact to act as a protective barrier.
After draining, the area should be coated with an antibiotic ointment or petroleum jelly and covered with a non-stick bandage or gauze pad. If the skin is already broken, the wound should be gently cleaned with mild soap and water, dried, and covered immediately. Persistent pain, increased redness, warmth, or the presence of pus are signs of a potential infection and require medical attention, particularly for individuals with diabetes or poor circulation.
Strategies for Prevention
Preventing heel injuries begins with selecting and preparing the right footwear, as proper fit is the most significant factor in reducing friction. Shoes should be tried on later in the day when the feet are slightly swollen to ensure a comfortable fit that minimizes heel slippage during movement. New shoes should be “broken in” gradually with short periods of wear before being used for extended activities.
The type of sock worn is equally important, as moisture significantly increases the skin’s susceptibility to damage. It is recommended to choose moisture-wicking materials like synthetic blends or wool, which draw sweat away from the skin, rather than cotton, which retains moisture and promotes friction. Wearing a thin liner sock underneath a thicker outer sock can also help, as the two layers rub against each other instead of against the skin.
Proactive application of protective barriers can shield high-friction areas before irritation begins. Products like moleskin, medical tape, or specialized blister patches can be applied directly to the skin or the inside of the shoe to create a low-friction interface. Additionally, applying lubricating balms or foot powder to the heel before activity can temporarily reduce the friction coefficient, helping the skin glide against the sock instead of catching and tearing.