[Surgicalcric]

Blatantly copied out of th Journal of Special Operations Medicine, Volume 2, Edition 3 / Summer 02

FOOT BLISTER CARE AT NIJMEGEN 2000
David L. Hamilton, PA-C
ABSTRACT
Forced foot marches have been a staple of soldiering throughout history. Unfortunately, many soldiers' and leaders' desire to cover long distances quickly can cause friction blisters to form on soldier's feet. Many techniques have been used to toughen feet, treat blisters and enable soldier to "Charlie Mike" (continue the mission) with varying results. This work presents an alternative blister care procedure to traditional moleskin donuts and pressure relief techniques. 1 These treatments may cause blisters to enlarge with continued marching, and may require frequent halts for adjustment / reapplication. By treating soldiers with severe early blister formation by taping, and pre-taping feet prone to blistering prior to long marches, soldiers may be returned to marching fitness during a time of need.
(Translation: Keeps you from having to carry them out!!!)
INTRODUCTION
While participating in the Nijmegen 4 Days' March in July 2000, the author observed a unique foot blister treatment system used by the Dutch Red Cross to provide medical support to thousands of marchers. This foot taping and blister management system limits further blister formation and enables marchers to continue marching for several consecutive days; marching 26 miles daily in combat uniform and equipment. The tape is sturdy enough to leave on for several days, if need be, to facilitate continuous operations, making it an ideal system for special operating forces on long foot movements.

PURPOSE:
This work presents an alternative blister care procedure to traditional moleskin donuts and pres- sure relief techniques. These treatments may cause blisters to enlarge with continued marching, and may require frequent halts for adjustment I reapplication. This work presents an alternative blister care procedure to traditional moleskin donuts and pressure relief techniques. These treatments may cause blisters to enlarge with continued marching, and may require frequent halts for adjustment I reapplication. By treating soldiers with severe early blister formation by taping, and pre-taping feet prone to blistering prior to long marches, soldiers may be returned to marching fitness during a time of need. (Translation: Keeps you from having to carry them out!!!)
BACKGROUND
The Nijmegen 4 Days Marches began in 1909, with marchers walking 140 kilometers in 4 days. Military groups now march 160km in 4 days. The walks have been held annually since 1909, except during the war years of 1913-14 and 1940-45. In the 2000 march, 41,000 people from 51 countries started and 36,377 finished.
During the 4-Day's March, military contingents billet at Camp Heumensoord. The Dutch, German and British Militaries establish formal camps and medical treatment facilities, the largest of which is the Dutch Field Treatment Station, roughly the size of a US Forward Support Medical Company Clearing Station, with the addition of Physical therapy.
American soldiers have no formal support (it was withdrawn after 1996 for various personnel draw-down and deployment reasons), and fall in with the Small Contingents formations. Many US units and individual soldiers still participate with their own funding (in 2000, 504 US military personnel started and 470 finished the march).
PROCEDURE
US soldiers receive their medical care from unit medics and the Dutch treatment tent, but as there may be 300-400 soldiers with blisters evaluated each evening at the treatment tent, waiting times are long (up to, 3 or 4 hours) During this waiting time, soldiers are signed in and issued a number, and given an approximate waiting time, so they may return at that time.
The Dutch "blaren" (blister) treatment area contains 20 to 30 treatment tables, staffed with Dutch medical specialists and Dutch Red Cross personnel. Several doctors are available for the specialists to consult regarding serious erosions and infections. Each area is well stocked with these supplies:
Finger lancets
Tincture of benzoin
Leukoplast 1/4 " tape
Large cotton tip applicators
Mild betadine solution foot wash
Cotton balls
2x2 gauze
4x4 gauze
Talc or foot powder Duo- Derm
Elastic Bandages
Epsom Salt or Domboro foot soaks
Sterile Normal Saline Irrigation
Foot basins
Ice (if available)
The system takes approximately 30 to 40 minutes to tape a pair of blistered feet.
The evaluation of the blistered foot requires the determination if the marcher can medically continue marching. Contraindications to continued marching include deep cellulitis surrounding vesicles; foul smelling purulent bullous fluid, deep dermal erosion and repeated bleeding from vesicle after initial debridement. For this article we will classify march blisters in 4 types: (See Figure 1)
1. Sealed vesicles filled with bullous fluid.
2. Sealed vesicles with purulent fluid.
3. Ruptured vesicles with intact roof or de- roofed vesicles.
4.deep dermal/sub dermal abrasions.
Soldiers are initially evaluated with a brief history, including location and severity of pain, ability to walk, types of socks and boots used, previous treatments, allergies, and significant past medical history. If serious injuries are discovered in the history, a medical officer is summoned to further evaluate the patient. If no significant medical problems are discovered, the medical specialist proceeds to examine the foot and ankle, with particular attention to the skin of toes and inter-digital spaces, heel, and ball of foot. Cleansing of the foot with a mild disinfectant solution is followed by removal of old tape, moleskin and tincture with tape remover or acetone. The skin is then re-inspected for signs, of erythema, severe edema or lymphangitis, indicators of cellulitis. If cellulitis is detected, the soldier is usually removed from marching status and treated with appropriate bed rest, limb elevation and antibiotics.
INITIAL TREATMENT OF VESICLES PRIOR TO TAPING (See Figure 2)


To Be Con't...