Bloody calluses on the feet and hands

Calluses are skin lesions caused by simultaneous friction and pressure, and a blood or bloody callus refers to wet calluses with the formation of a blister (blister or bulla) containing fluid and blood.

Causes bloody blister

The main reasons for the appearance of bloody blisters on the feet are poorly selected shoes: tight, squeezing the toes or heel, with a rough back and internal seams, or poorly fitting on the feet, with the foot moving inside the shoe when walking. The appearance of such blisters under the big toes is provoked by high heels. [ 1 ]

In addition, increased physical activity, which increases skin friction, can also cause the formation of blood blisters. This applies, first of all, to wet calluses on the heel.

Thus, a bloody blister on the heel can occur in runners: tension in the calf muscles transfers additional tension to the Achilles tendon, which pulls the heel bone of the foot up more strongly and quickly (which leads to increased friction of the skin covering it).

And bloody calluses on the hands appear during work with tools or during sports activities with equipment, which are accompanied by repeated (frictional) friction and mechanical pressure on the skin of the palms and/or fingers. [ 2 ]

Risk factors

In addition to unsuitable (or new, not yet broken-in) footwear and excessive loads, risk factors for chafing of the skin on the feet, heels or toes – with the appearance of blisters and blood calluses – include increased sweating of the feet (wet skin is injured more quickly, since increased sweating increases friction) and various pathological changes in the anatomical structures of the feet, which lead to disturbances in the movement of the foot, that is, its normal biomechanics. [ 3 ]

This refers to the presence of flat feet, hallux valgus, Haglund's deformity (a bone-cartilaginous growth on the back of the heel), Morton's toe (when the second toe is longer than the big toe), improper healing of an old fracture, etc.

Frequent appearance of bloody blisters under the first toe may be the result of a functional limitation of the joints of the big toes (hallux limitus), known to orthopedists, which reduces their flexibility during movement and increases mechanical pressure on soft tissues.

Excess weight also significantly increases the pressure on the feet.

Pathogenesis

When walking, the skin of the foot is subject to pressure, friction and shear, which can ultimately lead to damage to the skin in the form of a blister.

Friction blisters are caused by excessive shear stress between the basal (lowest) layer of skin and the stratum corneum (uppermost) layer. The layers of skin near the spinous layer of the epidermis (stratum spinosum) are most susceptible to shear. When this layer separates from the underlying tissue, plasma (a clear fluid) diffuses from the cells. This is a common callus blister. [ 4 ]

The pathogenesis of blood blisters is associated with the fact that when the skin of the foot comes into contact with shoes, a shear force arises, which, cyclically repeating during walking, affects the deeper layers of the dermis, damaging their cells. When the tissues of the areas of increased friction of the foot - on the joints of the fingers, on the bony protrusions of the back of the heel, on the metatarsal pads - can no longer withstand the force of friction and pressure, microscopic ruptures (separation of skin cells) begin to appear in the basal layer of the dermis, leading to the formation of a space where exudate accumulates.

The presence of blood in it - a bloody callus - indicates that the pressure led to a violation of the integrity of small blood vessels and venous anastomoses of the papillary and reticular layers of the dermis, the blood entered the epidermis (staining its cells due to local hemorrhage) and came out into the cavity of the blister, where it mixed with normal exudate.

Symptoms bloody blister

The first signs, or rather the precursor of a blister, are a reddened, hot to the touch area of skin in the rubbed area (on the leg or on the hands).

The main symptoms of a blood blister are localized swelling, pain, fluid accumulation between the layers of skin, and the appearance of a blood-filled blister.

Consequences and complications

The consequences of a blister rupture or an attempt to puncture it are infection with common obligate skin bacteria, such as staphylococci, as well as all other microbes in the environment. The development of the infection is manifested by the spread of hyperemia and increased edema (swelling) of the skin and subcutaneous tissue around the callus, the redness and pain of which become more intense.

Complications of infection lead to purulent inflammation. In people with diabetes, it can lead to gangrene, and in people with weakened immunity, to the development of sepsis.

Diagnostics bloody blister

Diagnosis is limited to physical examination of the limb, since a bloody blister is a clinical diagnosis.

Differential diagnosis

Differential diagnosis includes palmar-plantar erythrodysesthesia ( palmar-plantar syndrome ), which is a side effect of some cytostatic drugs used in cancer chemotherapy; heparin-induced bullous hemorrhagic dermatosis or bullous pemphigoid.

Treatment bloody blister

The most correct treatment for a blood blister is to let it heal for a few weeks: the blister is in sterile conditions, the fluid is gradually reabsorbed, mitosis occurs with the formation of new skin cells, and the blister shell gradually dries up and eventually falls off. But while the blood blister is healing in this way, it should be protected - with a special hydrocolloid patch Compeed, Reliance, Alpe, Corn Milplast, Septona, etc.

To reduce pain, it is recommended to apply ice to the corn or take painkillers such as Ibuprofen or other non-steroidal anti-inflammatory drugs with analgesic effect.

If, as often happens, the blister bursts spontaneously, its shell should never be removed, since healing under it occurs faster and without complications.

Opinions on the issue of puncturing a bloody blister – when it interferes with walking – are diametrically opposed. Some doctors consider attempts to open it a risky procedure due to the risk of infection, so they advise to see a doctor.

If you decide to get rid of the pain of a pressing blister by puncturing it, you need to do this with a sterile syringe needle - in a horizontal plane at the bottom of the blister (without touching the damaged skin) - with preliminary treatment of its surface with medical alcohol or vodka and subsequent treatment with the same alcohol or alcohol tincture of propolis. The callus is covered from above with a sterile bandage, or better yet, with a bactericidal or colloidal plaster.

At the slightest sign of inflammation, the bloody blister is lubricated with ointments such as tetracycline, Levomekol (Levosin), Baneocin, Oflokain or another ointment with an antibiotic, as well as an ointment or cream with silver sulfathiazole (Sulfargin, Argosulfan, etc.).

Prevention

To avoid rubbing your feet until bloody blisters appear, your shoes should fit you, and this applies not only to their size and width. Read more in the publication - How to choose shoes correctly.

In addition, in any orthopedic salon you can buy special silicone stickers for the back of shoes to protect the heel from strong friction of the skin from the Achilles tendon and the formation of blisters and bloody calluses.

If your feet sweat a lot, effective remedies for sweaty feet will help.

And one more thing. If calluses, including bloody ones, appear very often and regardless of what shoes you wear, you should consult an orthopedist or podiatrist who will identify the problem and help solve it.

And to avoid bloody blisters on your hands when you start working with tools, you just need to put on gloves.

Forecast

A bloody callus heals within a month or a little longer, so the prognosis for this skin injury is good. However, it is possible that over time a hyperkeratosis (increased keratinization) area will appear in this place with the formation of another skin callus, but this time dry.