The Uncommon Fracture Blister

There’s nothing worse than wearing your brand new pair of running shoes or a brand new pair of high heels out for a run or out for dinner and coming home with a shoe stained with blood from blistering. Whether the shoe was yet to be “broken in” or the shoe was ill-fitting in the first place, blisters are never a good thing. But did you know that blistering can occur after trauma as well? Fracture blisters are an uncommon, yet serious condition that can accompany significant fractures.


Fracture blisters occur in approximately 3% of all fractures, up to 5% in ankle fractures, up to 10% in fractures of the heel bone. Fracture blisters can develop overlying the fracture itself or along adjacent soft tissue structures. Their formation is related to significant edema, or swelling, that occurs as a result of an injury, leading to a significant increase in internal pressure. This pressure buildup causes the layers of skin to lose their cohesion and allows for fluid to collect within these areas of separation, thus causing blistering. The main contributing factors to blister development include the presence of thin skin, with little to no subcutaneous (“fatty”) tissue and no deep veins to help rid the area of excess fluid.


Could you imagine having a large fluid-filled blister overlying your already painful, swollen, bruised fractured foot? Not only are fracture blisters a drag for the injured person, but these blisters complicate the situation for the treating physician as well. The presence of fracture blisters poses significant challenges for surgical treatment. The rate of infection can double and incisional healing complications and wound formation can occur if the incision is made prior to complete healing of the blister itself. This can lead to significant delay in surgical management as blistering can take weeks to heal. The interim time waiting for fracture blisters to heal will require rest, ice, elevation, and complete immobilization in a splint and crutches to allow for reduction of swelling and thus reduce the tension of skin.


If large fracture blisters are present with significantly displaced fractures associated with nerve or vascular impairment, sometimes surgical treatment has to be staged.  An initial surgery would be performed to stabilize the fracture, improve blood flow and reduce post-healing complications.  A second surgery may be necessary once the blisters are healed to allow proper healing of the fracture.


The good news for anyone unfortunate enough to sustain a fractured foot or ankle is that while fracture blisters represent a significant obstacle in the surgical management of fractures, their development remains a rare occurrence. With patience and proper management, a full and uneventful outcome can be expected even in the presence of fracture blisters.


The doctors at Kansas City Foot and Ankle are experts in the treatment of fractures and other traumatic foot and ankle injuries.