No blister-prevention method has high-quality evidence; paper tape is the only one with moderate confidence, and the data on socks and antiperspirants come from military marching
Key Findings
Of 806 articles screened, 11 controlled trials were included: 5 on socks, 3 on antiperspirants, 3 on barriers; only 2 had a moderate confidence in the effect estimate.
The authors found a paucity of high-quality evidence in support of socks, antiperspirants or barriers for preventing friction blisters.
Moderate confidence suggests that paper tape may be an effective barrier.
Clinical and methodological diversity precluded a meta-analysis.
Practical Application
Be honest about the evidence: nothing is proven. Paper tape on known hot spots is the best-supported option REF-1030.
Sock construction changed blister rates in booted recruits (a thin liner under a dense sock: 40% vs 69–77%; Knapik 1996, DOI 10.1093/milmed/161.10.594) — it supports "socks matter, test yours in training", not a particular running sock.
Do not recommend antiperspirant by default: in cadets it lowered blisters (21% vs 48% when used at least three nights) but caused skin irritation in 57% (Knapik 1998, DOI 10.1016/S0190-9622(98)70075-1).
Lubricants, powders, toe socks, lacing patterns and sizing shoes up were not supported by any verified trial: offer them as practice.
Limitations
No pooled estimate; abstract only was read.