HEEL FISSURE

What is a heel fissure?

A fissure is simply a break in the skin. It is also commonly known as heel cracks. The two most common reasons for developing a heel fissure is extreme tension or reduced elasticity of the skin. The most common area affected is the heel because the skin thickness in this body part results in decreased elasticity. Frequent movement with walking also puts added tension to this area that may cause skin breakdown.

How do I know if I have a heel fissure?

Heel fissures may be grossly visible or microscopic. It may occur singly or in multiple areas. Dry skin with redness should be inspected for possible heel cracks. Break in the skin may come in different presentations. The lesion can be straight, curved, or branching. In the initial stages where a fissure is invisible, a stinging or burning sensation over the heel may indicate microscopic breaks. Pain is often produced when movement causes current fissures to form new ones. Redness and heat over the heel are some signs that the skin is inflamed and is prone to breaking down under pressure.

What are the risk factors for heel fissure?

• Thick skin

Thick skin, as mentioned above, is difficult to stretch compared to thinner skin. Elasticity is an important property that prevents skin breakdown. Areas such as the heel and palm are prone to fissures because of this reason.

• Old age

Skin becomes dry and stiff as one reaches an advanced age. Dry skin is easily chapped while reduced skin stretching ability can induce greater stress on the skin to cause breaks in the skin.

• Obesity

Obesity increases the shear forces placed on the heels when one walks. The added weight shouldered by the heel causes the skin to crack under pressure. Excess friction can also occur between the shoe and the heel that is another cause for fissuring.

• Exposure to cold

Cold weather exposure makes the skin dry. Lack of moisture in the skin increases the skin integrity’s susceptibility to get disrupted.

• Walking barefoot

Habitually walking barefoot causes repetitive microscopic trauma to the heel. The body responds by thickening the skin of the heel in order to avoid injury. Over time, extreme thickening of the skin renders it inelastic and causes fissures to occur.

• Wearing shoes without socks

Socks protect the skin from repetitive friction against the shoe’s insole. Wearing shoes without socks often promote constant rubbing of the heel against the insole that will lead to skin breaks.

What will I do when I see heel fissure(s)?

The best advice is to seek consult with a physician right away. Although there are a lot of home remedy solutions online, consulting with a doctor ensures adequate treatment and prevention of infection from creeping in. Diagnostic procedures are not routinely requested by attending physicians unless there is suspicion of an ongoing infection.

Treatment

• Topical steroids

Topical steroids are applied over the heel when there are signs of inflammation such as redness, heat, pain, or swelling. Clinicians prefer to wrap the heel with cling wrap after applying steroids. The reason for this is to facilitate better penetration of medication since the heel’s skin is very thick.

• Proper footwear

Wearing shoes that lessen impact on heel can prevent heel fissures from developing. Wearing socks reduces friction between the heel and insole of the shoe as well.

• Lose weight

Being overweight or obese poses a multitude of health problems and the heels are certainly affected by this condition. Exercise regularly, eat a sensible diet, and increase physical activity by doing daily switches such as taking stairs instead of escalators or elevators.

• Apply moisturizer or lotion

Daily application of moisturizer or lotion will make the skin smoother, nourished, and more elastic. These three effects of daily foot care go a long way in helping prevent the heel’s skin to breakdown.

• Topical antibiotics

Topical antibiotics is only used is cases when there is evidence of ongoing infection. Consult a physician first prior to application to avoid irrational antibiotic use.