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Heel and skin fissures can be found year 'round but are often seen in the winter months when the air is dry.
Fissures can occur at any site, but tend to be more common in areas where the
skin is either (a) changing from one type of skin to another or (b) areas that
are prone to callus.
 Heel fissures form at the junction of two types of skin;
glabrous and hairy
skin. These two types of skin come together at the outer rim of the heel.
Most of us would tend to think of a callus forming as the result
of
friction. But the formation of a heel fissure is very different. Heel
fissures form a unique type of callus that is created by
tension on the skin. Tension at the rim of the heel is created with weight
bearing. To explain this concept, let's use an example; fill a water
balloon at the sink and set the filled balloon on the counter. The weight
of the water in the balloon will cause the balloon to spread putting tension on
the walls of the balloon. Callus forms on the rim of the heel in much the
same manner. When weight is applied to the heel the skin surrounding the
rim of the heel is placed under tension. The higher the tension and the
greater the load applied to the heel, the greater the chance for the formation
of callus. As the callus becomes thicker and tension continues to be applied to
the rim of the heel, cracks will occur in the callus. These cracks
progressively deepen to become heel fissures.
Fissures aren't just specific to the heel though. Fissure
can also be found on finger and toes, particularly in areas that are prone to
callus.
Knowing that fissures occur secondary to the formation of callus,
the best way to prevent fissures is to prevent the formation of callus. Most skin softeners are inadequate when treating stubborn
heel callus and heel fissures. A
urea based cream
or sal acid based
cream is necessary to soften these thick calluses. Periodic
debridement with a pumice stone or callus file is also a must. We
recommend that you keep a
callus file or
pumice stone in
the shower and simply make debridement of the callus a part of your daily shower routine. In
cases of painful
heel fissures,
gel heel pads
may be of help.
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Nomenclature:
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Debride (debridement) - to trim with a pumice stone or sharp knife.
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Anatomy:
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No information is available for this topic.
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Biomechanics:
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No information is available for this topic.
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Symptoms:
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No information is available for this topic.
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Differential Diagnosis:
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The differential diagnosis for this
condition should include;
Abscess
Blister
Benign soft tissue tumor
Glomus tumor
Porokeratoma
Eccrine poroma
Malignant soft tissue tumor
Malignant melanoma
Kaposi's Sarcoma
Psoriasis
Ulcer
Verrucae
Wart
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Products Recommended for Heel and Skin Fissures:
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See Also:
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References:
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This article was written by Jeffrey A. Oster, DPM and last updated 6/12/07.
No additional information is available for this
topic.
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