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.
Common sense would have us think of a callus forming as the result
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 kitchen sink and slowly set the filled balloon on the counter.
The shape of the water balloon changes from a tear drop shape to something much
flatter like a donut. The volume of water in the balloon spreads placing
tension on the walls of the 'donut'. Callus forms on the rim of the heel in much the
same manner. When the heel strikes the ground and weight is applied to the heel, the skin surrounding the
rim of the heel is placed under tension much like the balloon. The greater the load applied to the heel, the greater the
tension in the skin at the rim of the heel and 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
Treatment of Heel and Skin Fissures
Knowing that the first step in the development of a heel fissure
is the formation of callus on the rim of the heel,
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.
Specialty heel pads
that soften callus, that are worn at night, are very effective in reducing thick
heel callus. In
cases of painful
gel heel pads
may be of help.