Skin/Heel Fissures
Description:
A fissure is a crack in the skin in combination with a thick formation of skin layers (callus) commonly found on ball of the foot, heel, sides of the foot. Fissures are caused by excessive pressure combined with the thick skin, and open shoe gear. A large majority of our patients get fissures when wearing rubber or leather sandals in the summer. This is caused mostly by an inflammation and swelling in the skin because those materials have been linked with an irritation reaction from direct contact with the skin. These fissures can deepen on the outer surface of the skin or can go deeper causing bleeding or infection. Pain ranges from dull to sharp depending upon the level of irritation and compression of the nerves that are around these areas.
Treatment: Conservative Care:
| Shoes: | A larger, softer shoe can relieve the direct pressure or pressure from adjacent toes. Make sure that the shoe has enough room at the end about the width of your thumb and that the toe box (front of the shoe) is high enough to allow your toes to move freely. |
| Paring: | Reduction by either professional sharp debridement (shaving) or consistent filing will give temporary relief. Use caution with over the counter callus removal medication or pads. The medication is a type of acid that can cause an ulceration or infection if not used properly or in excess. |
| Padding: | There is an array of over the counter pads. They can be placed directly over the fissure or on either side of the skin lesion to relieve the pressure. |
| Arch support: | Temporary arch supports or custom molded orthotics will give pressure relief on the ball of the foot, maintain the rounded surface of the heels, and is the best solution for long term treatment. |
| Medications: | Topical and sometimes oral anti inflammatory medicines will be prescribed to reduce the swelling that is causing the cracking. Infections must be treated first before this medicine can be used. |
Surgical Options:
The bone structure causing the pressure is either remodeled and smoothed down or repositioned. Depending on the location or severity, the skin lesion or callus itself is removed during the procedure or it will naturally fall off 3 to 4 weeks after the surgery. Incisions are minimal and vary in size (average 1.5cm to 3/4 inch). Sutures are removed at 2 weeks. The procedure is performed at an outpatient facility under sedation. Partial weight bearing is allowed after 48 to 72 hours of non weight bearing if the bone is remodeled or partial weight bearing is allowed after 1 to 3 weeks of non weight bearing with crutches if the bone is repositioned.
