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I have a 71 year old female patient that has horizontally cracked fissured heels. She isn't 'high risk', not being diabetic, or a smoker, and the cracks are horizontal, beneath the Achilles tendon insertion. I have debrided, moores disc smoothed, and applied amerigel (there is no infection, but the cracks do penetrate the full skin depth). I haven't redistributed pressure, the patient is not wearing shoes with a back. Is the issue more dermatological? She doesn't appear to have skin problems any where else. I have advised drinking fluid. I know it's a simple problem, but it's taking some time to resole (since the end of May). Any suggestions?

 

I would get her wearing shoes with a back. I had a client with a similar problem mostly made worse because she wore open backed shoes.

 

I agree with Teash.

The benefit of wearing socks and shoes is to retain the natural moisture of the skin.
If she is avoiding shoes due to irritating the wound on the heel counter, I usually create a pad in the rear of the shoe (like a donut) to prevent irritation.

I find those who present with the worst fissures are those who wear open shoes. The first step, and the most effective treatment is to get then is shoes and socks.

Good luck, keep persisting. Heel fissures can be really testing.

Sally Belcher

 

Hi Gillian,

I'm unsure if this product is available in Canada but possibly something similar is?

http://www.compeed.com/splash.jhtml

http://www.beunstoppable.co.uk/range/default.aspx

Actually sold as blister prevention although I have found them to be very useful in treating problematic fissures. Especially where no callus is evident & the skin is atrophic. Only use when NO infection is evident as they are occlusive. Very good at reducing shearing associated with location on heel.

Kind regards,

Mandy.

 

Return to shoes, as stated. I use Carmol 40% cream, under Tegaderm occlusion, at bedtime. If adhesive tegaderm is not available, saran wrap will do fine. Once the cracks/fissures are gone, discontinue the occlusion. -John

 

Try applying a thin line of "Crazy Glue" (cyanoacrylate) to the deepest fissures. Stops the pain immediately and allows healing underneath. Works much like Dermabond.

 

Assessment and identification of possible cause would be the first line of attack. I agree that backless mule-type shoes can exacerbate the problem, however there may be an underlying dermatalogical cause for hyperkeratosis. Debridement of the sides of the fissure and application of tincture of benzoin compound prevents penetration of deeper skin layers. Rehydration of the skin with a high urea-content cream Eg. CCS or Flexitol cream helps. Massage increases local perfusion. Advice on footwear modification, frequent dry rasping with foot dresser and application of cream at home, between office visits, will enhance treatment.

 

If the fissuring doesn't resolve with addressing the backless shoes and daily emollient. In my short time in the profession I have found Tinea can cause this type of fissuring! After a couple of weeks of topical terbinafine a reduction in the amount of Hyperkeratosis is usually noted, if Tinea is the cause!

 

Thats the problem, identifying the cause. Introducing too many pharmacologically blind treatments may develope resistance. Good hygiene, dedridement, re-hydration of the skin and the immune system, in most cases, resolves this situation.