I have a patient with a very painful lateral heel fissure.
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History of motor vehicle accident 2007 with subsequent right ankle fracture. Underwent ankle fusion. Now walks on lateral border of heel. Has now developed a lateral heel fissure which heels but then "splits". Has had fissure become infected with last infection 5/7 ago with redness spreading up leg, chills, fever, swelling in groin. Placed on antibiotics & majority of symptoms have resolved.
Heel has significant callus over lateral border which I have debrided & around the fissure as much as possible. He wears a Rockport shoe with a lateral flare. He also wears an approximately 10mm red PPT insole to provide increased cushioning.
Does anyone have any advice regarding other options to deal with this fissure. It will close over with debridement & dressings. That is not a problem. But will re-split fairly quickly once callus builds up. I will be debriding more frequently but are there other suggestions on either more appropriate footwear, footwear modifications, soft insole etc? He has no ability to evert his foot so I am thinking he needs much more cushioning. I've attached (hopefully) below some pictures. They were hurriedly taken & not perfect.
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