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Hydrocolloid Dressings for Full Thickness Heel Fissures?

Discussion in 'Diabetic Foot & Wound Management' started by Kerrie, Jan 17, 2013.

  1. Kerrie

    Kerrie Active Member

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    Dear All,
    I'm not quite sure if I am thinking on the correct track here but I was wondering if anyone has any experience with hydrocolloid dressings in heel fissures and hyperkeratosis? I remember seeing a Pod use granuflex on heel fissures when I was training but I am wondering if anyone else uses it and whether it is any good?
    I have a patient who is type 1 diabetic with severe psorasis, he has 2 large plaques around his calc region which are causing full thickness heel fissures which are subsequently causing infection and poor diabetic control due to infection etc.
    He is under a dermatologist and has a hx of trying betamethasone dipropionate and fucidic acid which have not helped.
    I'm just trying to think outside the box for this patient but don't want to look potentially silly in asking for a dressing which obviously won't work, I've only found evidence of hydrocolloids on linchen amyloidosis and acne.
    Any help much appreciated!
    Thanks in advance :drinks
  2. davsur08

    davsur08 Active Member

    Hydrocolloids are used to hydrate the skin. Yes you can use them to soften the hard skin on your patient. Soaking the feet in water, preferably warm water would acheive the same. apply mositurising cream and gladewrap the heel over night might also help soften the hard skin.
    If the heel fissures are infected, a combination of steroid + antibacterial similar to what you are using works. if the infection is not resolving than, 1: the hard skin might be a barrier 2: mechanical trauma could be causing tissue breakdown. is your patient sensory neuropathic?
    if you suspect the steroid is not doing the trick, discuss this with the dermatologist and suggest UV therapy.

    the heel need to be offloaded, use the steroid and fuscidic under occlusion (wrap a bandage), have him soak his feet in warm water for good half hour and give it a try to debride the hard skin.

    eliminate possble factors. Mechanical trauma - off load,
    just plain hard skin hindering access - soaking or occlusion and later debride.
    if wide spread psoriasis is suspected - Try oral Flucloxacillin 500 mg TID, to manage infection first followed by steroid under occlusion. or UV therapy.

    i am sorry if ive confused you more.

    hope this helps
  3. drdebrule

    drdebrule Active Member

    I have never used hydrocolloid for anything other than ulcers, but agree any hydrating scheme makes sense. Urea and ammonium lactate creams have been studied for xerosis, but not specifically heel fissures. Some of my patients over the years have used super-glue adhesive to help close painful fissures, but I am not aware of any reports in the literature. I like David's suggestion of trying to control the underlying disease or predisposing factors whenever possible.
  4. blinda

    blinda MVP

    See here;

    Liquiheel - heel fissures
  5. drdebrule

    drdebrule Active Member

    Thanks for the liquiheel link. I am thinking that glue is the way to go!
  6. davsur08

    davsur08 Active Member

  7. blinda

    blinda MVP

    Hi Dave,

    Yes, that was used in our literature search for the paper. Unfortunately, I don`t have an electronic copy of it, but it`s in the September 2010 issue of Pod Now.

    Here are a couple more articles;

    Attached Files:

  8. Kerrie

    Kerrie Active Member

    Dear All,
    Thanks for the replies!
    David - the patient is not neuropathic, which is why the heels are giving him so much trouble poor guy, another thing which I have found commonly occurs in heel fissures which is not occuring in this patient, he is not overweight, his BMI is 23 and he's very health concious so in terms of putting ALOT of weight through his foot, not really. I have used 2 x 6mm poron which I have fashioned into heel cups for him recently to use which he reports helps and makes to area more comfortable. He is on metronidazole and also prednisolone to control to psoriasis at present but the GP is reviewing the prednisolone.
    I haven't really heard of UV therapy, what does it entail, is it basically the same as used for really bad eczema?
    Also this superglue, can it be used if the fissures are infected and will a GP prescribe it?
    Cheers Guys
  9. blinda

    blinda MVP

    Hi Kerrie,

    Liquiheel (or any other skin adhesive) should not be used if there are clinical signs of infection. Dependant upon the extent of infection, and pathogen involvement, you could consider requesting a prescription for this topical steroid tape;

    Haelan tape

    It contains Fludroxycortide 0.0125% w/w.

    Ivan Bristow did a case study on its use on heel fissures; Bristow, I.R. (2008) Case Report: the management of heel fissures using a steroid impregnated tape (Haelan) in a patient with keratoderma climactericum. Podiatry Now, 11, (7), 22-23.

    You can request a copy here; Southampton uni eprints

    If there is no sign of infection, you can buy Liquiheel from some of the Pod supppliers.

  10. davsur08

    davsur08 Active Member


    Phototherapy has been proved to be effective in chronic severe Psoriasis. see article below.

    In your patient, i suspect the heel fissures are due to psoriasis. it fits the clinical presentation. Heel fissures do occur with palmoplantar psoriasis. see Pod Arena thread

    Attached Files:

  11. davsur08

    davsur08 Active Member

    Hi Bel,

    Thank you for the articles. when i attached the cochrane review article i was saying to myself, if Bel is on the discussion on derm there wont be any article she would have missed :D.

    one Q Bel, Cyanoacrylate the standard super glue and the medical glue N-butyl and 2-Octly cyanoacrylate right,. how does these differ. i mean could jus the Cyanoacrylate be used for heel fissures. i ask this because the medical gule is very expensive and most of the patients with heel fissures are from low scioeconomic group.

    thank you in advance
  12. blinda

    blinda MVP

    Hi Dave,

    Liquiheel is a classified as a topical Cyanoacrylate skin Adhesive (TCA) being a blend of n-butyl cyanoacrylates with slower setting 2-octyl cyanoacrylates (10% 2-octyl, 90% n-butyl). This formula is distilled to remove toxic by-products and results in a low viscosity liquid.

    As it is less `sticky` than your standard `super-glue` , it adheres to the peaks and troughs of the epidermis, thus holding the apposed edges of the fissure together effectively. This medical grade adhesive has been used for years for closure of Laparoscopic incisions.

    Other than it having so-called toxic products removed and being more runny, personally, I don`t think there is much difference. However, you may have difficulty justifying your clinical reasoning if the pt were to develop subsequent infection following your recommendation of super-glue.

    Hashimoto (1999) endorsed the use of “off –the-shelf-Superglue” for the treatment of heel fissures in patients with diabetes;

    Hashimoto H, Superglue for the Treatment of Heel Fissures. Journal of the American Podiatric Association 89(8)1999:434-435


    I just received an electronic copy of my glue paper (thanks Ivan, Ann Summers vouchers are on their way....), PM me with your email addy if you want a copy.
  13. Ian Linane

    Ian Linane Well-Known Member

    "I just received an electronic copy of my glue paper (thanks Ivan, Ann Summers vouchers are on their way....)"

    Can I get the same Bel, if I send you an electronic copy of the Daily Mail ;)

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