The skin covering the body is divided into an outermost layer called the epidermis and an inner layer called the dermis. Heel fissures occur when the epidermis skin layer is dry and cracked.1
Dermal heel fissures can develop from continuous epidermal stress on the heel. They are often deep in the dermal layer and obstruct the ability to walk or stand due to pain and bleeding.1,3
Causes of heel fissures?
Heel fissures are often caused by dry skin and a lack of moisture on the feet.1
Many factors can cause heel fissures such as prolonged standing, barefoot walking, and absence of socks while wearing shoes. Open-heeled shoes cause more strain on the heel of the feet due to withstanding body weight.1
Fissures are often surrounded by calluses on the heel of the feet. Calluses are dry and thick skin that appear discoloured, brown, or yellow.1
The skin that covers the heel of the feet is a thick type of skin called stratum cornea. The skin that covers the heel is thick because it is meant to be strong enough to support pressure from the body’s weight.1
Who is at risk?
Adults and elderly with diabetes are at risk for further developing ulcers, infection and amputation after being diagnosed with heel fissures. Patients suffering from diabetes, obesity, eczema and psoriasis develop dry skin conditions that can cause heel fissures.1
Fissure growth can lead to ulcer formation and an open wound that can cause an infection and then cellulitis. If pressure is put on the fissure, then the risk of ulcer formation increases.1
Symptoms
Mild heel fissure symptoms include dry, peeled and cracked skin.1
Patients with severe heel fissure in the dermal skin layer show symptoms such as pain, itching, discomfort, and bleeding.1
Prevention
Heel fissures are often a cosmetic problem that can further develop into a more serious and painful condition. The most effective way to prevent heel fissures is to hydrate and moisturize the feet frequently.1
Treatment
Emollient moisturizers that contain urea are used to prevent heel fissures by promoting skin elasticity. Products containing urea preserve water and moisture in the skin to remain and protect against cracks on the skin.1
Emollient moisturizers that are lipid-based are more effective and safer than petroleum or paraffin-based moisturizers. Lipid-based moisturizers lock in water and hydration while petroleum and paraffin-based moisturizers do not. Petroleum and paraffin-based moisturizers are also fire hazards.3
Keratolytic treatments can heal skin cracks and calluses by breaking down thick skin. Keratolytic treatments take weeks to show improvement because they have to be applied twice a day to the affected area until the doctor can debride the fissure.2
Hydroxyl and salicylic acids such as lactic acid and glycolic acid can be used to soften skin by lightly exfoliating the skin while keeping in the natural oils and moisture.1,4
Silicone Gel Heel Protector is a medical gel that is used to protect the heel from cracking.1
Kakato-tsurutsuru socks are used to keep the moisture of the skin in the heel to stop peeling and fissures from developing.1
The drug Timolol is proven to restore the skin barrier and treats fissures.1
Centella is a herbal extract that has been proven to cure heal wounds by promoting cell growth and strength using collagen. Euphorbia caducifolia latex is also an herbal extract known to be antibacterial, antimicrobial, and antifungal.1
Sesamum indicum is an oil that is extracted from plants that treats dry cracked skin.1
At-Home Remedies
Coconut, almond, and olive oil may improve heal fissures by preventing water loss and providing hydration to the skin.1
Olive oil is an essential household item that has many beneficial properties including vitamin E. Vitamin E is an antioxidant that can help reduce inflammation and promote healing of the skin.1
Honey can soften skin while keeping in its moisture. It is a natural remedy that can be used for its antioxidant properties.1
Aloe Vera has vitamins and minerals that can moisturize and hydrate the skin to improve the reconstruction of skin that is suffering from cracks and peeling.1
A mixture of turmeric and castor oil can be used to heal skin fissures. Turmeric is an antiseptic powder that can also reduce skin inflammation.1
What are the effects of heel fissures on the quality of life
The quality of life can be negatively affected due to the pain and discomfort felt by patients with dermal heel fissures. Aside from pain, patients can also be psychologically impacted by heel fissures because they often feel embarrassment due to the lack of maintaining skin health.1
Heel fissures result from repeated stress put on dry skin. It can be easily treated by various moisturizers and oils that retain water and promote skin elasticity. If untreated, heel fissures can cause dermal cracks that cause immense pain and discomfort.1
This article is not medical advice. It is important to consult your doctor before using any method mentioned in this article.
References:
1. Wadekar PH, Potnis V. A Review on Heel Fissures and its Management. International Journal of Research in Engineering, Science and Management . 2021;4(2). doi:2581-5792
2. Vlahovic TC, Hinton EA, Chakravarthy D, Fleck CA. A review of cyanoacrylate liquid skin protectant and its efficacy on pedal fissures. The journal of the American College of Certified Wound Specialists. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3601869/. Published March 15, 2011. Accessed August 7, 2021.
3. Longhurst B, Steele C. (Pdf) dry heel fissures: Treatment and prevention. Podiatry Focus.
4. Arif T. Salicylic acid as a peeling agent: A comprehensive review. Clinical, cosmetic and investigational dermatology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4554394/. Published August 26, 2015. Accessed August 7, 2021.
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