Heel fissures are a common problem seen in foot care. Heel fissures are seen in the winter months when the air is dry. Also, heel fissures are more common in folks that are moderately to severely obese.
Heel fissures seem to form at the junction of the two types of skin in the foot, glabrous and hairy skin (for additional information on skin, refer to the Foot and Ankle Knowledge Base at Myfootshop.com). These two types of skin come together at the rim, or junction of the side and bottom of the heel. For most people, the rim is a smooth transition between these two types of skin. For those folks that are over weight, the rim becomes an abrupt turn caused by over loading. This abrupt turn seems to stimulate the formation of callus around the rim of the heel.
Heel fissures are actually a problem that is secondary to recurrent callus formation. As the callus surrounding the rim of the heel thickens, the callus will crack or fissure. Fissures of the heel can become so deep and problematic that the bleed and become infected. Heel fissures can be particularly troublesome for those people that lack sensation in the foot such as diabetics.
Heel fissures have no cure. Prevention is the best medicine. The best that we can hope for with heel fissures is to prevent deep, painful cracks. This requires ongoing care. Care may include periodic debridement after a shower or soaking the feet. Softening creams that have "softening agents' are helpful. Some of these creams may use additives such as urea or salicylic acid to chemically debride away some of the callus. Occasionally heel pads or heel cups are helpful to redistribute the weight of the heel over a softer, more broad area.
Symptoms:
The symptoms of heel fissures vary based upon the degree of symptoms. The thickness of this unique callus can produce pain.
The majority of problems with this condition come from cracks that become hard to control. The cracks, or fissures, become increasingly deep as the callus thickens. Fissures may bleed and become infected.
Differential Diagnosis: The differential diagnosis for this condition should include;
Abscess
Blister
Benign soft tissue tumor such as a glomus tumor, porokeratoma or eccrine poroma
Malignant soft tissue tumor including malignant melanoma and Kaposi's Sarcoma
Psoriasis
Ulcer
Verrucae
Wart
About the author: Jeffrey A. Oster, DPM, C.Ped is a board certified foot and ankle surgeon. Dr. Oster is also board certified in pedorthics. Dr. Oster is medical director of Myfootshop.com and is in active practice in Granville, Ohio.
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