Terms used in some European countries: Rhagades
Linear split in epidermis – becomes painful if dermis involved. Due to an inability of the skin to cope with tensile stress.
Can be moist (eg if between digits) or dry (eg around heel).
Predisposing factors to fissure around heel:
• anhidrotic/dry and atrophic skin
• hyperkeratosis (edges of fissure almost always hyperkeratotic)
• tinea pedis
Treatment of heel fissures:
Debridement of overlying and adjacent hyperkeratosis- initially on a two weekly basis with self care by patient in intervening two weeks; keratolytics (initially) and emollients (later); antiseptic dressing & strapping to hold edge of fissure together; heel cups; self care by patient (‘buff’ pads/pumice, soaks & emollients).
May need to use Nystatin cream – assumed that some are infected with Candida or other deep fungal infection.
If no sign of infection or inflammation, consider use of Super Glue™ or similar adhesive – Dermabond™ could be used but may not be as strong and is expensive.
Prevention – regular podiatric debridement; use of emollients and buff pad/pumice by patient; rigid heel counter shoe or heel cup (or orthoses with deep heel cup, if indicated).
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