What are the treatment options for heel fissures?

Treatment Options for Heel Fissures

The most effective treatment for heel fissures includes regular application of moisturizing emollients, proper foot care, and addressing underlying causes such as hyperkeratosis with appropriate interventions. Treatment should follow a stepwise approach based on severity.

First-Line Treatment Options

Moisturizing and Hydration

• Apply emollient creams regularly to hydrate the skin and improve the appearance of heel cracks 1
• Use specialized foot care creams rather than generic moisturizers - specialized foot creams (like CCS Foot Care Cream) have been shown to provide significantly better hydration than basic options like Aqueous Cream BP 2
• Apply moisturizers at least once daily to the entire foot, focusing on cracked areas 3
• For best results, apply immediately after bathing when skin is still slightly damp

Proper Foot Hygiene

• Wash feet regularly with careful drying, especially between toes 3
• Use lukewarm water (below 37°C) to avoid further drying the skin 3
• Apply lubricating oils or creams for dry skin, but avoid application between toes 3
• Change socks daily and choose seamless options when possible 3

Mechanical Treatment for Hyperkeratosis

• For thickened, callused areas around cracks:
  • Gentle removal of excess callus after bathing using a pumice stone or foot file
  • Do not use chemical agents or plasters to remove corns and calluses without professional supervision 3
  • Professional debridement may be necessary for severe hyperkeratosis

Second-Line Treatments

For Persistent or Painful Fissures

• Salicylic acid preparations (6%) in a cream formulation can effectively treat hyperkeratotic areas and reduce fissures within 1-2 weeks 4
• For deep fissures, consider:
  • Propylene glycol 50% in water applied under plastic occlusion nightly 3
  • Hydrocolloid dressings to promote wound healing 3
  • Antiseptic baths with potassium permanganate (1:10,000 concentration) 3

For Painful Cracks

• NSAIDs such as ibuprofen may help manage pain during healing 5
• Avoid walking barefoot or wearing open-backed shoes until healing occurs 3

Footwear Recommendations

• Select appropriate footwear that doesn't compress the heel 3
• Shoes should be 1-2 cm longer than the foot itself 3
• Internal width should equal foot width at metatarsal phalangeal joints 3
• Avoid tight shoes, shoes with rough edges, or uneven seams 3
• Consider heel cushions or orthotic devices for biomechanical issues 3

Special Considerations

For Diabetic Patients

• More vigilant monitoring and aggressive treatment is required 3, 5
• Professional foot care is strongly recommended rather than self-treatment 3
• Inspect feet daily for new cracks or signs of infection 3
• Any fissures should be evaluated promptly by healthcare providers due to infection risk 3

When to Seek Professional Help

• If cracks don't improve after 2-3 weeks of home treatment
• Signs of infection (increasing pain, warmth, redness, swelling, discharge)
• Deep, bleeding fissures
• Diabetic patients with any foot lesions
• Recurrent heel fissures despite appropriate care

Prevention Strategies

• Daily application of moisturizers, especially in dry climates or winter months
• Regular gentle exfoliation to prevent buildup of callused skin
• Appropriate footwear that doesn't put pressure on heels
• Weight management if indicated 3
• Avoid prolonged standing on hard surfaces

By following this treatment approach, most heel fissures will resolve within 2-4 weeks. Persistent cases may require evaluation for underlying conditions such as psoriasis, eczema, or biomechanical abnormalities that contribute to excessive pressure on the heels.