Treatment of Fissures on the Sole of the Foot
For fissures on the sole of the foot, apply propylene glycol 50% in water for 30 minutes nightly under plastic occlusion, followed by a hydrocolloid dressing, and protect surrounding skin with petroleum jelly. 1
Primary Treatment Approach
The most effective evidence-based treatment for foot fissures involves:
- Propylene glycol 50% in water: Apply for 30 minutes under plastic occlusion (cover with plastic wrap) every night 1
- Hydrocolloid dressing: Apply immediately after the propylene glycol treatment to promote wound closure 1
- Petroleum jelly protection: Apply to surrounding intact skin before treatment to prevent maceration 1
Alternative Antiseptic Options
If propylene glycol is unavailable or not tolerated, use antiseptic treatments to accelerate wound closure:
- Potassium permanganate: Dilute 1 part in 10,000 for soaks 1
- Silver nitrate solutions: Apply topically to the fissure 1
- Antiseptic baths: Use chlorhexidine (5 parts in 1000-10,000) or octenidine 0.1% two to three times weekly 1
Important caveat: Always rinse antiseptics thoroughly to avoid skin irritation 1
Essential Supportive Care
Moisture Management
- Emollients: Apply oil-in-water creams or ointments at least twice daily to the entire foot, particularly after bathing 1
- Avoid alcohol-containing products: These worsen xerosis and delay healing 1
- Urea-containing preparations: Can be used on soles in adults (≥10% concentration), but avoid in children under 1 year except on limited areas 1
Inflammation Control
- Topical corticosteroids: If erythema or desquamation is present around the fissure, apply prednicarbate cream 0.02% 1
- Short-term oral steroids: Consider only for grade 3 erythema/desquamation 1
Prevention of Recurrence
To prevent fissure reformation after healing:
- Daily emollient application: Continue indefinitely to maintain skin hydration 1
- Proper footwear: Ensure shoes fit properly with adequate width and no rough internal seams 1
- Callus management: Remove excess callus regularly by a trained healthcare professional, as callus buildup predisposes to fissure formation 1
- Avoid dehydrating practices: Limit hot showers and excessive soap use 1
When to Refer
Refer to a podiatrist or dermatologist if:
- Fissures fail to heal after 2-4 weeks of appropriate treatment 1
- Signs of secondary infection develop (purulent drainage, spreading erythema, fever) 1
- Underlying conditions like diabetes or peripheral arterial disease are present, as these significantly impair healing 1
- Recurrent fissures despite optimal topical management 1
Critical pitfall: In diabetic patients with fissures, these are considered pre-ulcerative lesions requiring immediate professional treatment to prevent progression to foot ulceration 1. Never attempt self-treatment in this population.