Medical Term for Fissured Heels
The medical term for fissured heels is heel fissures or plantar heel fissures, with deeper cracks extending into the dermis classified as deep fissures 1, 2.
Clinical Classification
Fissures are categorized by depth, which has important clinical implications:
- Superficial fissures: Narrow skin cracks limited to the epidermis 1
- Deep fissures: Narrow, deep, linear skin cracks extending into the dermis, which carry significantly higher risk of ulceration and infection 1
The distinction between superficial and deep fissures is critical in diabetic patients because deep fissures breach the skin barrier and serve as portals for bacterial entry 3, 1.
Pathophysiology in Diabetic Patients
Deep fissures in diabetic patients develop through specific mechanisms:
- Autonomic neuropathy causes decreased perspiration leading to xerosis (dry skin), which is associated with both superficial fissures (OR 2.35) and deep fissures (OR 2.88) 1
- Peripheral arterial disease is uniquely associated with deep fissures (OR 3.29), suggesting impaired blood supply prevents adequate skin repair 1
- The combination of neuropathy and angiopathy creates the highest risk scenario for progression from fissures to ulceration 1
Clinical Significance
Heel fissures represent a critical pre-ulcerative state requiring immediate intervention:
- Deep open fissures are entry points for bacteria that can rapidly progress to infection, ulceration, and serious complications in diabetic patients 3
- The heel is anatomically vulnerable due to lack of muscle or fascia, minimal subcutaneous tissue, and exposure to high mechanical stress 4
- Fissures should be identified during the comprehensive annual foot examination that includes assessment of skin integrity, which the American Diabetes Association mandates for all diabetic patients 5
Risk Assessment Context
When evaluating fissured heels in diabetic patients, assess for:
- Loss of protective sensation using 10-g monofilament testing 5
- Peripheral arterial disease through pulse examination and ankle-brachial index if pulses are diminished 5
- Foot deformities that increase plantar pressure 5
- Signs of infection including erythema, warmth, tenderness, or purulent discharge 5
The presence of heel fissures, particularly deep fissures, places diabetic patients in a higher risk category requiring more frequent follow-up (every 1-3 months) and integrated foot care 5, 6.