It's problem that we see often enough at our Clinic. It's also one that can affect the self-esteem of the client because of the 'state' of their feet. Fissures result from severely cracked heels, and usually occur on both heels. While this condition isn't critical for some, people with diabetes; poor circulation; and those with immunosuppressant diseases can have major consequences.

The majority of people with heel fissures tend to be overweight, or wear mainly sling back shoes and slippers. With backless shoes, all the body fat and skin are displaced laterally, and tend to become callused. Since callused skin is not healthy skin, cracking will begin and fissures will form.

Because a fissure is a split in the skin, it's prone to infection. Infection can occur because the foot is usually subject to dirtier surrounding environments than the rest of the body, and bacteria can easily invade these fissures.

Symptoms

• Very thick calluses on the rim of the heel

• Discolouration on the heel, usually yellow or dark brown coloured skin

• Painful walking with a thin soled or open back shoe

• Itchy feet

• Peeling or cracked skin

• Flaky or red patches

• Bleeding (severe cases)

Risk Factors

• Living in a dry climate

• Obesity

• Inactive sweat glands

• Consistently walking barefooted

Causes

• Prolonged standing at work or home – Having hard floor surfaces may also contribute to the problem.

• Being overweight – There is a fatty pat under the heel and once overweight, there is an increase of pressure in that area. This causes the heels to expand. If it lacks flexibility, there is high pressure on the area.

• Sling back shoes - These allow the fatty pad to expand sideways due to improper support.

• Ill-fitting shoes

• Skin problems like eczema, psoriasis

• Diabetes, thyroid diseases

• Inactive sweat glands

• Vitamins, minerals and zinc deficiency

• Poor hygiene habits

• Mal-alignment of the metatarsals

• High arched or flat feet

• Athlete's foot

• Lack of foot maintenance

Complications

• Cellulitis

• Diabetic ulcer

Treatment Options/Preventative Measures

In an otherwise healthy individual, this problem can be easily remedied. But as stated earlier, in the diabetic or person with poor circulation for example, susceptibility to infection increases; this minor problem can then become major. The reality is that in those situations, the body is not able to heal the infection (or heal it quickly), and that is what can lead to gross outcomes.

There are a number of key things can be done to help prevent cracked heels…fissures. Most of them are based on the fact that fissures are basically a result of skin being far too dry. In order to restore moisture to your skin and help your skin retain it, you can undertake one or more of the following procedures to help in the prevention of the fissures:

• Begin drinking additional water. Some experts have long recommended that adults should drink at least eight glasses of water per day. However, that is a minimum amount of water needed to maintain health.

• Eliminate patches of dry skin through the use of a foot file. The best place to use one is generally in the shower or bath since at those times your skin will already be naturally softened because of the excess moisture. Gently rub the foot file across your heels in order to remove dry, dead skin cells. Do not expect a single application of this process to work wonders; it will take time and patience to reveal the underlying skin, which should be soft and smooth if all these recommendations are followed.

Use moisturiser on your feet, but follow these guidelines:

• Use a lotion/cream designed for deep or intense moisturising.

• Moisturise your feet twice daily.

• Until the fissure is gone, if it's a serious one, moisturise and sleep with socks to trap the moisture.

• Be cautious of engaging in vigorous physical exercise if you already have serious fissures. The pressure of activities like running, since you would be pounding your feet against hard surfaces, can cause the fissures to deepen further. Walking is generally acknowledged to be a safer option until your fissures have healed.

• In many instances avoiding open back shoes and only wearing closed shoes does not remedy the problem, as the fatty pad under the heel still expands too much laterally, even in the closed shoes. The best way to help keep the fatty pad under the heel and allow the skin to mend is through the use of a heel cup or arch supports.

• Do monthly pedicures.

• A deep, serious heel fissure should be seen by your physician/podiatrist/chiropodist/foot health practitioner.

Your feet mirror your general health . . . cherish them!

Leana Huntley is an English trained foot health practitioner attached to ALMAWI Limited – The Holistic Clinic. Call to make an appointment at 662-1732 or lhuntley@almawiclinic.com Tuesday - Saturday. Check for the Clinic at www.almawiclinic.com.