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Cracks and fissures

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What are Cracks and fissures? Breaks in your skin, the result of skin that is too dry to too moist.

Cracks and fissures are breaks in your skin. They may be the result of skin that is too dry to too moist. When skin is too dry, it can become rough and flaky. A large fissure often forms at the base of the heel. When skin is too moist, you may get a bacterial or fungal infection. This can cause cracks between the toes. People who often walk barefoot or wear open shoes are at risk for dry skin. People who wear shoes without socks or shoes and socks that don’t breathe well are at risk for moist skin problems. Your Podiatrist can treat your cracks and fissures.

Definition: ‘deep epidermal cleft that penetrates to dermis; frequently painful and may become infected; may complicate fungal foot infections; treated by addressing the underlying cause’ (Mooney, 2009:133).

Clinical Features: fissures may appear as moist or dry cracks in the epidermis at sites where skin is under tension, such as between the toes or on the heels and may extend into the dermis and introduce infection. The fissures are formed at 90 degrees to the direction of the tension stress (Frowen, 2010). There may be associated blistering of the soles and moist fissures are common to develop interdigitally (Merrimen, 2002). 

Cause: moist fissures can be found in areas of excessive hydration which usually displays as macerated skin. This can be due to occlusive dressings applied, long term immersion in water or poor personal hygiene (Merrimen, 2002). The quality of the skin can also be affected by systemic and peripheral states such as peripheral vascular disease, systemic sclerosis, dermatitis, psoriasis and tinea pedis (Frowen, 2010). 

Management: Remove the cause i.e. the allergen or encourage the use of treatments associated with tinea pedis such as skin (Daktarin antifungal sprays or creams) and footwear treatments (Mycil powders) (Frowen, 2010). Improving the epidermal strength can be beneficial, by controlling the water saturation of the stratum corneum. The hyperhidrotic skin needs to be dehydrated with astringents (IMS) or antiperspirants (aluminium chloride),care should be taken on application (Frowen, 2010). Deep fissures can also be closed using medical-grade acrylic glue, adhesive skin closure, hydrocolloid wafer or strapping (Frowen, 2010).

References: Frowen, P., O’Donnell, M., Lorimer, D. & Burrow, G. (2010) Neale’s Disorders Of The Foot. 8th ed. London: Churchill Livingstone Elsevier. pp.28,

Merriman, L.M. & Turner, W. (2002) Assessment of the Lower Limb. 2nd ed. London: Churchill Livingstone pp227, 439 

Mooney, J (2009) Illustrated dictionary of Podiatry and Foot Science, Churchill Livingstone Elsevier, London.

Skinsights (2015) ‘Athletes foot’ [On line available]

http://www.skinsight.com/adult/tineaPedisAthletesFoot.htm (Accessed 21/11/15).