A Gentle Touch: Homoeopathy for Treating Plantar Fissures

Dr Chrisel Jenicia Dsa

ABSTRACT
A plantar fissure is a condition in which deep cracks or splits form in the skin of the feet, particularly on the heels. These fissures usually occur due to dry, thickened skin and are very painful. In addition to discomfort, severe cases of plantar fissures may lead to infections if not properly treated. The primary causes of plantar fissures include prolonged standing, improper footwear, obesity, and environmental factors like cold and dry weather.

Conventional treatments for plantar fissures often involve moisturizing creams and protective foot care. Homoeopathy offers an alternative approach. Homoeopathy focuses on treating the root causes of the condition by stimulating the body’s own healing mechanisms. Remedies such as Graphites, Silicea, and Hepar sulph may be prescribed, depending on the specific symptoms and overall constitution of the individual.

Keywords: Cracks, dry skin, plantar fissure, moisturizer.

Introduction
A plantar fissure, commonly referred to as a cracked heel or fissured heel, affects the skin on the soles of the feet.

What Are Plantar Fissures?
Plantar fissures are cracks or splits in the skin on the bottom of the feet, particularly around the heels. The thick, tough skin of the feet can develop deep cracks, often caused by dryness, pressure, and friction. These fissures can vary in severity, from shallow cracks to deeper ones that cause significant discomfort or bleeding. Heel pad has an important role as shock absorber by reducing and transmitting impact force ^[1].

While plantar fissures are more commonly seen on the heels, they can also occur on the sides of the ball of the foot. Plantar fissure gets worse during colder months when skin tends to be drier.

Causes of Plantar Fissures
Dry Skin: when exposed to cold weather or air conditioning feet get prone to dryness. Dry skin lacks moisture and elasticity, results cracking feet.

Pressure and Friction: Standing or walking for long periods, especially on hard surfaces, can put excessive pressure on the heels. This leads to the thickening of skin

Obesity: Because of the overweight there will be more pressure on the feet, particularly on the heels, causing the skin to stretch and crack.

Improper Footwear: Shoes that don’t fit properly or lack cushioning.

Medical Conditions: diabetes, hypothyroidism, eczema, or psoriasis, can cause dry, cracked skin. These conditions may impair the skin’s ability to heal, leading to more severe fissures ^[2] .

Standing or Walking Barefoot: loses natural moisture ^[3].

Age: As people age, the skin’s ability to retain moisture decreases.

Clinical fissure:

• Cracking or splitting of skin.
• Pain on walking and standing for a long time.
• Deep cracks can lead to bleeding.
• If the severity increases there will be swelling around the fissure.
• Thickened skin around the heel called callus.
• Skin feels dry and rough on the touch ^[4].

Complications:

• Open cracks in the skin provide an entry for bacteria, increasing the risk of infection.
• Severe cracks can make it difficult or painful while walking.

Differential diagnosis

1. Calluses (Hyperkeratosis)

Calluses are thickened skin that occurs due to prolonged friction. More common in feet and can turn dry and thick which later crack and resembles plantar fissures.

Ruling out point: Calluses are usually painless. They are uniform in appearance and do not bleed unless the cracks are deep.

2. Plantar Warts

It is caused by human papillomavirus (HPV) and develops due to pressure points on the feet. These appear as rough, raised areas ^[5].

Ruling out point: Tiny black dots often appear raised above the surrounding skin.

3. Eczema

The Skin on the feet becomes dry, red, inflamed and crack. In this condition, it involves itching and scaling.

Ruling out point: eczema can occur anywhere in the body whereas plantar fissure is localized to heels or soles.

4. Psoriasis

It is an autoimmune condition that causes silvery scaling, thickened and cracked skin.

Ruling out point: It has silver or white scales, which are absent in typical plantar fissures.

5. Fungal Infections (Athlete’s Foot)

It is a fungal infection caused by dermatophytes and can lead to peeling, cracking, or fissuring of the skin, particularly between the toes or on the soles of the feet.

Ruling out point: It is associated with fungal symptoms such as itching, burning, and redness. Intense itching and eruptions mainly between toes.

6. Diabetic Dermopathy

Affects individuals with diabetes and is characterized by scaling patches on skin which appear usually light brown.

Ruling out point: pain is less compared to plantar fissure and is associated with diabetes.

7. Contact Dermatitis

When there is a reaction to specific allergens or irritants such as chemicals, soaps. It causes redness, itching, swelling, and cracking of the skin.

Ruling out point: associated with the history of exposure to allergens.

General treatment:

1. Moisturizing the Skin

The most important step in healing plantar fissures is to moisturize the feet. Thick creams or balms containing urea, shea butter, or petroleum jelly can help restore moisture to dry, cracked skin [5]. Coconut oil can be used as it has wound-healing properties and shows significant improvement in skin hydration ^[6,7].

2. Exfoliating the Skin

Exfoliating the feet can help remove dead skin cells and prevent the buildup of calluses. A pumice stone or foot file can be gently used to remove thickened skin.

3. Using Foot Soaks

Soaking the feet in warm water with Epsom salts or essential oils can help soften the skin.

4. Wearing Proper Footwear

Shoes with cushioning and adequate arch support can help reduce pressure and friction on the heels. Avoid wearing open-back shoes or sandals that can expose the heels to excessive stress ^[6].

5. Lifestyle Changes

Avoid prolonged standing or walking. Weight management for obese and overweight people.

HOMOEOPATHIC APPROACH:

1. Graphites

Graphites may be particularly helpful if the fissures are accompanied by itching, burning sensations, or oozing of a sticky fluid.

Cracked, rough, and dry skin on the heels; fissures that ooze sticky discharge; the tendency for skin conditions like eczema or psoriasis ^[9].

2. Silicea

Silicea can help promote faster healing of cracks and improve skin integrity.

Deep, painful cracks in the skin; poor healing of wounds or fissures; tendency for slow healing of skin lesions ^[10].

3. Calendula

Calendula, derived from the marigold plant, is frequently used in homoeopathy for its healing properties, particularly for skin injuries.

Cracked, inflamed skin that is sore and sensitive; deep, healing wounds or fissures; used both internally and externally for skin healing.

4. Sulphur

Sulphur is often recommended for individuals with very dry, rough skin that is prone to itching, burning, and cracking.

Dry, cracked, itchy skin; burning sensations; cracked heels that are red and inflamed; skin that is prone to infection ^[9,10].

5. Urtica Urens

Urtica Urens is a homoeopathic remedy made from stinging nettle, and it is typically used for skin conditions that involve burning, itching, and irritation.

Burning and stinging sensations in the heels; red and swollen feet; intense itching and discomfort.

6. Arnica Montana

Arnica is often used for healing bruising, soreness, and trauma.

Cracked heels or painful fissures after excessive physical activity or injury; soreness and swelling around the heels ^[9,10].

Conclusion
Plantar fissure is a common problem especially those individuals who have dry, cracked skin on their feet. Identifying the cause is most important in treating the case of plantar fissure. Homoeopathic treatment is individualized and every symptom is important for constructing the totality of the symptoms and proper treatment plan. Combining both management and homoeopathic remedies significantly helps to improve the healing process and prevent its recurrence.

Reference:

1. Longhurst B, Steele C. Dry heel fissures: treatment and prevention. Dermatological Nursing 2016, 15(3): 46-49
2. Harrison-Blount M, Hashmi F, Nester C, Williams AE. The prevalence of foot problems in an Indian population. The Diabetic Foot Journal. 2017;20(2):95-102
3. Pawar M. The title of the paper: Treatment of painful and deep fissures of heel with topical timolol. J Am Acad Dermatol. 2020.
4. Nall R. What are the symptoms of heel fissures? Available from: https://www.healthline.com/health/whatare-heel-fissures
5. Kate Carter AM, Judith Anders, Martin Grant, Elizabeth Cheek. A study to assess a cosmetic product in the treatment of cracked heels among diabetics. Dermatological Nursing. 2013;12(3):44-50.
6. Choi JY, Kim EJ, Jang SI, Kim AR, Lee TJ, Lee HK. A new technique for evaluating heel xerosis grade and the effects of moisturizer on heel skin dryness. Skin Res Technol. 2018;24(4):557-61.
7. Poljsak N, Kreft S, Kocevar Glavac N. Vegetable butters and oils in skin wound healing: Scientific evidence for new opportunities in dermatology. Phytother Res. 2020;34(2):254-69.
8. Agero AL, Verallo-Rowell VM. A randomized double-blind controlled trial comparing extra virgin coconut oil with mineral oil as a moisturizer for mild to moderate xerosis. Dermatitis: contact, atopic, occupational, drug. 2004;15(3):109-16
9. Kent JT. Lectures on homoeopathic materia medica. New Delhi, India: Jain Publishing Company; 1980.
10. Boericke W. New manual of homoeopathic materia medica and repertory. B. Jain Publishers; 2002

Dr Chrisel Jenicia Dsa
PG Scholar, Dept of Paediatrics
Dr Jyoshna Shivprasad  Professor, head of the Department, Department of paediatrics
Fr Muller Homoeopathic Medical College and hospital, Mangalore
Email: chriseljeniciadsa@gmail.com