Indian Journal of Dermatology
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ORIGINAL ARTICLE
Year : 2007  |  Volume : 52  |  Issue : 3  |  Page : 150-152
Treatment of fissure soles with occlusion using micropore tapes


1 Department of Dermatology, PSG Institute of Medial Sciences and Research, Coimbatore, India
2 Department of Community Medicine, PSG Institute of Medial Sciences and Research, Coimbatore, India

Correspondence Address:
C R Srinivas
Department of Dermatology, PSG Hospitals, Peelamedu, Coimbatore - 641004
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.35095

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   Abstract 

Fissure feet are a common condition; however, no effective therapy is available to date. This study was undertaken to study the effect of occlusion using 2″ micropore tapes in the management of fissure soles. The study was an open-paired, controlled study and included 26 volunteers with fissure feet. Fissures were graded separately over the right and left soles. All the volunteers were advised to wash their feet in tap water, air dry for 5 min before going to bed. To increase the tackiness of the tape, tincture benzoin was first applied and allowed to dry. The volunteers were educated to apply a 2″ micropore tape over the fissures at night on the right sole. The left sole was not taped and served as a control. The tape was removed the next morning and the fresh tape was again reapplied at night. The volunteers were advised to immerse the feet in water at room temperature and then remove the tape. Results were assessed after 15 days. Mc Nemar's X2 test was performed to determine the statistical significance. P value < 0.05 was considered to be statistically significant. The right sole (study) and the left sole (control) constituted a pair. Out of the 26 matched pairs, in 16 pairs, the study site showed improvement and the control site did not show improvement. Seven pairs did not show improvement over both study and control sites. Three pairs showed improvement in both study and control sites. Mc Nemar X2 value was 14.06 ( P < 0.001). Occlusion therapy is effective in the treatment of fissure soles.


Keywords: Fissure soles, hoop stresses, occlusion


How to cite this article:
Lakshmi C, Srinivas C R, Mathew AC. Treatment of fissure soles with occlusion using micropore tapes. Indian J Dermatol 2007;52:150-2

How to cite this URL:
Lakshmi C, Srinivas C R, Mathew AC. Treatment of fissure soles with occlusion using micropore tapes. Indian J Dermatol [serial online] 2007 [cited 2019 Sep 15];52:150-2. Available from: http://www.e-ijd.org/text.asp?2007/52/3/150/35095



   Introduction Top


Fissuring or cracking of feet is a common condition in the tropics affecting both the sexes. Fissuring may be minimal or severe enough to cause pain, tenderness and bleeding from the site. It could also serve as a portal of entry of organisms leading to lymphangitis and cellulitis (personal observation). Increased fissuring due to barefoot walking, occupational as in housewives and farmers has been reported. [1] Increase in fissure feet due to autonomic and sensory loss is reported among patients with diabetes and leprosy. [2],[3]

However, fissuring can occur in the absence of any of the abovementioned factors. The treatment of fissure feet includes keratolytics. In spite of being such a common condition in the tropics causing considerable distress, various treatment modalities have not been studied.


   Materials and Methods Top


Twenty-six female volunteers with fissure feet were considered. This was an open-paired, controlled study conducted over a period of 15 days.

Volunteers with a history of diabetes, hypertension, leprosy and other causes of peripheral neuropathy were excluded. The fissures were graded separately before and after treatment on the right and left sole from Grades 0-3 as graded by Sivakumar et al ., [1] i.e., Grade 0: no fissure; Grade 1: minimal superficial fissures; Grade 2: fissuring condition in between Grade 1 and 3; Grade 3: deep fissures. The right sole was the study site, whereas the left sole served as the control in each patient. All the volunteers were advised to wash their feet in tap water, air dry for 5 min before going to bed. To increase the tackiness of the tape, tincture benzoin was first applied and allowed to dry. [4] The volunteers were educated to apply 2″ micropore tapes over the fissures at night on the right sole, as shown in [Figure - 1]. The left sole was not taped and served as control. The tape was removed next morning, and fresh tape again reapplied at night. The volunteers were advised to immerse their feet in water at room temperature and then remove the tape. Results were assessed after 15 days.

Statistical analysis

The right and left soles in a patient constituted a pair. Improvement referred to a change in grading from a higher to a lower value. Mc Nemar's X 2 test was used to determine the statistical significance. A P value less than 0.05 was considered to be statistically significant.


   Results Top


Out of the 26 matched pairs, in 16 pairs, the study site showed improvement; however, the control site failed to show improvement. In seven pairs, both the study and control sites did not show improvement, and in three pairs, both the study and the control sites showed improvement. The Mc Nemar's X 2 value was 14.06 ( P<0.001), which was statistically significant.


   Discussion Top


The etiopathogenesis and treatment of fissures over the soles has not been effectively studied. The pathogenesis could be likened to the development of cracks in a barrel filled with fluid. Hoop stresses tend to make the barrel bulge outwards [Figure - 2]. If the material is not sufficiently resilient (elastic) (i.e., it is brittle), it cannot stretch and therefore tends to crack vertically. Similarly over the heel, vertically oriented fissures are developed when the overlying skin is unable to stretch. Dryness also may predispose to the formation of fissures. This can be likened to the cracks developing on parched earth during drought. Dryness causes a loss of cohesion between the corneocytes. The skin is less pliable to stretching and bending and cracks can occur as a result of this reduced elasticity. [5] Dry skin is characterized by a lack of moisture in the stratum corneum. For the skin to appear and feel normal, the water content of the stratum corneum must be greater than 10%. [6] When the skin becomes too dry, the outer skin layers stiffen and may develop cracks. The cracks become fissures into the skin that become irritated, inflamed and itchy. Palms and soles are more susceptible due to the anatomical variation in regulating water loss. [7] A higher percent of neutral lipids and lower percent of sphingolipids confer superior barrier properties. The plantar surface is known to be the most permeable surface, and it contained the highest amount of sphingolipids. [7]

Occlusion causes hydration, which enhances the rate of epithelialization. [8] A moist environment maintains a lateral voltage gradient that aids the repair process and causes fibroblast proliferation and increased collagen synthesis. [8] The dermal effects of occlusion is to accelerate the conversion from a predominantly neutrophilic infiltrate to a macrophage-rich infiltrate. [8] The oxygen gradient between the edge of the wound and its centre stimulates capillary ingrowth toward the relatively hypoxic centre. [8] The accumulation of heparin and TNF under occlusion may account for this enhanced angiogenesis. [8] The immersion of feet in water prior to removal of tape was advised in order to facilitate its removal. This had a mechanical cleansing action of stripping off the most superficial layers of stratum corneum. This could contribute to the beneficial effect obtained. Out of the 26 patients, 16 showed improvement in fissures at the occluded site, seven showed no improvement at both the occluded and unoccluded sites, and three showed improvement at both the control (unoccluded) and occluded sites. One patient developed contact dermatitis to the compound tincture of benzoin following its continued usage beyond 2 weeks. Gum mastic is a superior alternative. [9]

To conclude, occlusion with micropore tape is an effective treatment in fissures of the soles, and it helps to overcome the hoop stresses responsible for the development of fissures.

 
   References Top

1.Sivakumar M, Sivapriya N, Mathew AC, Chacko TV, Srinivas CR. Prevalence and correlates of fissure foot in a rural area in Tamil Nadu. Indian J Dermatol Venereol Leprol 1999;65:26-8.  Back to cited text no. 1    Medknow Journal  
2.Markandeya N, Martina V, Mathew AC, Srinivas CR. Sweat function in the diabetic foot. Indian J Dermatol Venereol Leprol 2004;70:18-9.  Back to cited text no. 2      
3.Ramu G, Ganapathy R. Leprosy: Classification, Clinical features and diagnosis. In : Valia RG, Valia AR, editors. IADVL Textbook and Atlas of Dermatology Vol 2, Bombay; Bhalani Publishing House 1994:1350-1371.  Back to cited text no. 3      
4.White SC. Padding and taping techniques In : Valmassy RL, editor. Clinical biomechanics of the lower extremities. Mosby: St Louis; 1996. p. 368-389.  Back to cited text no. 4      
5.Chernosky ME. Clinical aspects of dry skin. J Soc Cosmet Chem 1976;65:376.  Back to cited text no. 5      
6.Draelos ZD. Therapeutic moisturizers. Dermatol Clin 2000;18:597-607.  Back to cited text no. 6  [PUBMED]    
7.Lampe MA, Burlingame AL, Whitney J, Williams ML, Brown BE, Roitman E, et al . Human stratum corneum lipids: Characterization and regional variation. J Lipid Res 1983;24:120-30.   Back to cited text no. 7  [PUBMED]  [FULLTEXT]  
8.Choucair MM, Bello YM, Phillips TJ. Wound dressings. In : Freedberg IM, Eisen AZ, Wolff K, Austen KF, Goldsmith LA, Katz SI, editors. Fitzpatrick's Dermatology in General Medicine vol 2, 6 th ed. McGraw-Hill: New York; 2003. p. 2544-9.   Back to cited text no. 8      
9.Lesesne CB. The postoperative use of wound adhesives. Gum mastic versus benzoin, USP. J Dermatol Surg Oncol 1992;18:990.  Back to cited text no. 9      


    Figures

  [Figure - 1], [Figure - 2]



 

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    Abstract
    Introduction
    Materials and Me...
    Results
    Discussion
    References
    Article Figures

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