Year : 2007 | Volume
: 52 | Issue : 3 | Page : 150--152
Treatment of fissure soles with occlusion using micropore tapes
Chembolli Lakshmi1, CR Srinivas1, Anil C Mathew2,
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
C R Srinivas
Department of Dermatology, PSG Hospitals, Peelamedu, Coimbatore - 641004
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«SQ»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.
|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;52:150-152
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Lakshmi C, Srinivas C R, Mathew AC. Treatment of fissure soles with occlusion using micropore tapes. Indian J Dermatol [serial online] 2007 [cited 2020 Oct 31 ];52:150-152
Available from: https://www.e-ijd.org/text.asp?2007/52/3/150/35095
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.  Increase in fissure feet due to autonomic and sensory loss is reported among patients with diabetes and leprosy. ,
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
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 .,  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.  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.
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.
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  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%.  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.  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. 
Occlusion causes hydration, which enhances the rate of epithelialization.  A moist environment maintains a lateral voltage gradient that aids the repair process and causes fibroblast proliferation and increased collagen synthesis.  The dermal effects of occlusion is to accelerate the conversion from a predominantly neutrophilic infiltrate to a macrophage-rich infiltrate.  The oxygen gradient between the edge of the wound and its centre stimulates capillary ingrowth toward the relatively hypoxic centre.  The accumulation of heparin and TNF under occlusion may account for this enhanced angiogenesis.  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. 
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.
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