Superglue for the Treatment of Heel Fissures

To the Editor:

Fissure formation is a common, painful complication of hyperkeratotic skin lesions of the foot. Healing is usually delayed because weightbearing causes mechanical tension perpendicular to the fissure, dissecting the new, soft layers of the stratum corneum as soon as they are formed. Standard treatment devices for keratotic diseases include abrasive tools, keratolytics, emollients, and accommodating insoles,1 but they are of limited utility once the fissure develops. The author investigated the role of Superglue (Duro/Loctite Corp, Hartford, Connecticut)—an inexpensive, rapidly bonding cyanoacrylate glue that is related to other surgical tissue adhesives—in the treatment of heel fissures.

The use of cyanoacrylate tissue adhesives such as Superglue has increased in clinical practice. Such adhesives have been shown to be effective in cases of retinal detachment,2 circumcision,3 gastric varices,4 and cardiac injuries.5 Studies have shown a woundbreaking strength comparable to that of suture-repaired wounds at 5 to 7 days,6 but the repair is probably stronger in thick, hyperkeratotic skin. Recent randomized trials in the emergency-room setting for select lacerations showed cyanoacrylate glue to be less painful and faster to use than suturing.7, 8 Tissue glues can provoke a histologic inflammatory reaction in highly vascular tissues,9 but have cosmetic results comparable to those of suturing7, 10 and are probably noninflammatory in avascular, hyperkeratotic skin.

Ten consecutive patients with 14 heel fissures were evaluated by the author and had their wounds repaired with liquid Superglue. The fissures were irrigated with water and then dried. Two to three drops of Superglue were carefully spread along the entire length of the fissure. Wound edges were approximated and held tightly in place with fingers or forceps for 60 seconds. All patients reported immediate relief upon weightbearing and were given no specific instructions on activity other than the avoidance of foot soaks for 1 week. Patients were seen in the clinic or contacted by telephone after 5 to 7 days, at which time all but two fissures were still closed and pain-free. The patients were then instructed to begin mechanical debridement of the hyperkeratotic skin to prevent fissure recurrence.

This trial demonstrates the success of Superglue in firmly closing fissures, immediately relieving pain, and preventing deepening of the injury, thereby allowing the underlying softer keratinocytes to mature into an intact keratin sheet of new skin prior to mechanical debridement.

HIRO HASHIMOTO, MD

Columbia University College of Physicians and Surgeons

Northern Navajo Medical Center US Hwy 666 North

Shiprock, NM 87420