Cracked Heels?

Definition

Cracked Heels are a common foot problem also referred to as 'heel fissures'. Cracked heels are commonly caused by dry skin (xerosis). The symptoms are worse when the skin around the rim of the heel is thick (callous).

Description

Callus is simply a build up of skin that forms in response to irritation or friction e.g where a shoe repeatedly rubs against one part of the foot. Callus can be thick or thin and forms in many shapes and patterns. Thickening Callus can be a cosmetic problem when it forms on the heel. Cracks or fissures that occur within the Callus can be more serious and if left untreated may become deep, painful, infected and begin to bleed. Heel fissures are found at the junction of two types of skin; the skin of the bottom of the foot and the skin of the side of the foot. Heel fissures can be limited to just one side of the heel or wrap around the entire heel. Heel fissures are particularly troublesome for people with diabetes as this disease causes poor sensation and impaired wound healing in the foot area. Cracked Heels may, in some cases be known as pitted keratolysis. This is caused by a bacterial infection of the skin usually involving the weight-bearing portions of the soles of the feet, and characterised by the formation of shallow, round pits, some of which can form fissures. It is not known what causes a person to develop pitted keratolysis.

Cause

In some cases a person may have naturally dry skin that increases the risk of Cracked Heels. Callus that forms around the heel is prone to cracking due to mechanical factors that increase pressures in that area e.g the way a person walks. An illustration of this is to consider a tomato on the bench. When the tomato is pushed on from above, it wants to expand out sideways and eventually the skin cracks. This is what happens to the normal fat pad under the heel as the body weight pushes down, the fat wants to expand sideways and the pressure on the skin to crack is increased. Other factors that can be involved in the cause of Cracked Heels include: * Prolonged standing at work or home, especially on hard floors. * Being overweight - this increases the pressure on the normal fat pad under the heel, causing it to expand sideways. If the skin is not supple and flexible, the pressures may cause the skin to crack. * Open-back on shoes. This allows the fat under the heel to expand sideways and the pressure may cause the skin to crack. * Certain medical conditions cause the skin to become dry and cracked eg diabetes or an underactive thyroid. * Skin conditions such as psoriasis and eczema.

Treatment Options

As with all conditions your Doctor should be consulted to diagnose and treat this condition. If the cracking is severe or fissures have formed it is advisable to seek the advice of a Podiatrist or Dermatologist. The treatment of Cracked Heels may involve the following: * Investigation of the cause of the problem, so this can be addressed * Removal of the hard thick skin to promote healing. This may need to be done on a regular basis. * If Cracked Heels are very painful, strapping may be used to 'hold' the cracks together during the healing process. * Advice regarding the most appropriate moisturiser or emollient. * Advice about footwear and prevention of the problem. * Insoles may be recommended to alter the way you walk to prevent callus from developing on the heels. * A heel cup may be used to keep the fat pad from expanding sideways. This is worn in the shoe and can be a very effective preventative measure if used regularly. * In severe cases a Podiatrist may use a tissue 'glue' to hold the edges of the skin together to enable the cracks to heal.

Pharmacist's Advice

Ask your Pharmacist for advice. 1) Your pharmacy stocks a range of moisturisers and emollients to keep the skin on the heel supple. 2) Ask your Pharmacist to recommend a suitable cream to soften the heel skin and calluses. A urea-based cream may be recommended. 3) A pumice stone from your Pharmacy may help to reduce the thickness of hard skin by gently removing callous build up from the heels and soles of the feet when used regularly. 4) To avoid excessive pressure on the heel it is important to avoid open backed or thin soled shoes. 5) Avoid removing callus yourself with a razor blade or a pair of scissors as these techniques can remove too much skin and increase the risk of an infection developing. 6)Try to apply the moisturisers and emollients after bathing as skin moisture will be retained more effectively. PUMICE STONE Moisture and emollients in the market