Cracked Heels 101

Cracked heels, or fissuring as it is sometimes called, are a condition that is sometimes overlooked by many.

Your skin becomes cracked, usually around the heels but your skin can crack on other parts of the foot.

Unfortunately what cracking does is that it stop the greatest defense system from working effectively. Your skin is great in stopping anything from getting at your internal workings. And if broke, that system can fail.

Cracking of the skin states that there is a problem. Your skin should not crack readily, so cracking is an indication that there could be a lack of moisture making the skin dry and inelastic, or it could suggest that there is too much pressure going through or coming into contact with that specific area.

When most people have a crack, they tend to leave it. Unfortunately, this is not what is supposed to happen. This cracking is an alert system- your body is trying to tell you that something is wrong.

So most people continue to walk on that crack and eventually through different processes that crack can make the skin underneath bleed.

Bleeding states that the skin has been breached and now organisms can invade and it is not uncommon for a bacterial infection to develop into that area.

What Cause Cracked heels?

Here are the main reasons why we get cracked heels:

• Because we are overweight.

Unfortunately the bigger we get the more pressure we put on our heels and especially our heels. Our feet can only handle so much, and time and time again we have seen overweight patients have problems with their heels- ranging from heel spurs all the way through to the very common cracked heels.

• We wear some really poor shoes.

Now I have seen people wear high heels, and shoes that are just material around their foot or even slippers all day, and they wonder why they have heel problems. Sometimes just a change in shoes will help, but unfortunately, most patients will say “these are comfortable” or “I paid a lot of money for these”. Well, that is the cause of your foot problem.

• Medical illnesses.

Now, these are ones that increase hard skin deposition- e.g. Psoriasis, decrease the skin viability- Rheumatoid Arthritis or reduce the skin’s natural sweating mechanism, making the foot dryer- Diabetes/ underactive Thyroid. Read more about foot diabetes.

• Age.

I do not like to use age as a reason because a lot of medical professionals do, and patients get fobbed off with the “age reason”. But unfortunately, age does play a small part to play in heel cracks. As we get older the elasticity in our skin decreases and the moisture content reduces. Also, many older people are on medication and have illnesses that can affect the skin in many different ways. Also as we get older, our “fatty padding protection” reduces. The fatty padding is a “cushion” that protects our feet where stress is more likely to occur. The best place to feel it is under the balls of your feet- it should be quite squishy. As we get older this fatty padding area reduces and moves, now revealing high-stress areas.

• Season.

Probably should come under poor footwear, but every summer the number of people, especially women, who have cracked heels, goes up- guaranteed. Sandals and flip-flops are the main cause- little support and cushioning are the perfect environment for crack heels to thrive. That “slap slap” nature of the sandal on your heel with a plastic sole is not a good idea.

• Season (part 2).

We have air conditioners in the summer and forced air in the winter. These artificial environments dry us out causing our skin to be more mechanically susceptible.

• Mechanical misalignment.

Some people build up hard skin because they are mechanically misaligned. In other words, stress is going a little bit more on one area than it should. Now you may not notice it now, but over time and if you include any of the above factors then you may just notice hard skin be laid down that little bit more.

• Working environment.

Some people are standing all day or walking on hard floors all day. This adds pressure to your feet from above and from below. Store clerks, warehouse, and factory workers seem to be most affected.

• Unfortunately neglect can play a part.

If someone can not get down to their feet to treat themselves then the problem only gets worse. Neglect is not that uncommon. If someone has a poor foot problem they tend to cover it up, wearing socks and shoewear all the time. It isn’t until they become so much in pain or a family member/ health worker insists on checking their feet then the problems are discovered.

It would be nice and simple if the cause is just one thing, but usually, that is not the case. You tend to find multi-factorial issues and patients usually solve one but not the other. So some patients can easily be overweight AND Diabetic which is a bad combination. However, reducing weight will help with Diabetes which in turn will help with the feet and other body systems.

Treatment for Cracked Heels

So here are 6 ways to help dry skin.

• Use moisturizing cream. Many patients use some weird concoctions, but anything with “moisturizing” in it helps.

• Before you use your cream on some dry skin, make sure that you buff the area beforehand. Find a foot file and then buff the area when your feet are dry, rather than wet because more skin will come off (but not down to being sore). What you tend to find is that many patients will cream the dry skin, all they are doing is moisturizing the dry skin rather than their proper skin.

• Once you do have a moisturizing foot cream, use it. Many people do not, and if they do they apply the cream once or twice a month. When we have a bath/ shower water and soap they are designed to remove oils and dirt so our skin becomes dry. So you need to be applying the moisturizer once a day. If you have regular problems, then apply twice a day. The best time to cream your feet is when you are watching TV- have your feet up drying so you don’t walk around the house- or even going to bed and messing up your sheets.

• If you are prone to dry skin, creaming your feet is going to be a regular thing.

• If you have been using a cream for years and you don’t get any results from it, change it. Use that for a month, then change that. See which cream suits you.

• The best cream has “urea” in it. Urea adds moisture and also slightly removes dry skin from the area.

If you suffer from various medical conditions you might be fighting a losing battle. However, if you don’t moisturize then the problems could be much worse. If you are Diabetic make sure that your blood sugars are consistently level (between 4-7).

If you suffer from Psoriasis or some other condition that accelerates skin production, then seeing your Doctor for a specific moisturizing cream will help. These creams will be called Keratinolytics. Skin is made of keratin and what it does is gently remove the hard skin through a chemical method.

If you are overweight, then the best method is to reduce weight, which is harder said than done. Fad diets rarely work, it is up to you to start. Simple chair exercises are helpful, swimming even keeping a diary on what you eat through the days.

Shoewear- change them if they are causing a problem. If we could all wear running shoes then that would be great. Running shoes are designed to be comfy and designed to be walked upon. Sandals are a problem because there aren’t that many good sandals that have a cushioning base. Croc type of sandals are ok, but they are still made out of a plastic-type of material- not really that cushioning.

If you are elderly or have “boney feet” then orthotics can help. Simple orthotics (called insoles) that just have layers of cushioning that will “add back” the cushioning layer. Over-the-counter orthotics are very hit and miss- some patients even use “lambswool” insoles which do nothing apart from making your feet slightly warmer. Memory orthotics are the right idea- these will slightly reduce under pressure but will go back to their original shape when the pressure has been released.

If you are overweight or have a mechanical problem, then functional orthotics can help. Unfortunately largely overweight people can usually find little comfort in some orthotics because they deform, so special orthotics are needed. Orthotics can help only if you need them- which is an odd saying, but a lot of people jump for the orthotics first- and usually, they do not need them.

Orthotics are good for people with a mechanical problem which can be identified by a Chiropodist/ Podiatrist.

Ultimately it can become too much. Sometimes all the cream and all the filing in the world will not get rid of the heel crack pictures 2 & 3 that were first identified in our introduction.

Sometimes the only way to remove heel cracks is by professional care. The picture below shows a before and after. The picture comes from an anonymous site:

cracked heels treatment

These were (hopefully) debrided (reduced) with a scalpel blade. You may notice the healthy tissue in the right picture .i.e. it’s not yellow. However, the work is of poor quality and I am glad that it is here.

You may notice ridging- non-uniform debridement- this can cause areas of high pressure. Also, the edges of the heel fissure have not been reduced well and the main thing:

The fissures within the cracked heels (the cracks themselves) themselves have not been reduced. We can still see lines within the hard skin. This allows for irritation, and the problem to reoccur quicker.

Professionals tend to forget that the fissures are hard skin themselves:

cracked heels treatment

The above (anatomically astoundingly close to perfection 🙂 ) picture shows 2 heels.

When the left picture the cracked heel is debrided without reducing the fissure, the fissure is still present and still can cause problems. From the outside, the heel looks like it has been reduced.

The right cracked heel picture shows another heel debrided, this time the fissure has been reduced, but now it only shows an outline of where the fissure used to be. This is a far better treatment method for a couple of reasons:

1- Less pain and discomfort. If the cracked heels have not been debrided, initially you will find that the heel will be ok, but as time goes on that fissure will start to irritate and if the crack caused bleeding before, bleeding will commence again- because the problem has not been addressed.

2- Less frequent visits. If the job has been done properly then you, the patient, can go without appointments for longer. One patient had every 4 weeks appointments, they came to see us and we increased their visit time to 8 weeks. If the patient started to do things for themselves then that time period would only go up.

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