Heel Fissures
Definition
Heel fissures, also known as cracked heels can be a simple cosmetic problem and a nuisance, but can also lead to serious medical problems. Heel fissures occur when the skin on the bottom, outer edge of the heel becomes hard, dry and flaky, sometimes causing deep fissures that can be painful or bleed.
Causes
Heel fissures can affect anyone, but risk factors include: Living in a dry climate Obesity Consistently walking barefoot or wearing sandals or open-backed shoes Inactive sweat glands Like many foot conditions, heel fissures can become more dangerous if they go untreated and become deep or infected. This is especially dangerous for people with diabetes or compromised immune systems.
Some people tend to have a naturally dry skin that predisposes them to the cracks. The thickened dry skin (callus) around the heel that is more likely to crack is often due to mechanical factors that increase pressures in that area (eg the way you walk).
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 to ‘crack’ are high)
• open back on the shoes (this allows the fat under the heel to expand sideways and increases the pressure to ‘crack’)
• some medical conditions predispose to a drying skin (eg autonomic neuropathy in those with diabetes leads to less sweating; an underactive thyroid lowers the body’s metabolic rate and there is a reduction in sweating, leading to a dryness of the skin)
• skin conditions (eg psoriasis and eczema)
Treatment and Prevention
Moisturizing the feet regularly can prevent heel fissures. Once they occur, you can use a pumice stone daily to gently decrease the thick and flaky layer of skin. Avoid going barefoot or wearing open-backed shoes, sandals or shoes with thin soles. Shoes with strong shock absorption can help to improve the condition. Moisturizing the feet at least twice a day and wearing socks over moisturizer while sleeping can also help.
There is basically no cure for heel fissures. A better alternative is to prevent them by preventing deep, painful cracks. This is best done through continuous maintenance and foot care like periodic debridement after a shower and soaking your feet.
Also make it a point to regularly use softening creams having softening agents to moisturize the foot. Creams having additives like urea or salicylic acid help to chemically debride the callus.
You could also try using heel pads or cups to redistribute the weight of the heel over a broader area. It is better to avoid going anywhere barefoot and to wear open backed shoes or sandals or shoes having thin soles.
Even shoes with strong shock absorption help in improving the condition. As an added preventive measure for heel fissures, wear socks over your moisturized feet before sleeping.
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