cracked heels

see also:

• dermatology
• hyperkeratosis / thickened skin / ichthyosis / lichenification

• cracked heels are common and can not only be a cosmetic issue, but can be painful and if severe deep fissures, can become a site for infection and cellulitis although this seems less common than would be expected due to the general superficial nature of the fissures, but in diabetics can also lead to diabetic foot ulcers

• essentially they are an excessive skin callosity around the heel resulting from bulging out of the heel fat pad
• this is further exacerbated by dryness of the skin whether physiologic or pathologic from underlying skin conditions

• biomechanical conditions which push the heel fat pad laterally
  • genu varum (bow-leg)
  • tibial torsion
  • foot conditions such as flat feet may distribute weight unevenly
• genetic predisposition in some people
• dry skin conditions such as atopic dermatitis, juvenile plantar dermatosis, palmoplantar psoriasis and palmoplantar keratoderma
• systemic conditions such as diabetes, hypothyroidism
• obesity
• aging - aging skin becomes less elastic

• factors which further dry the skin - eg. barefoot in sand, dust; swimming pool chlorine; climate - summer is usually worse;
• prolonged standing or walking on hard surfaces
• wearing open-back sandals which do not provide adequate support for the heel pad and allows it to bulge further outwards

• avoid prolonged standing, exposure to drying agents (eg. sand, dirt)
• wear shoes with an encompassing rear side support for the heel
• orthotics or perhaps taping to prevent the lateral movement of heel fat pad for those with bio-mechanical issues such as genu varum
• regular moisturiser 2-3 times a day especially at first signs of thickening of heel skin
  • once a week, soak feet in warm water for 10-15minutes which will hydrate and soften skin to allow the pumice stone to be more effective - consider adding vinegar or an essential oil to the foot bath
  • exfoliate by gently rubbing with a pumice stone prior to moisturising
  • use thick creams or ointments not a lotion
  • after applying a night time application, cover heel to increase hydration eg. cotton sock or silicone heel covers

• use of heel balms containing a keratolytic to reduce build up of thick callous skin or those with water-retaining properties to reduce drying
  • urea
  • salicylic acid
  • alpha-hydroxy acids
  • saccharide isomerate

• Grind a handful of rice until u get a fine but coarse flour.
• Add a few spoons of raw honey to the mixture along with enough apple cider vinegar to obtain a thick paste.
• If the cracks are very deep, add a spoon of olive oil.
• Soak feet for 20 minutes & gently massage with this paste.

• paraffin wax baths
  • dip heels in warm wax and remove foot
  • leave for 10 minutes
  • gently peel off the wax which acts as an emollient

• debridement of thick skin
• strapping with bandages
• use of insoles / heel pads / heel cups
• for deep fissures, application of liquid or gel skin cover may reduce infection and ease pain