Fissures of the heel and soles, commonly referred to as cracked heels or chapped soles are very common, especially during the winter season when the skin tends to become dry. Although any part of the soles of the feet may be affected and become chapped or crack, it is the heels that are more commonly affected. The condition is also more common in females than males mainly due to wearing shoes that unevenly distribute the body weight and shoes that are opened at the back. Hormonal factors may sometimes be involved.
Not only are cracked heels and soles unsightly to look at, they can cause pain or discomfort in the feet. Bleeding may occur in severe cases. Infection may also occur, particularly if the person is diabetic. Simple measures such as proper foot care, with particular emphasis on keeping the feet well-moisturized, may help to prevent cracked heels and soles of the feet. If not dealt with early, the skin around the heels may become thick and callused with deep fissures in it, which will make healing more difficult.
Causes of Cracked Heels
Dry skin may predispose to development of cracked heels. Callus (dry, thickened skin) formation around the heels may lead to cracked heels. This can be caused by pressure on the heels caused by prolonged standing. Increased pressure on the fat pad under the heel makes it expand sideways which ultimately leads to splitting or cracking of the callus. Obesity may be another predisposing factor. People who go barefoot or those wearing sandals or shoes that are open at the heel are more prone to cracked heels.
Skin conditions such as eczema and psoriasis may cause this problem. Medical conditions such as diabetes and thyroid problems may also predispose to cracked heels. Sweating of the feet for a prolonged period wearing socks or shoes may make the feet soggy, as well as working barefoot in damp or waterlogged conditions. This may cause the heels to crack. Fungal infections can further aggravate the problem.
Symptoms of Cracked Heels
The initial symptom of cracked heels is callus formation around the heel. The skin will be thickened, dry, and hard and small cracks may be seen over it. If neglected at this stage, the cracks will become deeper and can cause pain or discomfort on standing or walking. Bleeding may occur from deep cracks. The cracks may become infected and result in cellulitis in severe cases.
Neuropathic changes in diabetic patients often result in decreased sensation in the feet. In such cases, even severely cracked feet may be ignored due to lack of pain sensation. Such patients are at risk of developing foot ulcers which are often difficult to heal.
Treatment of Cracked Heels
A little care can help to prevent cracked heels. Keeping the heels well-moisturized, especially in the winter months or in dry weather, can not only prevent the formation of calluses and cracked heels, it can heal the condition in the initial stages. Soaking the feet in warm water for 10 to 15 minutes, followed by rubbing gently with a pumice stone can remove the thickened skin. This may be followed by application of a moisturizer to keep the feet soft and smooth. Heel balms containing keratolytic or water-retaining agents may be used, such as urea, salicylic acid, alpha-hydroxy acids, or saccharide isomerate. In case of deep fissures, a liquid, gel, or spray bandage can help to protect the area and allow it to heal, as well as relieve pain.
A podiatrist may be consulted in severe cases that are not amenable to the above measures. Treatment may involve :
- Identifying the cause and treatment of the underlying condition such as diabetes.
- Appropriate antibiotics in case of infection.
- Debridement or removal of the hard skin by cutting it away.
- Strapping the heels with bandage or dressing.
- Use of softening or debriding agents such as urea or salicylic acid.
- Use of heel pads, heel cups, or insoles.
- Special tissue glue that can hold the cracked skin together, thus allowing it to heal.
- Advice regarding appropriate footwear.
- Maintaining proper foot care at home on a regular basis.