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Cracked Heels and Fissures
The Ultimate Guide
Cracked heels, also known as heel fissures, are a common foot condition where the skin on the heels becomes dry, thickened, and begins to split.
What are Cracked heels and fissures?
Cracked heels, also known as heel fissures, are a common foot condition where the skin on the heels becomes dry, thickened, and begins to split. These splits or fissures can range from shallow, painless cracks to deep, painful ones that may even bleed or become infected if left untreated. Cracked heels are more common in individuals with dry skin or those who frequently walk barefoot or wear open-backed shoes. While they can be a cosmetic concern, severe cases can lead to discomfort and complications, making it important to address the issue early on.
Symptoms and Causes
Causes:
Dry Skin:
The most common cause of cracked heels is dry skin. When the skin loses moisture, it can become rough, thickened, and less elastic, making it more prone to cracking under pressure.
Pressure on the Heels:
Standing for long periods, particularly on hard surfaces, increases the pressure on the heels, which can cause the skin to expand sideways and crack.
Footwear:
Wearing open-backed shoes, such as sandals or flip-flops, can leave the heels exposed, causing the skin to dry out more quickly. Tight shoes that don’t fit properly can also contribute to heel fissures.
Obesity:
Carrying excess weight places additional pressure on the heels, exacerbating the risk of the skin splitting.
Medical Conditions:
Certain medical conditions, such as diabetes, hypothyroidism, and eczema, can lead to dry skin, making individuals more susceptible to cracked heels. Diabetics, in particular, need to be vigilant as they are at higher risk for foot complications.
Ageing:
As we age, the skin naturally loses moisture and elasticity, making older adults more prone to developing cracked heels.
Symptoms:
Dry, Thickened Skin:
The skin around the heels often becomes dry, hard, and thickened, which may be the first sign of potential fissures.
Visible Cracks:
Shallow to deep cracks or splits in the skin on the heels, which can vary in severity. In more serious cases, these cracks can be deep enough to cause pain or bleed.
Pain or Discomfort:
When heel fissures are deep, they can cause significant pain, particularly when standing or walking.
Redness and Inflammation:
The skin around the cracks may become red and inflamed, especially if there is an infection.
Bleeding or Discharge:
Severe cracks may bleed or ooze, which is a sign that the fissures are deep and potentially infected.
Management and treatment
Effective management of cracked heels involves addressing the underlying causes, maintaining proper foot care, and using appropriate treatments to heal the skin and prevent further cracking.
Foot Care:
Moisturising:
Regularly applying a thick, emollient moisturiser or foot cream, particularly one that contains urea, lactic acid, or salicylic acid, can help to soften the skin and prevent it from cracking. Moisturising should be done after washing the feet, and ideally before bed, to allow the cream to work overnight.
Exfoliation:
Gently exfoliating the heels with a pumice stone or foot file can help to remove dead skin and reduce the thickness of calluses. However, it’s important to avoid over-exfoliation, which can lead to further irritation.
Foot Soaks:
Soaking the feet in warm, soapy water for about 10-15 minutes can help to soften the skin and make exfoliation easier. Adding a few drops of essential oils like tea tree or lavender can also have soothing and antiseptic benefits.
Footwear:
Supportive Shoes:
Wearing well-fitting, supportive shoes with a closed back can help reduce pressure on the heels and keep the skin from drying out. Avoiding walking barefoot or wearing open-backed shoes can also help prevent further cracking.
Orthotics:
Using insoles or orthotic devices can provide additional support and reduce pressure on the heels, which can help prevent and manage heel fissures.
Medical Treatments:
Topical Treatments:
In cases where over-the-counter creams are not effective, a podiatrist may prescribe stronger topical treatments containing higher concentrations of urea or salicylic acid to soften and remove thickened skin.
Bandaging:
Deep cracks may need to be bandaged to protect them from further damage and to allow the skin to heal. Hydrocolloid dressings can be particularly effective in keeping the area moist and promoting healing.
Infection Control:
If the fissures become infected, a healthcare professional may prescribe topical or oral antibiotics to treat the infection and prevent further complications.
Preventing Recurrence:
Regular Foot Care:
Maintaining a regular foot care routine that includes moisturising, exfoliating, and wearing appropriate footwear can help prevent cracked heels from recurring.
Addressing Underlying Conditions:
Managing any underlying conditions, such as diabetes or eczema, is crucial in preventing heel fissures. Individuals with these conditions should work closely with their healthcare providers to manage their overall health and reduce the risk of complications.
Cracked heels and fissures are a common but preventable foot condition that can range from a mild cosmetic concern to a painful problem requiring medical attention. By practising good foot hygiene, using appropriate moisturisers, and wearing supportive footwear, most people can effectively manage and prevent cracked heels. For those with persistent or severe heel fissures, seeking the advice of a healthcare professional is important to ensure proper treatment and avoid complications.