Dry, cracked heels, also known as heel fissures are a very common skin condition that is often seen in podiatry offices. Heel fissures have more than just a cosmetic concern. Heel fissures can become painful and may even lead to infection if left untreated.
Understanding the causes, risk factors and treatment options can help prevent this condition from occurring and keep your feet healthy.
Heel fissures are linear cracks in the thickened dry, skin on the back of the heels. The heel is responsible for absorbing significant pressure during walking and standing. The skin in the heel is vulnerable in developing thickened skin which is prone to dryness and cracking. When pressure is applied during walking or standing, the dry skin can split, leading to painful cracks. The cracks can be superficial or become deep enough leading to bleeding, pain with walking and increased risk of infection.
When skin lacks moisture, it becomes less flexible and prone to cracking. Dry skin also known as xerosis develops when the skin loses its natural oils that normally keep it soft and flexible. The skin on the heels is thickener and has fewer oil glands, making it more prone to dryness and cracking. There are many environmental factors that can contribute to the causes of dry skin such as cold weather, low indoor humidity, hot showers or baths and frequent washing.
Dry skin of the feet is particularly more common in middle aged and older adults. As we age, the skin naturally produces less oil. The results are drier skin that is more susceptible to roughness, flaking, cracking and the development of heel fissures. There are certain medical conditions that can increase the likelihood of developing dry skin. These include diabetes, hypothyroidism, psoriasis, eczema, tinea pedis (athletes foot) and peripheral vascular disease. Not drinking enough fluids can contribute skin dryness. When the body is dehydrated, the skin will lose its elasticity and moisture. Many harsh soaps, detergents and skin cleaners contain chemicals that remove the skin’s natural oils. Prolonged standing and mechanical stress exposes the skin on the heels to constant pressure and friction. This mechanical stress can cause thick callus formation, which can reduce skin flexibility and increase risk of cracking. Certain footwear choices can worsen dry skin and crack heels such as open back shoes, flip flops and poorly cushioned shoes. These types of shoe gears allow the heel fat pad to expand outward causing additional stress on the dry skin, leading to skin fissures to occur.
Treatment for dry skin and cracked heels focuses on removing thickened skin, restoring moisture and reducing pressure on the heel. Medical grade moisturizers and foot soaks that include urea, lactic acid, Allantoin, Sodium Bicarbonate and salicylic acid help soften thickened skin and restore moisture.
Professional evaluation is recommended with a Podiatrist when the skin becomes thickened and dry leading to painful cracks, the fissures begin to bleed and/or signs of infection develop, and when the condition doesn’t improve with home care. A Podiatrist can safely remove the thickened skin with sterile technique, resolve deep heel fissures and recommend the appropriate medical grade creams and foot soaks, to help restore moisture back to the skin.
About the Author
Dr. Joseph Cione is a board certified Podiatrist with offices in Manhasset, Woodbury and Mineola. Dr. Cione is known for his thorough evaluations, precise diagnosis and compassionate approach to patient care. His goal is to relieve pain and address the underlying cause of the condition so patients can return safely back to work, sports and daily activity.
