Cracked heels are so common that they rarely get the attention they need. For a start, heel fissures are about more than just dry skin peeling off. They can lead to extreme discomfort while walking. And the resulting pain felt while doing different activities can affect the quality of life.
The general notion is that only adults get cracked heels and the treatment involves just exfoliating the dry skin. But experts say there are many reasons behind the painful cracks.
“Cracked heels, which are unattractive to look at, can get painful as well,” says Dr Poonam Wadhwani, a Mumbai-based dermatologist and cosmetologist. “The skin on the feet thickens and gets dry. The cracks expand with increased pressure on the heel, leading to splitting of the skin. Sometimes obesity, open footwear or prolonged standing with too much pressure on the heel can cause cracks.”
Causes of cracked heels
Hyperkeratosis — thickening of the skin because of excessive dryness — is a common cause of fissures and cuts. But other medical and hereditary conditions can also make people prone to heel fissures.
“People with asthma, thyroid or even diabetes, where dry skin is a common symptom, are prone to cracked skin, resulting in foot fissures,” says Dr Sachith Abraham, consultant dermatologist at Sachith’s Skin Clinic and senior consultant at Manipal Hospitals, Bangalore. “Hereditary conditions such as palmoplantar keratoderma can cause fissures. People with psoriasis are prone to it too.”
Heel fissures are also seen in children, though rarely.
“Foot fissures [can] occur in children up to the age of 12 and [in those] who have a condition called juvenile plantar dermatosis,” says Dr Sachith.
Pain and infection with heel fissures
Foot fissures are associated with slight discomfort that develops into pain and gets severe over time. Because of constant exposure to different microorganisms, the open cuts get easily infected if left untreated for extended periods.
“When people walk barefoot and do not get treated on time, the cuts get deeper and bacteria enter the skin, causing infection,” says Dr Abraham. “Usually, the infection occurs with bacteria such as staphylococcus, streptococcus or pneumococcus, which can also cause a mild pain. When the cuts get deeper, ulcers can be formed and, on rare occasions, the infection can enter the bloodstream too.”
Deep cracks or fissures can cause bleeding.
“The infected heels can cause cellulitis [a common bacterial skin infection],” adds Dr Wadhwani. “If the person has diabetes, the fissures can lead to diabetic foot. [This makes] healing difficult and can cause neuropathic damage or loss of sensation in the feet.”
How to prevent cracked heels
Proper foot care and moisturising go a long way in preventing cracked heels, especially if you are prone to them because of certain underlying medical conditions.
“Wearing the right footwear without a very hard sole helps,” says Dr Wadhwani. “Routine care of the feet by applying exfoliating creams and hydrating creams on a regular basis is required.”
“Petroleum jelly and creams help soak the skin and loosen it,” says Dr Abraham. This prevents the skin from thickening and cracking over time.
A common practice is using a pumice stone to rub and remove the dead cells. But this must be done with utmost care to avoid further infection.
Treating heel fissures
Treatment of heel fissures can be tricky, especially because most people considered them to be minor problem and believe that just moisturising is enough.
“Creams containing exfoliating agents such a salicylic acid, urea or lactic acid can be used to remove the thick layers of skin,” suggests Dr Abraham.
“However, [applying] steroid-based creams on the cuts should be avoided as they prevent healing,” adds Dr Sachith. “[Using such creams] will create an illusion of the pain subsiding, but the cuts would remain and get deeper, and may not heal for months together.”
“Insoles or heel pads that help even out the weight and provide support can also be used,” adds Dr Wadhwani.
But in cases of severe foot fissures, it is necessary to do certain blood tests (for diabetes and thyroid, for example).
Takeaways
- Cracked heels mostly occur because of dry skin. They can also be seen in people with health conditions such as asthma, diabetes, thyroid and psoriasis, and even in children with juvenile plantar dermatosis.
- The cuts in cracked heels can easily get infected with bacteria, resulting in infection and pain. Severe cuts can cause bleeding when pressure is applied on them.
- Proper foot care and moisturization are crucial to prevent heel cracks.
- Treatment involves using exfoliating creams, removing dry skin with a pumice stone, using insoles and heel pads to evenly distribute weight, and doing certain blood tests to check for underlying conditions.
