Cracked heels

Symptoms Of Cracked heels

The symptoms of heel fissures can vary in intensity from mild to severe. They include:

• Visible cracks or split on the skin on the heels

• Dry, hard, thickening of the skin around the rim of the heel

• Callus formation with brown or yellow discoloration

• Sensitivity or discomfort beneath the surface of the skin

If not treated, mild symptoms can worsen and develop into more severe ones like:

• Pain while walking

• Itching and bleeding from the fissures on the heels

• Infection leading to warmth and redness

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Causes Of Cracked Heels

Prolonged friction, pressure, or dryness can lead to the development of thick, hardened layers of dead skin, known as calluses. Calluses tend to easily crack if they become too dry or are constantly walked on. This can cause fissures to penetrate deeper layers of the skin, resulting in bleeding and discomfort. 

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People with diabetes often experience heel fissures. Diabetes can lead to nerve damage, particularly in the feet, which can result in reduced sweating and moisture. These heel fissures may predispose to foot ulcers that do not heal easily.

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Risk Factors For Cracked Heels

Dehydration

It is one of the main reasons for cracked heels, as the skin on the feet's soles tends to lose moisture more easily when dehydrated.

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Athlete's foot

It is a type of fungal infection that appears as a scaly rash and may result in the formation of cracked skin on the heels.

Eczema

Also known as atopic dermatitis, it causes dry, inflamed, and cracked skin, which can lead to heel fissures.

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Uncontrolled diabetes 

It can lead to neuropathy, which is a type of nerve dysfunction that damages the nerves responsible for sweating. This raises the likelihood of individuals developing calluses and cracked heels.

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Hypothyroidism 

It is a condition where the thyroid gland does not produce sufficient hormones. When thyroid hormone levels are low, the body's metabolism slows down, leading to decreased production of natural oils that keep the skin moisturized. This can cause dry and cracked feet.

Palmoplantar psoriasis 

It is a specific form of psoriasis that occurs on the palms and soles of the feet, leading to the formation of pustules(lesions), calluses, and cracks on the heels.

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Juvenile plantar dermatosis

Also known as sweaty sock syndrome or wet sock dermatitis, this is a skin condition that primarily affects children, between the ages of 3 and 14 years. It is characterized by red, dry, and scaly patches on the soles of the feet.

Sjogren's Syndrome 

It is a rare disorder in which the body's immune system targets and damages glands responsible for producing sweat and moisture, resulting in dry skin.

Obesity

Studies suggest that obesity can cause skin changes. Individuals who are obese may have a higher likelihood of experiencing cracked heels due to the additional weight-adding pressure on the heels.

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Pregnancy

The hormonal changes, weight gain, and increased pressure on the feet during pregnancy can contribute to skin dryness leading to cracked heels. 

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Aging

As you age, the skin tends to become thinner, drier, and less elastic, reducing the production of natural oils that keep the skin moisturized, resulting in dryness and can contribute to cracked heels.

Other factors

There are additional factors related to the environment and body mechanics that may also be important.

• Living in dry and cold climates

• Taking long and hot showers

• Poorly fitted or open footwear (does not cover the back of the foot)

• Spending long periods of time standing, especially on hard surfaces

• Excessive running, jogging, and climbing that involve significant pressure and friction on the feet

• Occupations that involve constant friction or pressure on the skin, such as athletes or construction workers.

Diagnosis Of Cracked Heels

Cracked heels are generally noticeable on the physical examination itself, but your doctor may conduct a few tests to diagnose the underlying cause. The diagnosis of cracked heels may require the following:

1. Medical history and physical examination

During the examination, the doctor will look for signs of cracked heels and may ask about the type of shoes worn and any past treatments. They will also inquire about your walking style and foot positioning to identify any potential mechanical problems.

2. Laboratory tests

The doctor may use other tests to find out what is causing cracked heels.

• Blood tests: These are not typically done specifically for cracked feet. However, some blood tests that may be considered to find the underlying cause may include:

• Complete blood count (CBC): This test helps detect signs of infection or inflammation.

• Blood glucose test: Measures the level of glucose (sugar) in the blood and is used to check for diabetes or impaired glucose tolerance, which can affect skin health.

• Nutritional tests: Certain deficiencies, such as in vitamins A, C, D, and E, can affect skin health, and blood tests can identify these deficiencies.

• Pedobarographic studies: Pedobarographs also known as pressure studies can be used to identify areas that have high pressure on the feet, which can be linked to cracked heels.

• Skin biopsy: In certain cases, a skin tissue biopsy is performed and sent to a laboratory for l examination. The pathologist looks at the sample under a microscope and considers other information, such as medical history, to determine a diagnosis. 

3. Imaging tests

These are not usually done but may be required to determine the exact cause of a fissure heel. These include:

• Dermoscopy: It is a technique using a dermatoscopy, a handheld device that illuminates and magnifies the skin. It is a non-invasive tool for the diagnosis of skin conditions.

• Wood's lamp examination: In this examination, the doctor uses ultraviolet light to examine the skin to detect any underlying skin conditions or infections.

• Radiographs: Weight-bearing foot X-rays can be used to identify bony protrusions that contribute to the development of cracked heels.
  
  

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Prevention Of Cracked Heels

There are a number of approaches that help to prevent the development of cracked heels. These include:

• Make sure to apply moisturizer to your feet regularly, both in the morning and at night, in order to maintain soft and smooth skin.

• Exfoliate regularly using a gentle foot scrub or pumice to prevent the buildup of excess dead skin cells.

• Wear shoes that fit well and are not too tight or too loose. 

• Avoid walking barefoot on rough surfaces regularly as it can cause heel damage and dryness. 

• Wear non-skid socks or house slippers at home.

• Use heel cups in your shoes. These can be bought at drugstores or sports stores as they help alleviate stress on your heels.

• Examine your feet every day to identify any initial indications that cracks may be forming.

• Keep yourself hydrated to avoid dehydration or dryness.

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Specialist to visit

Cracked heels may not be a serious health concern, but neglecting their treatment can lead to discomfort and inconvenience. Doctors who can help diagnose and treat cracked heels include:

• General physician

• Podiatrist 

• Dermatologist 

• Orthopedic

A general physician can help diagnose and treat any underlying cause of cracked feet. 

A podiatrist is a foot specialist who uses techniques like debridement to remove dead skin and prevent heel cracking.

Dermatologists are specialists who can diagnose and treat skin conditions. 

Orthopedics are specialists in bones, muscles, and joints who can help identify underlying bony conditions causing cracked heels along with various treatment options.

When to visit a doctor?

See a doctor if:

• Cracked heels are causing you pain or discomfort

• Are interfering with your daily activities

• You have health conditions such as diabetes, poor circulation, or other serious illnesses.

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Treatment Of Cracked heels

The treatment of cracked heels is determined by the severity of the condition and the underlying cause. It generally consists of the following:

1. Over-the-counter (OTC) treatment

• Foot balms or moisturizers: Applying healing balms or moisturizers that contain humectants (water-retaining agents) can effectively treat cracked heels. Regularly massaging the heels with a moisturizing lotion or balm can keep the skin soft and hydrated. 

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• Liquid bandage: It should be applied around the affected area and left on for a sufficient amount of time to seal the cracks. Liquid bandages not only seal existing cracks but also provide protection against infections and prevent future cracking. 

2. Professional treatment

If the heels are severely damaged or if self-treatment does not show improvement after a week, it may be necessary to seek professional help.

• Prescription debriding agents: These creams contain higher amounts of active ingredients such as salicylic acid, urea, silver nitrate, and cream with 10% glycerol. These medications assist in removing debris and dead tissue from wounds, aiding in the healing process and decreasing the risk of infection.

• Topical medications: Topical timolol helps to restore the skin barrier and aid in the healing of deep and painful cracked heels.

• Debridement: This is a medical procedure where a doctor removes the tough and damaged skin on your heels.

Note: This shouldn't be done at home using a razor blade or scissors, as there's a risk of infection and removing too much skin.

• Strapping: In order to promote healing, your doctor will wrap a bandage tightly around your cracked heels to keep the affected skin from moving.
  
  

• Shoe inserts: You may recommend using shoe inserts to redistribute weight and provide better support for the heel. They may also suggest using heel pads or cups to support the heel.
  
  

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• Tissue glue or adhesives: Tissue glue has the ability to effectively treat cracked heels by holding the deep fissures together.

Home Care For Cracked Heels

Cracked heels aren’t a cause for serious concern. You may be able to relieve it with over-the-counter or by simply applying heel balms or moisturizers. Additionally, there are home remedies that can treat dry and cracked heels and prevent their recurrence. They include:

• Honey (Madhu): The healing properties of honey can help heal cracks in the feet by acting as a natural antiseptic and moisturizer, preventing dryness.

How to use it? 

Mix a cup of honey with lukewarm water in a tub and soak your clean feet for 15-20 minutes while massaging them. Once finished, dry your feet and apply a moisturizer. 

• Coconut oil (Nariyal tel): Coconut oil is highly effective at moisturizing the skin and reducing inflammation, which can help fight infections due to deep heel fissures.

How to use it?

Apply a generous amount of coconut oil to your heels to benefit from these properties.

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• Oatmeal: Colloidal oatmeal is highly regarded for its ability to reduce inflammation and provide antioxidant benefits. Research has demonstrated its effectiveness in treating dry, scaly, and rough skin. 

How to use it?

Mix colloidal oatmeal with coconut oil till it becomes a paste. Apply the paste to your cracked heels, let it sit for 20-30 minutes, and then gently scrub and rinse off with lukewarm water.

• Apple cider vinegar: It possesses antibacterial and anti-inflammatory qualities that can provide relief and prevent infection in heel cracks.

How to use it?

Mix 1 part vinegar with 2 parts cool water in a large bowl and soak your feet in the solution for 5 to 10 minutes.

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• Banana (Kela): They are a great source of essential nutrients that can improve skin elasticity and keep feet hydrated. Researchers have discovered that an anti-heel crack band made from banana peel gel is very effective for treating cracked heels. 

How to use it?

Mash two ripe bananas into a paste and apply it to your cracked heels. Rinse your feet with lukewarm water after 30 minutes, and repeat this process daily for two weeks for optimal results.

• Aloe vera: It is used in the treatment of dry skin due to its moisturizing effect. The vitamins and minerals present in aloe vera contain powerful antioxidants that can help in the regeneration of the skin. 

How to use it?

Directly apply aloe vera gel on cracked heels to increase to heal the cracks.

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• Turmeric (Haldi): It has anti-inflammatory and antiseptic properties that can be used to prevent infections due to cracked heels. 

How to use it?

Mix castor oil with a pinch of turmeric powder to treat the cracks.

Complications Of Cracked heels

Cracked heels may seem like a small issue, but if not treated promptly, they can lead to certain complications like:

• Loss of feeling in your heel: This may occur when deep cracks or fissures extend into the underlying tissues, affecting nerves and reducing sensitivity.

• Cellulitis: Heel fissures can cause open sores that can become infected and lead to a painful skin infection.

• Foot ulcers: Deeply cracked heels can provide an entry point for bacteria, leading to infection and tissue damage.

• Emotional stress: This is caused by concerns related to one's appearance. Symptoms that keep returning and can make it hard to walk or stand, which can have a negative impact on quality of life.
  
  

Alternative Therapies For Cracked Heels

Along with self-care and home remedies, there are certain alternative therapies as well that can provide some relief from cracked heels. They include:

Ayurveda

Ayurvedic doctors recommend using herbal ointments containing various natural ingredients to treat cracked heels. Ayurveda also suggests regularly massaging the cracked heels with warm sesame oil that is calming for Vata dosha (one of the three energies in our body that takes care of body movements).

Yoga

It is possible to treat cracked heels with specific yoga asanas. Yoga can aid in circulation, and foot flexibility, and promote stress reduction, while also encouraging mindfulness about foot care and enhancing balance and posture. 

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Living With Cracked Heels

Though it may not seem like a big problem, living with cracked heels can significantly impact one's quality of life, causing discomfort, pain, and limitations in daily activities due to difficulty in walking or standing comfortably. Here are a few things you can do to pamper your feet:

Limit bath time

Do not shower for more than 5-10 minutes. Bathing for too long can make your skin dry and cracked heels worse. Also, do not rub your skin with harsh towels.

Go gentle with products

Always opt for mild, fragrance-free cleansers while cleaning your feet. This can help your feet retain their natural oils.

Do not forget to exfoliate

The skin on your heels is thicker than the skin on the rest of your body, which makes it more likely to become dry and crack. To alleviate cracked heels, you can soak your feet in lukewarm water and gently exfoliate the hard skin with a pumice stone, loofah, or foot file. Using foot scrub creams daily can also help.

Never skip moisturization

The best practice is to moisturize within 5 minutes of bathing and apply it to your heels immediately after bathing while your skin is still damp to lock in the moisture.

Set a bedtime ritual

Soak your feet in plain or soapy water for around 10 minutes, and dry gently. Exfoliate your heels gently and apply a richer, oil-based cream or petroleum jelly. Then wear thin cotton socks to enhance the moisturizing effect.

Protect your heels

Coat the cracks in your heels with a liquid bandage to form a protective shield, promoting faster healing, reducing discomfort, and preventing germs from entering the skin. Also, wear proper fitting shoes to avoid any discomfort.