Cracked heels (heel fissures) occur when the outer layer of skin (epidermis) surrounding the heel becomes hard and callused and then splits due to mechanical stress. While in some cases these cracks are painless and merely an annoyance, they can lead to more problems if left untreated. Superficial splits in the skin can turn into fissures, penetrating the deeper layers of the skin (dermis). Once in the dermis, these fissures may bleed and become painful, making it uncomfortable to walk. They can also provide an entry point for pathogens, leading to infection.
Our feet are responsible for supporting our body’s weight and are therefore capable of withstanding a great amount of force. When pressure around the heel is applied with weight bearing, the skin around the heel is exposed to a large amount of force and mechanical stress, causing it to expand sideways. This repeated action can cause the skin to split. When the heels is dry and callused, the skin loses its elasticity and has a reduced ability to withstand mechanical forces.
Cracked heels may be due to:
– Skin conditions causing dryness such as atopic dermatitis, psoriasis and tinea
– Systemic conditions including hypothyroidism and diabetes
– Increased weight gain
– Mechanical stress from poor, unsupportive footwear
– Standing for prolonged periods of time, especially on hard floors
– Barefoot walking or wearing open back shoes
How to treat cracked heels
The best form of treatment is preventing the cracks from forming in the first place. The heels can be managed at home by:
– Filing with an emery board or pumice stone to reduce the thickness of callused skin
– Applying moisturisers on a regular basis. This will keep the skin hydrated and prevent the cracks from splitting further.
– A heel balm is ideal for treating dry and cracked heels as it works by descaling the thickened skin and retaining moisture
– Inspecting the feet daily for deep cracks or breaks in the skin, and applying antiseptic and dressings to encourage healing and prevent infection
Treatment at home may not be sufficient if crack are severe and already painful. Intervention by a podiatrist may be required to remove the callus overlying and surrounding the fissures back to healthy skin. People who are diabetic, have circulation issues, or have trouble reaching their feet are strongly encouraged to see a podiatrist for regular management, and should not attempt to remove the callus at home.
Regular maintenance is key to preventing heel cracks from occurring. The skin’s hydration can be managed by regularly applying moisturiser to the heels to maintain it’s elastic texture. Harsh soaps and lotions can damage the skin’s moisture barrier and increase water loss, so it is best to avoid these. Drinking enough water daily can also help with general skin hydration. Wearing supportive footwear can also assist with reducing areas of pressure around the heel. Shoes that are supportive, well padded and cup the heel will reduce mechanical stress, slowing the formation of callus. Additional support around the heels including insoles or heel cups can improve shock absorption.
Podiatrists are able to safely remove the cracks and reduce callus thickness. The procedure is painless and often leaves the skin around your heels feeling much lighter and flexible. We are also able to assess underlying factors that may be contributing to heel fissures and provide education for ongoing care so you are able to manage this at home.
Much like when you get a deep cut, the heel fissures can penetrate the deeper layers of the skin, essentially becoming an open wound. Weight bearing activities can cause increased pressure on the fissure, exacerbating the pain. The surrounding area may also become inflamed as the damaged tissue attempts to heal itself, or infected in more serious cases. This is usually accompanied by redness, swelling, heat and increased pain.