Cracked heels

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

• Visible cracks or splits on the skin of the heels
• Dry, hard, thickened 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 such as:

• Pain while walking
• Itching and bleeding from the fissures on the heels
• Infection leading to warmth and redness

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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 subjected to constant pressure. This can cause fissures to penetrate deeper layers of the skin, resulting in bleeding and discomfort.

Did you know?

• People with diabetes often experience heel fissures.
• Diabetes can lead to nerve damage, particularly in the feet, resulting in reduced sweating and moisture.
• These heel fissures may predispose individuals 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 soles of the feet tends to lose moisture more easily when dehydrated.
• Athlete's foot: This 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.
• Uncontrolled diabetes: It can lead to neuropathy, a type of nerve dysfunction that damages the nerves responsible for sweating. This raises the likelihood of individuals developing calluses and cracked heels.
• Hypothyroidism: This condition occurs when the thyroid gland does not produce sufficient hormones. Low thyroid hormone levels slow down metabolism, leading to decreased production of natural oils that keep the skin moisturized, causing dry and cracked feet.
• Palmoplantar psoriasis: 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.
• Juvenile plantar dermatosis: Also known as sweaty sock syndrome or wet sock dermatitis, this skin condition primarily affects children aged 3 to 14 years, characterized by red, dry, and scaly patches on the soles of the feet.
• Sjogren's Syndrome: A rare disorder where 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.
• Pregnancy: Hormonal changes, weight gain, and increased pressure on the feet during pregnancy can contribute to skin dryness, leading to cracked heels.
• 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 contributing to cracked heels.
• Other factors: Additional factors related to the environment and body mechanics may also be important, including:
  • 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 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

Cracked heels are generally noticeable during a physical examination, 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 various tests to determine the cause of 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 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: Also known as pressure studies, these can identify areas with high pressure on the feet, which may be linked to cracked heels.
• Skin Biopsy: In certain cases, a skin tissue biopsy is performed and sent to a laboratory for 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 fissured heel. These include:

• Dermoscopy: A technique using a dermatoscope, a handheld device that illuminates and magnifies the skin. It is a non-invasive tool for diagnosing 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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There are several approaches to help prevent the development of cracked heels. These include:

• Apply moisturizer to your feet regularly, both in the morning and at night, 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, 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 purchased at drugstores or sports stores to help alleviate stress on your heels.
• Examine your feet daily to identify any initial indications that cracks may be forming.
• Stay hydrated to avoid dehydration or dryness.

Looking for ways to heal and moisturize your cracked heels? Check out some effective remedies.

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.
• 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
• 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 aids 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: Your doctor 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.
• Tissue glue or adhesives: Tissue glue can effectively treat cracked heels by holding the deep fissures together.

Cracked heels aren’t a cause for serious concern. You may be able to relieve them with over-the-counter products 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.
• 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 until 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.
• 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 help heal the cracks.
• 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.

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

• 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, leading to a painful skin infection.
• Foot ulcers: Deeply cracked heels can provide an entry point for bacteria, resulting in infection and tissue damage.
• Emotional stress: Concerns related to one's appearance can lead to emotional distress. Symptoms that keep recurring can make it difficult to walk or stand, negatively impacting quality of life.

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Along with self-care and home remedies, there are certain alternative therapies that can provide relief from cracked heels. These 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, which is calming for Vata dosha (one of the three energies in our body that takes care of body movements).
• Yoga: Specific yoga asanas can help treat cracked heels. Yoga aids in circulation, foot flexibility, and stress reduction, while also promoting mindfulness about foot care and enhancing balance and posture.

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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 worsen cracked heels. Also, avoid rubbing 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, making it more likely to become dry and crack. To alleviate cracked heels, 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 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. Additionally, wear properly fitting shoes to avoid any discomfort.