Cracked Heels / Fissures - Deseree Myburgh Foot Health Practioner

Cracked Heels / Fissures

According to the national institute of health (NICE) the heel takes over 60% of the body weight, therefore they withstand a tremendous amount of pressure. The weight and pressure we place on our heels causes the skin to expand outwards and if our skin is dry, it becomes less elastic and more prone to cracking and developing fissures.

Heel fissures are splits or cracks in the epidermis, they normally start off as superficial but with increased pressure these splits/fissures can become deeper and spread into the dermis, this can cause bleeding and pain and carries the risk of becoming infected.

Certain medical conditions may be an underlying factor that causes dry skin/cracked heels:

Being over weight
Diabetes
Eczema
Hypothyroidism
Infections such as athletes’ foot

Other causes:

Standing for long periods (worse if it is a hard floor)
Poor fitting shoes
Dry/cold weather
Not drinking enough water – dehydration.
Biomechanical factors such as flat feet and gait problems

How would a foot health practitioner help?

The skin can be improved by reducing the Hyperkeratosis (increased thickness of the stratum corneum, the outer layer of the skin) regularly with a scalpel
The FHP may or may not need to apply a dressing or medical grade skin adhesive to help close deep fissures to aid in healing.
The FHP may recommend the use of in-shoe devices such as heel cups
The FHP would recommend the regular application of a suitable product to hydrate the skin to help the skin restoration. An emollient cream is one that keeps the water in the skin, keeping it well moisturised and preventing it from drying out.Most emollient products are plain (containing no active ingredients), however for fissures/dry heels an emollient that contains 10-25% urea, alpha hydroxy acid, or salicylic acid is normally recommended.

Good to know

Urea is considered to be both a humectant (a type of ingredient that helps attract and retain moisture) and an emollient (a type of ingredient that helps soften and smooth your skin).
Alpha hydroxy acids (AHAs) are used for chemical exfoliation of the skin. They dissolve the bonds that hold dead skin cells on the surface of the skin, so the skin will gently shed, revealing smoother skin underneath.
Salicylic acid is a keratolytic. It belongs to the same class of drugs as aspirin (salicylates). It works by increasing the amount of moisture in the skin and dissolving the substance that causes the skin cells to stick together. This makes it easier to shed the old, dead skin cells.

It is much easier to prevent the cracks/fissures from forming than to get rid of them once they are there.

Some things you can do:

Don’t walk barefoot in public places, bare feet exposed our feet to bacterial and fungal organisms that can infect the skin and nails.
Change your socks every day. There are more sweat glands per inch in our feet than anywhere else in the body. If at all possible, alternate shoes if you can so that your shoes have time to dry.
Spray your shoes with an antibacterial shoe spray and make sure they are completely dry before putting them on.
Wash feet and in-between toes with warm water with a mild soap-free body wash every day. Try to limit your baths/ showers to 10 minutes, bathing to long can dry out the skin.
Dry well, particularly between the toes
Look for a moisturizing cream that contains 10-25% urea, alpha hydroxy acid, or salicylic acid, and apply it to your heels immediately after bathing while your skin is still damp and whenever your heels feel dry to lock in moisture. (Please avoid applying it in between toes)
Hydrate by drinking plenty of water and eating water rich foods such as cucumbers and watermelons

References:

August 7, 2023 Deseree Myburgh Articles chiropodist, Cracked heels, dessiefhp, feet, FHP, Fissures, foot health, foot health practitioner, footclinic, foothealth, heels, nails, painful heels, podiatrist