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Cracked heels, also called “heel fissures,” are a fairly common foot condition.  For many people they are merely a nuisance or a cosmetic problem, but if the cracks are deep, they can be painful when you’re on your feet. Cracked heels may also bleed.

Cracked heels generally are caused by dry skin (xerosis) and are more difficult to treat if the skin around the rim of the heel is thickened or callused. In severe cases, the cracks or fissures can become infected. According to the 2012 National Foot Health Assessment conducted by the NPD Group for the Institute for Preventive Foot Health, 20 percent of US adults ages 21 and older (about 44 million people) have experienced cracked skin on their feet. The problem is more severe among women, who report the condition at a rate more than 50 percent higher than men.

Symptoms of Cracked Heels

Visual symptoms usually are obvious – cracks or fissures in the skin in the heel area that may cause discomfort or pain and bleeding.  Bacteria may enter through the breaks in the skin, resulting in infection. Signs of infection include redness/red streaks, swelling and warmth to the touch. In addition, the area may be painful to the touch, or when more pressure is applied.

Causes of Cracked Heels

Beyond dry skin, other causes for cracked heels include:

  •     Biomechanical problems that increase pressures in the heel area.
  •     Prolonged standing, especially on hard floors.
  •     Obesity, which increases the pressure on the normal fat pad under the heel, causing it to expand sideways. If your skin is not supple and flexible, the pressure can cause cracking or fissures.
  •     Open backs on shoes or sandals, which allow the fat pads in the heel to expand sideways and increase pressure on the skin, causing it to crack.

Some medical conditions predispose people to dry skin. For example, neuropathy can cause people with diabetes to lose the ability to perspire, which leads to skin dryness. Sjogren’s Syndrome is a rare condition, seen mostly in women, that creates dry skin as the body’s autoimmune system attacks perspiration and moisture-producing glands. In addition, certain skin conditions such as psoriasis, eczema and fungal infections cause drying of the skin and increase the likelihood of cracking. 

Prevention and Treatment of Cracked Heels

Properly designed shoes or boots can help prevent heel cracks. Good solid heel counters in the rear of the shoe or boot help protect the heel. Avoid open-heeled shoes. If your skin is very dry, applying moisturizing creams can protect the heel as well.

To ensure that feet are optimally protected, IPFH suggests wearing properly selected and fitted, as part of an integrated approach, padded socks with shoes with non-slip outsoles and any inserts or orthotics prescribed or recommended by a doctor or foot health professional.  Peer-reviewed, published studies have shown that wearing clinically-tested padded socks can help protect against injuries to the skin/soft tissue of the foot.

A pumice stone can be used to reduce the thickness of calluses and hard skin caused by the condition.  However, people with diabetes and/or neuropathy should not attempt to scrape or cut the skin of their feet with pumice stones, razors or scissors due to the risk of infection. Instead, see a medical professional such as a podiatrist or dermatologist. The doctor may remove (debride) dead skin and/or use mechanical treatments such as gait adjustment to address excessive pressure that may be causing or worsening the issue.

Source: Institute for Preventative Foot Health

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