What really causes cracked heels?

“For heels to crack, the skin around them becomes dry, thick and loses its elasticity. As a result, when you step on the ground, instead of flattening outwards, they start cracking,” he explains.

While anyone is prone to heel fissures, there are risk factors that can lead to the condition. Dr Sserunjogi says these include standing for long on hard surfaces, cold and dry weather, poorly fitting shoes, having cold and dry skin, using harsh soaps as well as frequently taking hot showers and baths. 

“Among urban dwellers, this includes walking barefoot on tiles, and in villages, it is the roughness of the surfaces and stones that aggravate the condition,” he says, adding that there are also some medical conditions that predispose one to getting cracked heels. These include diabetes, obesity, eczema, hypothyroidism (when the thyroid is not making enough of some hormones), infections, and athlete’s foot.

Caution

Dr Sserunjogi says it is important to know the cause of the cracks since sometimes, they can be prevented while in other instances, a doctor’s visit is important. 

“To prevent cracked heels, it is important to keep the feet clean and moisturised, avoid walking barefoot, and wear shoes that fit properly and provide adequate support. Additionally, you can use a pumice stone or foot file to remove dead skin from the heels on a regular basis, and avoid standing or walking for long periods of time. If you have tiles at home, you are advised to use indoor shoes or put woollen carpets in areas where you spend most of your time such as the living room,” he explains.

Treatment

As is with any other medical condition, cracked heels can be subtle while others may be so bad that they bleed when one stands. While the former may be eased or alleviated using home remedies, Dr Sserunjogi says the latter will necessitate a visit to the doctor. 
“For people with an underlying medical condition such as diabetes, a doctor will devise a better treatment plan,” he says.

Medical options

Salicylic acid cream
In case of deep cracks that are not infected, one can use salicylic acid. Dr Sserunjogi prescribes soaking the feet in warm, salty water for 15 minutes at night. Thereafter, thoroughly dry the feet and fully apply 10 percent salicylic acid cream overnight. Do this for a month or so until they clear. Then apply the cream every other day. “Salicylic acid is known to dissolve dead skin progressively and stimulate regeneration of new and softer skin,” he says.

Apply a keratolytic

With time, the skin around the cracked heels thickens because a lot of keratins getting deposited into it as a response to excessive pressure and trauma to the area. Dr Sserunjogi says it worsens as more pressure is applied on the heel. In order to thin the skin, the doctor may prescribe the use of a keratolytic such as urea. 
“Using keratolytic will also remove dead skin cells, dissolve the excessive keratins as well as loosen the epidermis. Once the skin thins, it also gets easier for it to remain moist, which further reduces reoccurrence of cracked heels,” he says.

Strapping 
This is when a medical personnel straps the cracked heels using bandage which helps to compress the fat pad that keeps getting bigger with time. “Additionally, the dressing reduces the pressure on the heel while also keeping in the moisture,” he says. 

Debridement 
The doctor may also recommend cutting away any thickened and hardened skin on the heels. It is important that people desist from doing this on their own as they may cut too much which creates painful cuts as well as infections. 

“This is done in a hospital setting and in severe cases, the doctor may have to suture the remaining wound after debridement. The wound will then be managed until it heals with a new layer. During this period, it is not advised to step on the ground such that the heel is given enough undisturbed time to heal,” Dr Sserunjogi says.

Recommend insoles 
These shoe insertions are ideal in helping one with cracked heels to get better foot support through proper weight redistribution on the heel. Ultimately, the heel is prevented from expanding sideways, thus further cracking.

Home remedies

Emollients work by filling up the space between the cracks to create a barrier, thus preventing moisture from leaving the skin. “This makes the skin at the heel soft, smooth and flexible,” Nancy Karuhaga, a beauty specialist at Moonic Spa, shares. She adds that once applied, humectants attract water from the atmosphere to the heel. They then bind the water to the skin, thus keeping it moist. 

“Since they have the ability to draw water from the air means they improve the hydration of the heel, hence reducing the chances of probable extreme dryness,” Karuhaga says.

Use a pumice stone
In mild cases, once the skin around the heel is moisturised, it is now possible to use a pumice stone to rub off the calluses. However, it is important not to over use the stone as the condition may worsen. “Additionally, a person suffering from diabetes should not use these stones since any cut may easily get infected yet even a minor infection may cause life threatening complications,” Dr Sserunjogi says.

Use an occlusive
Coupled with the humectant and emollient, it is advisable to use an occlusive. Occlusives include vaseline and lanolin and these create an extra coating on the skin to prevent moisture loss from the epidermis (outermost skin layer). 

“Apply this before going to bed to ensure all the moisture is locked in,” Karuhaga advises.

Wear cotton socks
Occlusives are often greasy and messy. Therefore, to avoid dirtying your bedsheets, wear purely cotton socks as you get into bed. 

“These will also help to keep the moisture locked in yet allow the feet to breathe and prevent sweating of the feet which may lead to athlete’s foot,” she says.