Causes and Treatment of Cracked Heels

What are heel fissures or cracked heels?

Fissures are cracks or splits to the skin. These may present with dry skin and/or overlying hard skin (known as callus or hyperkeratosis).

When the fissures are shallow, they don’t fully break the skin barrier, they are not considered to be a wound at this stage and they are not painful, however these splits can develop into deep fissures, which are wounds, they may bleed and cause pain when standing and walking. These deeper heel fissures are a risk factor for infection and cellulitis, particularly in people who are more at-risk, such as those with diabetes or with peripheral vascular disease.

Fissures develop commonly on the heel because of the direct physical stress on this part of the foot. Callus develops as a protective measure by the skin in response to this physical stress, however the callus can split and develop a fissure, particularly if the skin is dry. Skin dryness increases when consistently wearing open backed shoes or sandals, so you might notice heel cracks developing more often during the summer months.

Some health conditions are associated with increased skin dryness and/or abnormal pressures through the feet and therefore increase the chance of developing heel fissures. Examples of these conditions are:

• Diabetes
• Hypothyroidism
• Rheumatoid Arthritis
• Systemic sclerosis
• Scleroderma
• Eczema
• Psoriasis

Treatment:

1. Successful treatment of heel fissures first involves removal of callus (if present). Regular routine podiatry treatments, where a podiatrist will remove callus using a scalpel or abrasive file, will often be necessary to resolve heel fissures and prevent them from developing in the future.
2. If infection is present, this may need to be treated with appropriate medication such as antibiotics
3. Dry skin must be managed to restore the skin barrier and allow healing to take place. This is also important in heel fissure prevention. Emollients such as creams, sprays, lotions and gels are used to hydrate and prevent water-loss from the skin. The emollient may be more effective if the area is also sealed off, for example by applying a hydrocolloid dressing on top such as DuoDerm, wearing socks or a heel sleeve. The most effective emollients have added naturally occurring ingredients such as urea, lactic acid or glycerine. These attract moisture from the deeper layers of the skin to the surface of the skin where the dryness is visible. Urea is found to be particularly useful in the treatment of heel fissures and in higher concentrations also helps to break down callus. Please note that emollients make the skin slippery and so there is a risk of slipping and falling if walking around barefoot, therefore it is recommended to apply creams at night before bed.
4. A painful deep fissure may need to be closed by a health care professional by applying a medical-grade skin adhesive. These are only used if there is no infection present. This provides pain-relief, reduces the risk of infection and promotes skin healing.
5. Occasionally, if the fissure is not resolved with the above measures, the pressure on the heel may need to be adjusted by wearing a heel cup inserted into the shoes or an orthotic device.

Your podiatrist can help you to manage this common foot complaint by assessing the condition of the heels, safely and expertly removing any callus present and creating a management plan to resolve your heel fissures long term.

Written by Patricia McFadden