Cracked Heels More Than Just a Cosmetic Problem?

Cracked heels, often the bane of people’s existence and can cause people to hide their feet away from embarrassment. Whether from a personal perspective or comments made from others, cracked heels can impact on a person’s confidence and self-esteem, often opting to put into storage ones favourite pair of sandals. We all see commercials of model-esque feet and advertisements for various products that promise smooth, silky heels, however the truth of the matter is a little more complex than they would have you believe. Cracked heels can be caused by a myriad of different problems, some more serious than others. Some heel cracks (or fissures technically), do not cause any discomfort whilst others can become painful and infected if neglected long enough. So in short, yes, cracked heels are indeed more than just a cosmetic problem but to understand why, we need to delve a little bit deeper into the issue.

Why do heels crack?

Heel fissures largely form when layers of skin are exposed to pressure long enough to cause the connective tissue to split and separate. This will most often occur when skin is covered in thick layers called callouses or is excessively dry. Either of these causes often reduces the skins natural ability to ‘bounce back’ from pressure and ongoing strain on the tissue will result in damage. Excessive time spent walking barefoot, or in poor fitting/chosen footwear can also result in callous and fissures forming around the heels since the heel plays a vital role in the weight bearing gait process (remember; ‘heel to toe’?). Weight gain, such as seen in pregnancy, can also predispose people to heel fissures forming as it means extra force going through the heel structure.

Can heel cracks become painful?

Yes. There are a number of reasons as to why heel cracks can become painful which includes:

Fissures penetrating deeper layers of skin to affect the superficial nerves and capillaries.
Existing fissures have comes infected with fungal or bacterial pathogens.
Penetration of the fissures by foreign objects.

The important thing to remember is; the more neglected your heels are, the worse they will look and feel.

Can having cracked heels be a sign of bigger health problems?

In short, yes, potentially. Herein lies the importance at making people appreciate that cracked heels may not be simply a ‘cosmetic’ problem. I have on a number of occasions assisted in the successful diagnosis of medical conditions where the patient initially presented with ‘sore, cracked heels’. Now that’s not to say that cracked heels means you have something medically wrong, however it is an important consideration that podiatrists consider when assessing your feet to determine both the cause and appropriate course of action for your feet.

The following are some conditions often associated with fissured heels:

Diabetes
Circulation issues.
Kidney problems.
Dermatitis
Psoriasis
Eczema
Genetic conditions such as Palmoplantar Keratoderma.
Issues with the thyroid or hormonal imbalances.
Chilblains
Vitamin and mineral deficiency.
Side effect to cancer, rheumatoid arthritis or other heavy duty medication/therapies.

In many of the above cases, avoiding complications associated with infections and ulceration of heel fissures is absolutely vital to ensure that patients can use their feet for as long and comfortably as possible.

So what is the solution?

In most cases, heel fissures are easily treated. Podiatrists can remove thickened skin safely and reduce the fissures to facilitate the natural healing process. Since everyone’s skin is different, a podiatrist is also able to give you personalised advice on the types of creams and techniques that can be utilised at home to prevent and treat these cracks. Infected or sore fissures can also be treated safely and effectively. In cases where patients suspect some more medically serious conditions may be involved, the podiatrist can assess your health status and work with you and your primary health care provider to identify exact causes of your cracked heels.

The solution however IS NOT to attempt to clear calloused skin by yourself, or to use creams without professional advice. By doing so, you may be doing more harm than good. I often to advise patients to soak their feet in warm salty water daily (EPSOM salts are fine), and apply a generous dollop of Sorbolene cream and rub it in well. For deeper fissures, Eulactol Heel Balm Gold (or other Urea containing creams) is also fine, however only use a 20c piece worth on each heel.

Always remember: if in doubt, let your podiatrist check it out.

Dr Anel Kapur (Podiatrist)