Cracked Heel

Fissured or cracked heels are deep splits in the skin on the rim of the heel. Heel fissures are seen more in the winter months when the air is dry. Also, heel fissures are more common in folks that are moderately to severely obese.

Heel fissures form at the junction of the two types of skin, glabrous and hairy skin. Glabrous skin is the skin found on the bottom of the foot. Hairy skin is on the top of the foot. Glabrous and hairy skin come together at the rim, or junction of the side and bottom of the heel. For most people, the rim is a smooth transition between these two types of skin. For those folks who are over weight, the rim becomes an abrupt turn caused by excessive load applied to the heel. This abrupt turn stimulates the formation of callus around the rim of the heel.

Why do heel fissures form? Heel fissures are formed by a unique mechanism that is very different from the manner in which most callus is formed.  The formation of a heel fissure can be compared to the force generated in the walls of a water balloon when the balloon is set on a hard flat surface. As the weight of the water in the balloon expands, the walls of the balloon are put under tension. Think of the heel acting much like the water balloon.  Tension occurs in the rim of the heel each time the heel strikes the ground. The skin reacts to this tension by forming callus. Repeated tension on the callus causes the callus to split. The cycle of callus and splitting repeats itself with each step.

Fissures of the heel can become so deep and problematic that they bleed and become infected. Heel fissures can be particularly troublesome for those people that lack sensation in the foot such as diabetics.

Treatment of Heel Fissures

Heel fissures have no cure. Prevention is the best medicine. The best that we can hope for with heel fissures is to prevent deep, painful cracks. Prevention will require ongoing care. Care may include periodic debridement after a shower or soaking the feet with a safety razor, callus file or pumice stone. Softening creams that have softening 'agents' are helpful such as Ureacin-20, containing 20% urea as a chemical debridement agent. Other creams such as ClearZal Callus contain small amounts of salicylic acid that help to debride thick callus.  Many patients prefer the ease of callus cream such as  Myfootshop.com Foot  Butter.  Foot Butter is particularly useful for thick, heavy areas of callus.   Heel cushions can be used by day to redistribute the weight of the heel over a larger, softer surface area.  Bosby Heel Pads are a unique form of heel pad that are worn at night and are used specifically to soften suborn heel callus and heel fissures.

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Biomechanics of the foot, especially abnormal gait, may contribute to the formation of callus surrounding the heel. Excessive rolling (varus or valgus) of the heel may create friction and contribute to callus formation.

The symptoms of heel fissures vary based upon the thickness of teh heel callus. As the callus grows thicker, greater pressure is exerted on the skin beneath the callus.  Increase activities will increase the number of steps taken in the course of the day.  With each individual step, more pressure is placed on the skin beneath the callus increasing pain.

As the heel callus grows thicker, there is a greater tendency for the callus to split or fissure.  Fissures can be quite painful, bleed and become infected.

The majority of problems with this condition come from cracks that become hard to control.  The cracks, or fissures, become increasingly deep as the callus thickens.  Fissures may bleed and become infected.

The differential diagnosis for this condition should include;

Abscess

Blister

Benign soft tissue tumor

Malignant soft tissue tumor

Psoriasis

Ulcer

Verrucae

Wart

• Athletes Foot

• Callus

• Heel and Skin Fissures

• Skin

• Dermatitis

This article was written by Jeffrey A. Oster, DPM and last updated 2/5/13.

No additional information is available for this topic.