Cracked (fissured) heels are deep splits in the skin on the rim of the heel. Cracked heels are seen more commonly in the winter months when the air is dry. Cracked heels can be deep enough to bleed and become infected. Cracked heels are more common in people who are moderately to severely obese and are seen equally in men and women. Cracked heels are common between the ages of 20-60 years.
The symptoms of cracked heels vary based upon the depth of the crack and the thickness of the surrounding callus. 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.
Cracked heels form at the junction of the two types of skin, glabrous and hairy skin. Glabrous skin is the thicker 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. When excess weight is carried on the feet, the rim of the heel becomes an abrupt turn caused by excessive load applied to the heel. This abrupt turn creates a mechanical stimulus and irritation of the skin which results in the formation of callus around the rim of the heel.
Heel fissures are formed by a unique mechanism that is very different from the manner in which most callus is formed. As an example, think of the pad of the heel as being much like a water balloon. As the heel strikes the ground, the walls of the heel stretch much like a water balloon would when filled and set upon a flat surface. 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 crack. This cycle of callus formation and potential cracking repeats itself with each step.
Cracks of the heel can become so deep and problematic that they bleed and become infected. Cracked heels can be particularly dangerous for people who lack sensation in their feet, such as diabetics.
Causes and contributing factors
Contributing factors for cracked heels include dry skin, obesity, and diabetes. Flip-flops and open-heel shoes also tend to be a contributing factor.
The differential diagnosis for cracked heels includes:
Heel fissures have no cure and therefore require ongoing care. Care may include periodic debridement with a safety razor, callus file or pumice stone. Softening the callus by soaking or debridement following a shower may be helpful. Creams that contain softening agents such as lanolin, sal acid or urea help to soften thick heel fissures between debridements. Heel cushions can be used by day to redistribute the weight of the heel over a larger, softer surface area.
When to contact your doctor
Heel callus and cracked heels can usually be managed at home. If you develop deep cracks and require care, please be sure to consult your podiatrist or family doctor for debridement of callus and suggestions for care.
References are pending.
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Cite this article as: Oster, Jeffrey. Cracked Heels. http://myfootshop.com/article/cracked-heels
Most recent article update: March 7, 2018.
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