Swimthelanguage

Cracked skin around heels are a common painful and often unsightly problem. The fissures occur in the heel when the fat pad under the heel bone expands out sideways. This expansion stretches the skin around the edge of the heel and if the skin is dry and thick, it is highly likely to crack or split. This cracking of the dry hard skin, then pulls on the good skin below and can tear it. This becomes painful and can bleed. The mechanism is similar to squashing a tomato, in that when the pressure is applied, the tomato expands and the skin splits. A similar process happens when the fat pad under the heel expands out sideways.

The main risk factors for cracked heels are obesity, wearing open heel shoes and dry thick skin. Those that are obese probably have more fat under the heel to expand out sideways and carry more weight to compress the heel fat pad out from under the heel bone. Wearing an open shoe allows the fat pad to extend out from under the heel to put pressure on the skin, whereas wearing a closed in shoe will help keep the fat under the heel. Those will dry skin and calluses skin are at significant risk for this, as it is easy for this type of skin to crack. Once it has cracked, it will not heal and put pressure on the good skin beneath it.

The best treatment for cracked heels is meticulous debridement or shaving off of the thick skin around the edges of the spilt. Strapping then needs to be applied to hold the edges together, as even with the thick skin removed, normal weight bearing will still try and stretch to edges apart. Once this has healed, ongoing care is then needed long term to prevent them happening again. The use of some sort of file is recommended to keep the thick callused skin down and if this does not work, then regular debridement from a podiatrist may be needed. Emollient and moisturising creams really do need to be applied every day to keep the skin supple, so it will not fissure. Avoiding open back shoes and wearing closed in shoes around the heel will also help stop the fat pad expanding and putting pressure on the skin. This generally helps most people with this problem. If not, then a heel cup to help keep the fat under the heel is recommended.