**Cracked Heels: Causes, Management, and Prevention**
Cracked heels, also known asheel fissures or rhagades, are a common dermatological condition characterized
by dryness, thickening, and the formation of splits or cracks in the skin ofthe heels. While often considered a cosmetic issue, severely cracked heels can
cause significant pain, discomfort,
 |
**Cracked Heels: Causes, Management, and Prevention**
and even lead to secondary
infections if left untreated. This article provides a comprehensive overview of
the causes, effective management strategies, and preventive measures for
dealing with cracked heels.
**Understanding the Anatomy and Physiology of Heel Skin**
The skin on the heels, likethat on the palms and soles, is thicker and more specialized than skin
elsewhere on the body. This is due to the presence of a thicker stratum
corneum, the outermost layer of the epidermis, which is composed of tightly
packed layers of dead keratinocytes. The stratum corneum acts as a protectivebarrier, shielding underlying tissues from external damage. The lack of sebaceous
glands (oil glands) in this region, coupled with the constant pressure and
friction from daily activities, makes the heel skin more prone to dryness andcracking.
- Normally, the skin maintains its elasticity
- and moisture balance through a combination
- of natural moisturizing factors (NMFs)
- sebum production, and the barrier function
- of the stratum corneum.
- When this balance is disrupted, the skin loses moisture
- becomes dry and less flexible, and is thus more
- susceptible to developing fissures or cracks.
**Causes of Cracked Heels**
Several factors contribute to
the development of cracked heels, broadly categorized into environmental,
physiological, and lifestyle-related causes:
1. **Environmental Factors:**
*
**Dry Air:** Exposure to arid climates, both indoors (due to heating or
air conditioning) and outdoors, can lead to excessive transepidermal water loss
(TEWL), causing the skin to become dehydrated and more prone to cracking.
*
**Cold Weather:** Low temperatures and reduced humidity in winter can
exacerbate skin dryness.
*
**Prolonged Exposure to Water:** Paradoxically, prolonged exposure to
water, like in swimming, can leach away natural oils and lead to dryness,
especially if the skin is not properly moisturized afterwards.
2. **Physiological Factors:**
*
**Dehydration:** Insufficient water intake impairs the body's ability to
maintain skin hydration from within, making the skin more susceptible to
cracking.
*
**Aging:** As we age, the skin's ability to retain moisture decreases,
and the stratum corneum becomes less efficient as a protective barrier.
*
**Underlying Medical Conditions:** Certain medical conditions such as:
*
**Diabetes:** Impaired circulation and nerve damage in people with
diabetes can lead to reduced blood flow and diminished sensory perception in
the feet, making it more difficult to notice and address skin dryness and
cracking.
*
**Eczema:** Eczema, or atopic dermatitis, causes dry, itchy skin, which
can lead to cracking and inflammation.
*
**Psoriasis:** Psoriasis is an autoimmune condition causing rapid cell
turnover, which results in thick, scaly plaques, often found on the heels and
prone to cracking.
*
**Hypothyroidism:** An underactive thyroid gland can lead to dry skin,
including on the heels.
*
**Athlete's Foot (Tinea Pedis):** Fungal infections can cause skin
thickening and scaling, increasing susceptibility to cracking.
*
**Obesity:** Excess weight places additional pressure on the heels,
which can contribute to the development of heel fissures.
*
**Nutritional Deficiencies:** Deficiencies in certain vitamins, such as
vitamin E, and minerals, like zinc, can affect skin health and integrity.
3. **Lifestyle-Related Factors:**
*
**Prolonged Standing:** Standing for long periods, especially on hard
surfaces, can place increased stress on the heels, leading to skin dryness and
cracking.
*
**Improper Footwear:** Wearing open-backed shoes or shoes that don't provide
adequate support can increase the friction and pressure on the heels.
*
**Poor Foot Hygiene:** Failure to clean and moisturize the feet
regularly can exacerbate dryness and cracking.
*
**Harsh Soaps:** Using harsh soaps or detergents can strip the skin of
its natural oils, leading to dryness.
**Management of Cracked Heels**
The management of cracked
heels often involves a combination of home care remedies and, in severe cases,
professional dermatological treatments:
1. **Home Care Remedies:**
*
**Soaking:** Soaking the feet in warm water with mild soap helps to
soften the skin and makes it easier to remove dead skin cells. Avoid using very
hot water, as this can exacerbate dryness.
*
**Exfoliation:** Gentle exfoliation with a pumice stone or foot file
after soaking helps to remove thickened skin. However, avoid vigorous
scrubbing, which can further damage the skin.
*
**Moisturization:** Applying a thick, emollient moisturizer immediately
after soaking and exfoliation is crucial. Look for moisturizers containing
ingredients such as:
*
**Urea:** A humectant that helps to attract and retain moisture.
*
**Lactic Acid:** An alpha-hydroxy acid that gently exfoliates and
moisturizes the skin.
*
**Glycerin:** A powerful humectant that draws moisture into the skin.
*
**Petroleum Jelly:** An occlusive agent that creates a barrier,
preventing moisture loss.
*
**Shea Butter, Coconut Oil, Olive Oil:** Rich in fatty acids and
emollients that nourish and moisturize the skin.
*
**Nighttime Treatment:** Applying a thick layer of moisturizer to the
heels before bed and wearing cotton socks to lock in moisture can be highly
effective.
*
**Liquid Bandages:** For severely cracked heels that bleed, liquid
bandages can help to seal the wound, prevent infection, and promote healing.
*
**Lemon Juice and Vaseline:** A
combination of lemon juice (for gentle exfoliation due to its acidity) and
Vaseline (for its occlusive properties) can provide some relief. However, use
this method cautiously as lemon juice can be irritating for some individuals.
2. **Professional Dermatological Treatments:**
*
**Prescription-Strength Moisturizers:** Dermatologists can prescribe
stronger topical corticosteroids or retinoids to manage inflammation and
promote healing.
*
**Debridement:** In severe cases, a dermatologist or podiatrist may
perform professional debridement to remove dead skin buildup.
*
**Patch Testing:** If an allergy is suspected as a contributing factor,
patch testing can identify irritants.
*
**Treatment of Underlying Conditions:** Addressing underlying medical
conditions, like diabetes or fungal infections, is essential for successful
treatment of cracked heels.
**Prevention of Cracked Heels**
Preventing cracked heels is
often more effective than trying to treat them after they develop. Here are
some essential preventive strategies:
1. **Proper Foot Care Routine:**
*
**Daily Moisturizing:** Apply a foot cream or moisturizer after bathing
or showering while the skin is still slightly damp.
*
**Regular Exfoliation:** Gently exfoliate the heels one to two times per
week to remove dead skin cells.
*
**Wear Proper Footwear:** Choose shoes that fit well, provide good arch
support, and have closed backs to protect the heels.
*
**Avoid Harsh Soaps:** Use mild, moisturizing cleansers when washing the
feet.
2. **Hydration and Nutrition:**
*
**Stay Hydrated:** Drink plenty of water throughout the day to maintain
skin hydration from within.
*
**Eat a Balanced Diet:** Consume a diet rich in vitamins, minerals, and
essential fatty acids to support skin health.
3. **Environmental Awareness:**
*
**Use Humidifiers:** In dry climates, using a humidifier at home or work
can help to increase air moisture and prevent skin dehydration.
*
**Avoid Extreme Temperatures:** Take steps to protect the feet from
extremes in temperature and excessive exposure to water.
**Conclusion**
Cracked heels are a common
concern that can be effectively managed with proper understanding of their
causes and implementation of appropriate treatment and preventive strategies.
By adopting a daily foot care routine, maintaining adequate hydration and nutrition,
and protecting the feet from environmental stressors, individuals can
significantly reduce their risk of developing heel fissures and enjoy smoother,
healthier feet. If home remedies do not provide adequate relief or if symptoms
worsen, seeking professional advice from a dermatologist or podiatrist is
recommended to rule out underlying conditions and receive appropriate
treatment.