Tuesday, May 17, 2022

Causes, Treatments, Home Remedies and More

  • Cracked heels develop when skin becomes dry, hardened and callused
  • This condition develops due to certain everyday factors, or underlying health conditions such as diabetes, hypothyroidism and vitamin deficiency
  • Over-the-counter topicals, liquid bandages, supportive insoles and home remedies can address discomfort and support the healing process
  • Persistent, infected or severe cases of cracked heels can be treated by professional care with debridement and prescription medication

Cracked heels, also known as heel fissures, are a common and sometimes painful skin condition. They develop when the skin on the heel pad becomes dried out and hardened, and then splits due to the pressure applied from standing and walking. 

Many options are available to heal cracked heels, including over-the-counter (OTC) topicals, medical treatments and natural remedies.

What Causes Cracked Heels?

Cracked heels are caused by calluses – thick, yellow layers of hardened dead skin that develop due to prolonged friction, pressure or dryness. Once a callus has formed, it can easily become cracked if it becomes too dry or if you continue to walk on it.

While these fissures may be superficial at first, they can deepen with continuous pressure and friction. Eventually, a fissure can reach the skin’s soft deeper layers, causing bleeding and intense discomfort.

A number of factors can contribute to the development of calluses and heel cracks. These include ill-fitting footwear, harsh weather and lack of moisturize, as well as certain medical conditions.

Common everyday causes

Footwear plays a significant role in heel callus and fissure formation. Wearing open-back shoes or poorly fitted footwear can cause increased friction and pressure against the heels.

Callused and cracked heels are also caused by a lack of hydration, which can be triggered by a number of factors. Cold, dry weather disrupts the skin’s barrier function and reduces its ability to retain moisture. Washing with harsh soaps strips the skin on the feet of its natural oils, which has a similar drying effect. 

Standing for long periods of time results in prolonged pressure on the heel pads, and can also cause fissures to develop. People with obesity are more at risk, as their weight causes an increased level of pressure.

Medical conditions

Several underlying medical conditions can increase your risk of developing cracked heels. These include the following:

  • Athlete’s foot, a fungal infection that presents as a scaly rash, can lead to the development of cracked skin on the heels
  • Diabetes causes neuropathy, a form of nerve dysfunction that cause damage to the nerves responsible for sweating; this increases the risk of a person developing calluses and cracked heels
  • Eczema causes the skin to become inflamed, dry and cracked, and can cause heel fissures
  • Hypothyroidism is a condition in which the thyroid doesn’t produce enough hormones and causes the skin on the feet to become dry and cracked
  • Palmoplantar psoriasis, a type of psoriasis that develops on the palms and feet, can cause pustules, calluses and heel cracks to develop
  • Vitamin B12 deficiency can cause neuropathy in the sensory and autonomic nerves, and lead to cracked heels in a similar manner to diabetes

Over-the-Counter Treatments for Cracked Heels

A wide variety of products are available at a pharmacy to treat heel fissures. Moisturizers and keratolytics work to soften calluses, while heel cups, insoles and liquid bandages support healing by protecting against infection and further damage.

Keratolytics

Keratolytics are compounds that work to exfoliate and soften hardened outer layers of skin. Such compounds include salicylic acid, alpha hydroxy acids (AHAs) and urea. Topical skin care products marketed for their keratolytic effects may contain any or all of these ingredients, and are typically available in lotion or cream formulations.

Heel cups and insoles

Heel cups and insoles cushion the feet while standing or walking. They can help reduce pain while walking, prevent cracked heels from worsening and support the healing process.

Heel cups are typically made of silicone gel and are made to wrap around the heel; insoles may be made of rubber or silicone and are designed to extend the full length of the foot.

Liquid bandages

Liquid bandages are a suitable option for preventing cracked heels from bleeding, further drying out or becoming infected, and can help speed up the healing process.

Liquid bandages are typically made of a polymer dissolved in alcohol, and are applied either with a spray bottle or a small brush. The product solidifies after a few seconds and typically lasts 5–10 days before falling off.

Moisturizers

There are three main types of moisturizing agents: humectants, emollients and occlusives. All three can help support the healing of heel fissures in different ways.

Emollients form a protective barrier that work to lock in moisture, and include urea and plant-based oils such as olive, coconut and jojoba oil.

Humectants such as hyaluronic acid and AHAs draw in moisture from the surrounding environment. Occlusives such as petroleum jelly and beeswax provide moisture and form a protective shield from environmental contaminants.

Moisturizers are available in a number of different formulations, ranging from lightweight gels and lotions to heavier creams and balms. Lighter formulations consist primarily of humectant ingredients, whereas heavier formulations typically contain all three moisturizing agents. When treating dry, cracked skin, heavier cream and balm formulations tend to be more effective.

To treat cracked heels with a moisturizer, begin by soaking your feet in lukewarm, soapy water for 20 minutes and then patting dry. Use a foot brush to gently remove any loose skin, and then apply a thick layer of moisturizer. Wear a pair of cotton socks to lock in moisture, and repeat twice daily.

Strapping

Strapping the heels with bandages or medical tape can help hold fissures closed while they heal; this can also help reduce pressure applied by standing and walking, and protect against infection and further moisture loss.

Home Remedies for Cracked Heels

A number of natural remedies can also help treat cracked heels. Apple cider vinegar can reduce inflammation, while pumice stones are suitable for exfoliating dry, hard skin. Coconut oil, honey and oatmeal can prevent infection and protect against further moisture loss.

Apple cider vinegar

Apple cider vinegar has antibacterial and anti-inflammatory properties, and these properties may benefit heel cracks by soothing discomfort and staving off infection. 

You can make an apple cider vinegar foot soak by combining 1 part vinegar with 2 parts cool water in a large bowl. Soak your feet in the mixture for 5–10 minutes.

Coconut oil

Coconut oil has potent skin moisturizing properties, as well as anti-inflammatory effects that help combat infection. To take advantage of these benefits, apply a thick layer of coconut oil to your heels in place of a moisturizer.

Honey

Honey has antimicrobial and skin moisturizing effects to soften cracked heels  and protect them from infection. Take advantage of these benefits by applying 1 teaspoon of raw honey to your heels, allow it to rest for about 20 minutes, and then rinse off with lukewarm water.

Oatmeal

Colloidal oatmeal has long been valued for its anti-inflammatory and antioxidant benefits. Studies have shown it can successfully treat skin dryness, scaling and roughness. 

You can make a scrub by combining colloidal oatmeal with coconut oil or another plant oil. Place equal amounts of both in a blender and blend until it forms a paste. Apply this paste to your cracked heels, allow to rest for 20–30 minutes and then gently scrub with a foot brush. Rinse off the mixture with lukewarm water and apply a rich moisturizer.

Pumice stones

Pumice stones have an abrasive surface that is ideal for exfoliating calluses on the feet, and can abrade hardened layers of skin and encourage the growth of soft, healthy new skin.

Soak your feet in soapy lukewarm water, exfoliate your heel with the pumice stone and follow with a rich moisturizer.

When Should I See a Doctor?

Speak to a dermatologist or podiatrist about your heel fissures if you notice any signs of infection—such as redness, swelling or a burning sensation—or if they persist despite at-home treatments.

Your provider will help diagnose the cause of your cracked heels, provide daily care tips and offer medical treatment. The standard medical treatment offered for cracked heels is debridement. Your provider will also prescribe an antibiotic topical medication if your heels are infected.

Debridement

A debridement procedure involves your provider carefully removing the layers of hardened, thick skin with a scalpel. This process is not painful, as callused skin does not contain any pain receptors.

A debridement procedure will usually take 15–60 minutes, depending on the size and depth of the callused skin. 

Preventing Cracked Heels

There are a number of strategies you can take to help ensure you do not develop cracked heels. Some of these include:

  • Avoid walking barefoot
  • Drink plenty of water to maintain hydration
  • Ensure your footwear fits properly
  • Moisturize your feet daily
  • Wash your feet daily with a mild soap
  • Wear thick socks and warm footwear when the weather is cold and dry

Takeaway

The most common causes of cracked heels are dry or cold weather conditions, lack of moisturize, use of harsh soaps, standing for long periods and wearing ill-fitting footwear. They can also be caused by inflammatory skin conditions, or medical conditions such as diabetes, hypothyroidism and a vitamin deficiency.

OTC moisturizers and keratolytic skin care products treat cracked heels by softening hardened layers of skin and restoring hydration. Liquid bandages and strapping can help to prevent infection, while heel cups and supportive insoles provide protective padding to prevent further damage and support the healing process.

Home remedies such as apple cider vinegar soaks and oatmeal scrubs can also provide relief.

If your heel fissures do not respond to at-home treatment,  see your health care provider. They can remove hardened layers of skin with a debridement procedure and treat infection with prescription medication.

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