Dry crack skin is a commonly encountered clinical condition when there is impaired protective barrier of the skin. Untreated dry skin with cracks over the heels is not only cosmetically unsightly, it can also lead to callus formation, deep fissures, pain when walking or infection. The prevalence of dry cracked heels is higher in women possibly due to frequent open back footwear or lower estrogen levels upon menopause. Other triggering factors include ill-fitting footwear, obesity, prolonged standing on hard floors, cold weather, poor hygiene and old age. Predispositions of crack heels are higher among individuals with underlying disease such as iron or zinc deficiencies, xerosis, atopic dermatitis, psoriasis, juvenile plantar dermatosis, athlete’s foot, palmoplantar keratoderma or even systemic conditions such as diabetes mellitus or hypothyroidism.
What is the best way to treat crack heels?
The most effective treatment for cracked skin is by treating the underlying skin disease or systemic cause. Blood work for iron study, thyroid hormone and glucose level may be required to identify any underlying cause of the dry crack skin.
Generally, patients are encouraged to stay hydrated daily, practice good feet hygiene, and wear custom made shoe-inserts such as clinically-tested padded socks or silicone heel cups. One should avoid wearing tight shoes, sandals, high heels, open back footwears and most importantly not to walk barefoot. Showering with lukewarm water should be limited to no more than ten minutes to prevent water loss, causing dehydration. Reducing weight and avoiding prolonged standing is crucial especially for obese individuals as both factors can increase the pressure over the fat pad on the heels, thus worsening the crack heels.
Effective heel balms should contain keratolytic or humectants such as urea, salicylic acid, alpha-hydroxy acid and saccharide isomerate. A study from the Journal of Foot and Ankle Research found that the most important primary active ingredient in a moisturiser is urea. A higher percentage of urea containing cream has higher keratolytic properties, enhancing the efficacy of the treatment. A study on a moisturiser that has a combination of urea, glycerine and petrolatum concluded that it is effective in treating deep open fissure and dry skin.
These creams work by reducing water loss as well as maintaining moisture. In severe cases, the occlusive property of moisturisers is good to prevent evaporation of moisture from the skin. During a relapse, the cream should be applied more frequently. It is important that individuals continue to moisturise the skin even after symptoms have subsided to prevent crack heels from recurring. Greasy moisturisers like petroleum jelly should be applied before bedtime as some consider it messy. Wearing a pair of 100% cotton wool socks after applying petroleum jelly may be helpful as it allows better air ventilation. Whereas, the less greasy ones can be applied anytime during the day.
Thicker callus can be rubbed with a pumice stone to reduce the thickness. However, this is contraindicated in patients with diabetic neuropathy to avoid unintentional injury. Another alternative is to visit a podiatrist. Daily foot inspection is necessary to check for any injury as diabetic neuropathy patients are unable to feel their legs and may have diabetic foot ulcers or cellulitis. It is important to treat any open fissures early to reduce the risks of infection. Infection requires prompt treatment to prevent further undesired complications such as prolonged hospital stay, reduced ambulation which subsequently increases the risk for deep vein thrombosis or sepsis.
These steps may seem tedious and effortful but are necessary in order to repair the impaired protective function of the skin, ultimately healing the dry crack heels.
