Heel Fissures: A Guide to Treatment and Prevention




What Are Heel Fissures?

Heel fissures are a common foot problem that plagues many people. As the name suggests, the condition consists of a series of cracks (or possibly one) that develops in the heel area of one or both feet; in fact, the common term for the problem is simply "cracked heels."

Heel fissures can certainly be unsightly enough to make you want to enclose your feet in closed shoes instead of sandals, but the issue of cracked heels is more than a cosmetic consideration. Cracks in dry skin, such as heel fissures are also painful enough to interfere with exercise and even with the ordinary needs of life as they can make walking uncomfortable enough to be difficult. Moreover, over time heel fissures that remain untreated can worsen, splitting open more and more, getting both wider and deeper. In the worst case scenario, a heel fissure can begin to reveal underlying tissue, even exposing it to infectious agents if the fissure begins to bleed.

This guide will tell you all you need to know about heel fissures so that you can prevent them in most cases and treat them properly when they do in fact occur.

Symptoms of Heel Fissures or Cracked Heels

heel fissuresHeel fissures generally occur in areas that have already become callused. A callus is generally a thickened area of skin and is your body's way of protecting itself against friction or other sources of irritation. Calluses form in areas, for example, where the foot repeatedly rubs against the interior surface of a shoe. In general, calluses are a good thing as they prevent the formation of blisters in these affected areas.

However, when it comes to the heel area, calluses may become very thick. At this point it is possible for them to actually crack open when insufficient moisture is present.

Heel fissures are often found in two areas on the heel:

  • the bottom of the heel
  • the side of the heel

Cracks in the heel area may be short or long. In the worst cases they may wrap from one side of the heel to the other, a condition which will make walking very painful and running almost impossible.
Treatment for heel fissures should not be delayed because as they worse, they can bleed and even become infected.

cracked heel pictureHeel fissures generally develop over time and announce themselves with significant symptoms and warning signs in advance. Learning to recognize these can be key to responding quickly with home or professional treatment so that full blown heel fissures do not have a chance to develop.

 

 

Early onset symptoms include:

  • patches of skin around the heel which appear to be flakyand / or red.
  • itchy skin on the heel area

If early symptoms are not heeded, then true cracks can develop. At that point you will have actual heel fissures. Symptoms at this stage include:

  • small linear lines in and around the heel area of one or both feet
  • initial cuts on the top (surface) layer of the skin only, without bleeding
  • pain when walking or standing, particularly when pressure is applied directly to any of the heel fissures
  • over time the fissures can get both longer and deeper until bleeding results

What Causes Heel Fissures or Cracked Heels

The most basic cause of heel fissures or cracked heels is dry skin. Some people have skin that is naturally quite dry; these people will have to take more aggressive preventative steps to protect themselves from the occurrence of heel fissures. In other cases, dry skin is more of an environmental factor that can be controlled with effort.

Another major cause of heel fissures results from mechanical stress factors that can increase pressure on the heel, making it more likely to crack from the strain. A person's particular style of walking can be a contributing factor in some cases.

The following list details reasons why heel fissures might develop. Some of these causes are mechanical in nature and others relate specifically to the existence of dry skin:

  • diabetes, which can lead to dry skin
  • conditions which repress thyroid activity, which can lead to dry skin
  • conditions specifically involving the skin, such as eczema and psoriasis
  • shoes with an open back. By not supporting the heel properly, this kind of footwear can allow the heel to splay out. The skin may crack under this pressure.
  • prolonged periods of standing up, particularly on hard surfaces
  • conditions which lead to weight gain. The excess weight can increase pressure on the heels, causing it to crack when the natural pad of fat under the heel is  not enough to cushion this pressure.
  • improper care of the feet

Investigation of the cause of the problem, so this can be addressed.
Removal of the hard thick skin to promote healing. We may prescribe special creams and socks that will help to deeply moisturizer the area.
If Cracked Heels are very painful, strapping may be used to 'hold' the cracks together during the healing process.
Advice about footwear and prevention of the problem.
Orthotics or arch supports may be recommended to alter the way you walk to prevent callous from developing on the heels.

Treatment Options for Heel Fissures or Cracked Heels: Medical Measures

A qualified podiatrist will take a detailed questionnaire about your health and wellness habits as well as your daily routines in order to ascertain any underlying causes contributing to your heel fissures. These underlying causes will then be addressed in order to prevent recurrences.

However, a podiatrist can also provide direct treatment and relief for existing heel fissures. Among the many treatments that may be applied and / or recommended are the following options:

  • removal of areas of thickened or hardened skin
  • prescription strength lotions or creams to provide deep moisturization
  • changes to footwear including style of shoe
  • special inserts or orthotics to relieve pressure on the heels
  • arch supports or other orthotics to alter the patient's gait and prevent the onset of future heel fissures

Treatment Options for Heel Fissures or Cracked Heels: Prevention Measures

There are a number of key things you can do that will help prevent cracked heels. Most of them rely on the fact that heel fissures are basically a result of skin being far too dry. In order to restore moisture to your skin and then help your skin retain it, you can undertake one or more of the following procedures that will help to prevent the onset of heel fissures:

  • Use a humidifier to add moisture to the air in your home. Humidifiers are now available at a very low cost – you can usually find one for less than $20.00. In fact, they are so cheap these days that there is no reason not to have several, including different ones for different seasons. In the summer, it's best to use a cool air humidifier as it won't add any heat to your home. In the winter, you have the option of switching to a steam based humidifier which will not only add moisture to the air but help to warm up the room it's in.
  • If you don't have a humidifier and don't wish to purchase one, then a shortcut method to achieving the same effect is simply to boil water to produce steam. The drawback to this, of course, is that unless you have a portable electric tea kettle, the steam will always be produced in the kitchen. This might not be the best place. Humidifying your bedroom is likely to be more effective as you spend a lot more time sleeping in bed than you probably do hanging out in the kitchen – and the key to getting moisture to absorb into your skin is to allow time for the process to happen.
  • Begin drinking additional water. This will humidify you from the inside out, as opposed to from the outside in as in the previous two suggestions. Some experts have long recommended that adults should drink at least eight 8 oz. glasses of water per day (8 fluid ounces is equal to one cup when using standard measuring cups). However, that is a minimum amount of water needed to maintain health, and more recent studies of human hydration needs have noted that the true amount of water needed by an adult varies according to body weight. A good rule of thumb is to take your weight in pounds and divide it by two to determine the number of ounces of water needed daily. By this measure, a 200 pound man should drink 100 ounces of water each day. That's far in excess of the 64 ounces he would consume under the old "8 glasses a day" standard.
  • Eliminate patches of dry skin through the use of a pumice stone. The best place to use one is generally in the shower or bath since at those times your skin will already be naturally softened because of the excess moisture. Gently rub the pumice stone across your heels in order to remove dry, dead skin cells. Do not expect a single application of this process to work wonders; it will take time and patience to reveal the underlying skin, which should be soft and smooth if all these recommendations are followed. Avoid the use of a pumice stone directly around any existing heel fissures as it may cause irritation, which could actually worsen the incidence of cracked heels.
  • Use moisturizer on your feet, but follow these guidelines:
    • Use a lotion, salve, or body butter designed for deep or intense moisturizing.
    • The best time to moisturize your feet is directly before you go to bed.
    • After applying lotion, salve, or body butter, slip your feet into socks. Trapping heat against your feet will help the lotion absorb better, and a side benefit is that you won't smear oils or creams onto your bedding or blankets.
    • Don't use moisturizer directly before engaging in vigorous exercise activity since that can cause your feet to slide around inside your socks and shoes. An injury could result and it might be a serious one, which means in this case the risks outweigh the benefits.
  • Be cautious of engaging in vigorous physical exercise if you already have serious fissures in your heels. The pressure of activities like running as you pound your feet against hard pavement can cause the fissures to deepen further. Walking is generally acknowledged to be a safer option until your fissures have healed.
  • A deep, serious heel fissure should be seen by a qualified health care professional (see above). Your health insurance company may insist that you see a general practitioner first, but when you do, be sure to ask for a referral to a podiatrist (foot specialist). A podiatrist can take steps that will help your fissures heal and offer expert prevention advice for the future.

Home Treatment Remedy for Heel Fissures

In addition to the treatment options recommended above, it can also be a good idea to provide your feet with an occasional deep soaking treatment in order to more fully and thoroughly moisturize them. Some guidelines to providing  yourself with an effective soaking regimen include all of the following:

  • Use lukewarm water only, never water that is overly hot or cold. The ideal temperature should actually match your body temperature as this will make the absorption of moisture as effective and efficient as possible.
  • Add a small amount of assisting agent to the water. A capful of hydrogen peroxide can be helpful in this regard. If you do not have that chemical on hand, you can substitute lemon juice. If using lemon or lime juice, you will need more than a mere capful. Using about a half a cup of lemon juice for each gallon of water involved in the foot soak is a good guideline.
  • Soak your feet for at least fifteen minutes in order to allow the moisture time to sink in; thirty minutes is even better.
  • The water will cool off during this span of time. This is unavoidable unless you purchase a foot bath with a heating option designed to keep the water at a stable temperature.

 


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