Skin around the heel is thicker and often dryer than other skin of the body. This is because we have fewer oil glands on our feet and they experience daily wear and tear. Dryness and heel pad pressure can cause the skin to crack causing fissures and possible entry points for infective microorganisms.
Everyday contributors to dry heels include a lack of moisture (due to limited oil glands), irritation (friction from ill-fitting shoes and pressure from standing), heat and humid environments (synthetic shoes or boots), harsh soaps (leaving residue or causing dryness), aging (skin loses its ability to retain moisture as we age) and some medications (such as diuretics).
Symptoms
As well as the obvious dry, hard and cracked skin, other symptoms might include flaky skin, itching, pain, redness, inflammation, bleeding and ulceration (infection).
Symptoms of infections such as pain, warmth, redness and swelling can be serious especially in diabetics and could be an indicator of a serious infection (cellulitis or a diabetic foot ulcer) and medical help should be sort.
Causes of cracked heels
Standing for long periods of time, wearing non-supportive and non-protective footwear (thongs and opened-back sandals or ill-fitting enclosed shoes; long, hot showers and harsh soaps and climate (cold climate, low humidity) are common contributors to the development of cracked heels.
Medical concerns which may lead to cracked heels include:
Diabetes – high blood sugar, poor circulation and lack of pain sensation due to nerve damage.
Thyroid disorders – both under and over-active can present with foot conditions which may contribute to cracked heels. Auto-immune thyroid conditions may present with both types.
- Hypothyroidism – dry, coarse skin (Palmoplantar keratoderma); itchy skin; reduced circulation (cold feet); swollen feet; paraesthesia (tingling, numbness, pins and needles sensation); infections.
- Hyperthyroidism – thickened skin, itchy skin; infections; feet which smell (due to excess perspiration causing bacteria or fungal infections.
Fungal infection – athlete’s foot (tinea pedis).
Juvenile Plantar Dermatosis – a specific form of irritant contact dermatitis caused from repeated cycles of moisture exposure followed by rapid drying.
Atopic dermatitis – itchy skin can make skin dryer and result in cracks.
Psoriasis – is a condition in which skin cells build up and form scales and itchy, dry patches.
Other conditions which are associated with dry and cracked heels include:
Obesity
Pregnancy
Aging – skin tends to become dryer, thicker and loses its elasticity as we age.
Nutritional deficiencies – Vitamin B3 deficiency (called Pellagra) can result in dry, flaky skin anywhere on the body, including heels. Excess alcohol can cause a B3 deficiency.
Treatments and prevention of dry heels
Foot soak
When the skin of the heel is thickened such as with callouses, attacking the area too aggressively will often lead to tenderness and can result in infection.
Start with a foot soak to soften skin before any exfoliation begins.
Try for 20 minutes in warm water.
Exfoliate
The regular removal of dead skin from the foot keeps skin soft and helps prevent dry skin becoming hardened, calloused and cracked. A variety of different methods are available to try.
- An electronic foot dry skin exfoliator. These can be used on wet or dry skin making them easy and convenient to use.
- Pumice stone. Pumice is a volcanic rock that consists of highly vesicular, rough textured volcanic glass, which is light, abrasive and effective in removing dry, dead skin from feet. Use wet on wet skin.
- A Foot file has a coarse surface which can safely remove rough, dry or hard skin and a finer surface which smoothes the skin, leaving it softer and more refined.
- A loofah is a natural, hardened sponge -like product obtained from dried tropical or subtropical gourd. Loofah should be change regularly to avoid bacteria growth.
- Patches for callouses or really hard skin – patches can be applied with slow-release softening agent worn through the day. These may contain salicylic acid or urea.
- Alpha-hydroxy acids – creams containing citric acid, lactic acid and salicylic acid exfoliates rough skin by dissolving dead cells. They can be applied in the evening and washed away in the morning.
- Heel socks are available to wear daily for 30 - 45 minutes at a time to soften, exfoliate and repair heel skin and will usually show results after a few days.
Moisturise
Moisturisers help to prevent dehydration of the skin and are available as gels, creams, balms or even an oil. Look for the following ingredients.
Manuka honey – in a medicinal cream is ideal for cracked skin especially if a mild infection is suspected, due to its antimicrobial and anti-inflammatory activity.
Lanolin contains fatty acids and works as an occlusive substance which physically blocks water loss.
Vitamin E offers protection and supports healing.
Aloe vera has anti-inflammatory anti-pruritic, wound healing and analgesic properties. Aloe also contains salicylic acid and can aid in hydration.
Plant oils can offer therapeutic benefits to the skin depending on their anti-inflammatory and antioxidant properties supporting wound healing and repair of the skin barrier.
- Shea butter - offers potent anti-inflammatory and antioxidant properties.
- Coconut oil – fast repair and improving barrier function.
- Olive oil - anti-inflammation, reducing oxidative damage, and promoting dermal repair.
- Avocado oil - rich in linoleic acid beneficial for dry, damaged skin and improves wound healing and inflammation.
- Jojoba oil – contains a high content of wax esters making it excellent for repair and offers anti-inflammatory effects.
- Borage oil - contains high levels of omega-6 essential fatty acids that are important in the function and structure of the skin.
Infection. Treating mild infection using medicinal manuka honey or tea tree cream can be effective, but serious infections or very hardened skin should be seen by a doctor, or podiatrist, especially if sufferer is diabetic or elderly.
Nutritional considerations
Supplementing with nutrients may help prevention and repair.
- Vitamin C needed to support skin integrity and repair.
- Zinc to improve the condition of skin cells and offers wound-healing support.
- Omega - 3 fatty acids helps with inflammation, wound healing and skin integrity.
- Vitamin E protects, softens and strengthen skin.
Include a variety of fruit and vegetables, legumes, seeds and nuts, fish, chicken and meat to help supply nutritional needs.
In summary
Spending a little time looking after your feet can help prevent more severe conditions developing.
- Wear heel protective and supportive foot wear with added orthotics if needed.
- Wear good-quality padded socks.
- Silicone heel cups can help protect the heel.
- Exfoliate the foot regularly to prevent build-up of dry, hard skin.
- Avoid harsh soaps and too hot, long showers.
- Moisturise morning and night.
- Avoid standing in one spot for long periods of time.
- Drink water!
References
- Moisturizers: The Slippery Road https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4885180/
- Honey and Health: A Review of Recent Clinical Research https://www.ncbi.nlm.nih.gov/pubmed/28539734
- Anti-Inflammatory and Skin Barrier Repair Effects of Topical Application of Some Plant Oils https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5796020/
- https://hypothyroidmom.com/10-signs-your-feet-are-warning-you-about-a-thyroid-problem/
- https://www.podiatrytoday.com/diagnosing-patient-painful-cracks-both-soles
- The Role of Moisturizers in Addressing Various Kinds of Dermatitis: A Review
- Henry, Osiecki; The Nutrient Bible 9th Edition, Bio Concepts, AG Publishing; QLD, Australia
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