Remedies for cracked heels

The heel is the back part of the foot that lines the calcaneus bone, which is the largest bone in the foot. Physiologically, the heel has a very thick stratum corneum which thickens and cracks, due to the daily pressures that are applied to the heel through walking or playing sport. In individuals who do not walk (e.g. infants, chronically bedridden individuals or paraplegics), the skin of the heel does not have a thicker stratum corneum and is very soft to the touch. The thickness of the stratum corneum on the heel is therefore linked to consistent, considerable pressure and friction from day-to-day activities.

Hyperkeratosis of the heel

The thickening of the stratum corneum in the heel is physiological and protects skin cells and dermal structures from the pressures exerted by the weight of the body. Sometimes, the stratum corneum of the heel thickens excessively, a condition which is referred to as hyperkeratosis of the heel.

Causes of hyperkeratosis of the heel

The causes of hyperkeratosis can be behavioral or pathological in nature.

Behavioral causes include:

• Gymnastic sports activity with pressure on the feet
• Use of hard footwear (boots, clogs, flip-flops, etc.)
• Walking barefoot on abrasive ground
• Having a tic that involves rubbing the feet
• Use of abrasives (pumice, rasps, abrasive appliances, etc.)

Pathological causes include:

• Being overweight or obese
• Menopause
• Venous or arterial insufficiency
• Cardiovascular deficiency
• Psoriasis
• Atopic dermatitis
• Peripheral neuropathy

From hyperkeratosis to cracks and fissures

As the stratum corneum thickens, it becomes stiffer, less elastic and loses its ability to dissipate force. At this point, cracks or fissures may form on the heel. When these are superficial, they will appear as whitish callosities with small incisions on the edge of the heel. If the hyperkeratosis is more severe, deep cracks form.

How to treat heels with fissures

Glycocream+ can be applied in mild cases of hyperkeratosis or cracked heels. Apply every evening with an exfoliating brush which will help reduce the thickness of the stratum corneum.
However, when cracks or fissures are present, it is important to identify the probable causes before intervening. A first step is to help the heel absorb the forces it endures by switching to more suitable footwear or adding anti-shock insoles or heel pads. The second important step is to stop getting the feet wet. When water – or worse, detergent gel – come into contact with fissures, they cause inflammation and can even cause infection. Instead of washing, apply aqueous benzalkonium chloride solution (Disintyl 240 ml) to a cotton cloth, wring it out and rub gently on the foot to sanitize the area.

Reducing treatments

When there are fissures on the heel, it is important to both heal and close the cuts and reduce the thickness of the stratum corneum of the heel.

Closing fissures

To ensure fissures heal correctly, the thickness of the stratum corneum must be reduced. In order to do so, it’s important not to get the feet wet (use dry washing instead), use insoles or heel pads and apply PEG Ointment. To ensure the stratum corneum reduces sufficiently, it’s important to also add a reducing agent alongside PEG Ointment. Thanks to a combination of salicylic acid and colloidal sulfur, 2S Cream can be used as a reducing treatment or, in some cases, Coal Tar may also be considered as an alternative.

Treatment of heel cracks

In practice, treating heel cracks can be achieved by:

• ameliorative or decisive action on the causes
• supporting the heel in shock absorption by using specialized pads or insoles
• stop getting the affected foot wt and use dry washing instead
• Application of a keratolytic exfoliant (Glycocream+) in the evening.
• applying PEG Ointment in the morning and repeat as necessary through the day

Incorrect treatments discouraged by DermaClub

To treat fissures of the heel, treatments that DermaClub considers incorrect are often put in place.
They mainly are:

• Using urea creams, as they have poor keratolytic (reducing) activity and can be irritating
• Using cortisone cream as they can increase the risk of fissures becoming infected without resolving the problem itself
• Filing the feet with pumices or mechanical abrasive therapies, as this can cause inflammation which will worsen hyperkeratosis