Cracked Heels
Cracked heels or heel fissures are a
common foot problem. The problem is
generally caused by increased pressure on the fat pad under the heel causing it
to expand sideways. The lateral
expansion of the fat pad causes the splitting or cracking at its
extremities.
Those more prone to suffer from
cracked heels include the following:-
(a) Those
carrying excessive weight or whom are obese.
(b) Those
involved in prolonged standing on hard surfaces.
(c) Wearers
of open backed shoes or sandals.
(d) Suffers
of dry skin.
(e) Suffers
of atopic dermatitis.
(f) Suffers
of juvenile plantar dermatosis.
(g) Suffers
of psoriasis.
(h) Suffers
of diabetes.
(i) Suffers
of hypothyroidism.
(j) Suffers
of palmoplantar keratoderma.
(k) Those
suffering from corns and calluses around the heels generally.
Cracked heels or heel fissures are
usually only a cosmetic issue for the patient where the fissures are
shallow. Treatment normally involves
debridement and the application of a topical moisturising cream to keep the
skin supple and hydrated. Specialist
topical ointments are available containing descaling (keratolytic) or water
retaining (humectant) agents such as:-
(a) Urea.
(b) Salicylic
acid.
(c) Alpha
hydroxy acids.
Deeper fissures or more severe cases
can become painful limiting your patient's ability to stand or lead to reduced
mobility. Such cases can become infected
or lead to cellulitis. Such conditions
are of particular concern to those suffering from peripheral neuropathy, such
as diabetic patients as without detection and appropriate treatment the area
may become ulcerated.
In more severe cases treatment may
include:-
(a) Debridement.
(b) Prescription
of stronger softening agents such as urea or salicylic acid creams.
(c) The
prescription of antibiotics.
(d) Strapping
and dressing of the heel.
(e) Tissue
glue to hold fissures together to allow healing to take place.
(f) Innersoles or other such devices through with useful
redistribute the pressure on the heel fat pad.
