You probably don’t think too much about your feet, let alone about the health of your feet. For most of my patients, they are out of sight and out of mind. But keeping your feet looking healthy is actually incredibly important, which is why I want to address a question Julie sent to me on Facebook:
Cracked heels are a common problem that can be troublesome to fix and especially problematic in certain diseases where they can become painful and infected. Before I get to answering Julie’s question, I first want to go through some of the reasons people end up with cracked heels.
Why do I even have a heel?
The heel has a couple of different functions, but it serves mainly as one side of the arch of your foot, with the ball of your foot being the other side of that arch. Together, the ball of the foot and the heel of the foot help to spread out the pressure your foot experiences both when you’re standing and when your foot hits the ground during walking or running. The heel also acts as a tether for your calf muscle and as a convenient bony support during standing.
Because of its position in the foot, the heel bears a lot of weight and uses two main tools to help disperse that weight to avoid injury. First, it has a pad of tissue that sits between the bone and the skin that acts as a shock absorber. Second, the skin on the bottom of the foot can thin or thicken depending on the pressure from above and the texture of the ground below. This skin tends to be thick and tough in general, but standing for long periods of time or being obese can push this skin to thicken even more than usual.
Why does the heel skin crack?
The problem isn’t just thick skin. It’s the combination of this thickened skin with the drying effects of air, exposure to environment when walking barefoot, certain fabrics, diseases like diabetes, skin conditions like eczema, or fungal infections that can lead to skin cracking. This is because dry skin doesn’t stretch as easily. When you put weight on the heel, the thick, dry skin can’t stretch to accommodate the change in shape as easily and it cracks.
What can I do to prevent and treat my cracked heels?
The first thing to do that’s always important for dry skin is to drink enough water. This will keep your skin hydrated and supple. The second thing to do is to make sure you keep any chronic medical conditions under control, since they might be contributing to your dry skin. Beyond that, there are a few steps you can take to both prevent and treat cracked heels.
- Moisturize the skin of your heel at least twice a day. The first time should always be first thing in the morning before you start walking around. That will help soften the skin and improve its flexibility before it starts to bear weight. The second time can be around midday or in the early afternoon when your heels might need a little more love to get through the second half. Moisturizers with specific ingredients like urea and alpha hydroxy intensively hydrate and gently exfoliate to soften and smooth skin.
- Keep your calluses under control. If you have thick calluses on the bottoms or your heels, try to keep them under control. You can do this with a foot file or a pumice stone. Don’t go crazy. You need some callus to protect your feet. The idea is just to thin the skin a little bit to increase its flexibility and suppleness.
- Wear closed shoes when you can. Wearing socks and shoes can help to maintain skin moisture in your heel and reduce dryness over the course of the day.
- Alternate standing and sitting, if possible. If your day consists of a lot of standing, try to sit for short amounts of time periodically. You don’t want to sit the whole day, you just want to give your heels a break every now and then.
- Keep the cracks clean. Heel cracks can become infected, so if you get one, put some antiseptic ointment in it and cover it with a clean dressing. Do this every day until the crack heals.
- See a podiatrist. If the crack is especially painful, is bleeding, or doesn’t seem to be healing, make an appointment to see a podiatrist right away. They can help to address the heel crack while giving you good strategies to prevent them in the future.