What are Cracked Heels?
Also termed as heel fissures, the presence of these cracks on one’s heels is a very usual condition. Based on the National Foot Health Assessment conducted last 2012, around 44 million people from the United States, which is roughly about 20%, have had heel fissures. 
When these heel fissures are present, the skin may appear dry and callused. Discoloration on the medial area, yellow to dark brown in hue, may also be observed. These cracks and fissures are usually quite easy to recognize. 
A picture representing the cracks in one’s heels, or heel fissures.
Causes of Cracked Heels
Heel fissures tend to be formed when there are enough stimuli to trigger and cause the skin to split. These skin splits pertain to the visible fissure and cracks, and they can be brought about by the following factors. [2, 3, 4, 5, 6]
- Dry skin, lacking moisture
- Increase in age
- Athlete’s foot
- Atopic dermatitis
- Sjogren’s syndrome
- Too small sizes of footwear
- Prolonged standing
- Wearing whose with open backs
- Residing on an area with dry climate
- Presence of corns and calluses at the heel area
Signs of Having Cracked Heels
Having cracked heels may also predispose one into having a dry, scaly skin on both feet, particularly on the heel area. Thickened and hardened skin can be visible along the heels, further prohibiting the skin to coaptate, heal and return to its normal state. 
Pressures exerted on the heels, such as when walking or standing, can also predispose to fissures. If left untreated, extra pressure is added on the heel. These cracks become deeper and tend to split open. They eventually bleed, be painful and more prone to infection. [4,5]
Sequelae of Heel Fissures
In cases of severe cracked heels, the fissures may become infected and be predisposed to bacterial infection and cellulitis. This is usual for diabetics with peripheral neuropathy, who suffer unknowingly to infected heel fissures. These cracks can be associated with numbness of the feet, and may lead to diabetic foot ulcers and worse, gangrene. 
An image depicting a diabetic patient with cracked heels now complicated with a foot ulcer.
Treatment and Prevention of Cracked Heels
The most accurate treatment for cracked heels is still prevention. Heel fissures can be prevented by adequate moisturizing of the skin of the feet, including the heels. This can be done with the use of moisturizers and balms that can keep the integuments well nourished and hydrated. Such balms may contain water-retaining and descaling agents like alpha-hydroxy acids, salicylic acids, urea and saccharide isomerate. 
An oil-based moisturizing cream may be applied twice a day for further feet hydration. As adjunct, a pumice stone can be utilized to remove dead and thickened skin. 
Fissures may be managed with a gel, liquid or spray bandage to diminish pain and provide room for more immediate healing. 
One must also avoid walking barefoot, and wearing shoes open at the back or with thin soles. Instead, shoes with a well-built shock absorption property can be worn. Good solid heel counters in the hind area of the shoes can also protect the heel from fissure formation. [6,7]
Attempting to remove the hard thickened heel skin is not advisable. This can only induce bleeding, pain and further infection. A pumice can be used instead to remove those dead skin cells while bathing, when the skin is soft. 
If one notices cracking of the heels, along with bleeding, failure to heal despite adequate management or any sign of infection, a consult with the physician or the podiatrist must be done. 
What Can Podiatrists Do?
Also known as foot doctors, podiatrists are physicians with specialties dealing with the disorders of the ankle, foot, and lower extremity. In dealing with cracked heels, below are the possible management modalities usually done by podiatrists. [2, 8]
- Distinguish and address the root of the problem
- Perform regular debridement of hard thick skin found along the heels for prevention of cracked heels
- Give advice regarding adequate foot wear and hygiene
- Advise on the use of insoles to improve one’s walk and prevent development of thickened skin
- Prescribe the use of a heel cup to prevent the fat pad from expanding laterally, consequently preventing fissures
- Once with pain, strap the heel cracks while still healing to further prevent its recurrence
- National Foot Health Assessment 2012. Institute for Preventive Foot Health. 2012 June.
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