The soles of the feet bear the greatest force throughout life and the skin, muscles and bones of the feet have developed accordingly. The soles have thick skin with extra fat padding and when this skin becomes dry, it is particularly prone to cracking. It is not an uncommon condition in a person of any age and is often seen as little more than an unsightly inconvenience, particularly to women. However, cracked heels can be a serious condition that can lead to severe discomfort and even hamper a person’s normal activity. The elderly, with many of the age-related changes that occur in the body, are especially prone to cracked heels.

What are cracked heels?

Cracked heels, known as heel fissures, are thin and sometimes deep openings in the skin of the heels and may also occur at other sites on the soles of the feet. It is likely to occur and be more severe when calluses form on the soles, particularly the heels, which are thickened areas of skin. This is further complicated if a person has dry skin which essentially weakens the skin thereby leading to the formation of cracks. Apart from being painful and leading to bleeding, it also increases the chances of infections setting in on the sole of the feet.

Causes of Cracked Heels

Cracked heels are more likely to occur in certain people and situations. In the elderly, the problem lies largely with dryness of the skin that sets in with age coupled with other factors like change in gait (the way a person walks) with growing older and disabilities. Lifelong factors further contribute to the development of cracked heels in the elderly, such as :

• obesity which increases the pressure on the soles due to the greater than normal body weight.
• standing for long periods with poorly supportive footwear, especially on hard surfaces.
• using open-back shoes most of the time which shifts the tissue of the soles outwards and to the back.

Open-back shoes is the reason why women are more likely to suffer with cracked heels than men. Some diseases increase the likelihood of cracked heels developing due to drying of the heels or skin damage. This includes :

• diabetes mellitus
• peripheral arterial disease
• hypothyroidism
• contact dermatitis
• psoriasis
• eczema

Treatment of Cracked Heels

The key to treating cracked heels is to reduce the pressure on the soles of the feet. Supportive footwear which is soft and fits properly can help reduce the pressure. Counter pads can be placed over the affected areas to reduce pressure on it and allow it to heel. Antimicrobial ointments will eradicate any infection in the area and is then later treated with anti-inflammatory applications to reduce swelling and pain. Special types of skin ‘glue’ can help to seal the area but this is only to be used by podiatrists and dermatologists. The elderly with changes in gait due to disabilities or with the use of mobility aids should seek advice about proper foot wear and custom made orthotic inserts for the shoes. This will help to reduce excessive pressure on specific parts of the soles.

The callus can be treated and removed in several ways.

• Debridement is the removal of the thickened skin by shaving and filing it away. This should be done by a podiatrist who specializes in foot care. The incorrect technique can severely damage the area and worsen the condition.
• There certain types of medication to ‘thin’ the skin. These are acidic substances which can severely damage the skin if used incorrectly.
• Pumice stones may help to reduce the thickening of the skin and soften the area. It should not be used aggressively in an attempt to totally remove the callus or it can severely damage the skin.