Now I know cracked heels may not seem like a big thing as they are so common, but actually they can be a lot more troublesome than maybe you realise. Whilst “weathering” of the heels through wearing open-backed footwear such as sandals in the summer months is one of the main causes of cracked heels, there are other causes that can indicate or lead to worse problems.
For instance, underlying fungal infection can lead to dryness of the skin and make it more prone to cracking/fissuring. In such circumstances, applying just moisturising cream to the dry skin will actually prolong the problem as the fungus thrives with the additional moisture. Then if not dealt with properly, the fungal infection can spread to other parts of the feet including the nails leading to a fungal nail infection that can be a lot harder to solve.
In addition there are underlying medical conditions that can lead to cracked / fissured heels. For instance diabetes can lead to autonomic neuropathy where control of sweating is lost and thereby moisture regulation of the skin is impaired. Sometimes this is one of the clues to identifying those who may need testing for diabetes if they haven’t been previously diagnosed.
Whilst the vast majority of heel cracks/fissures only affect the outer layers of the skin (the epidermis), sometimes they can progress to the deeper layers (the dermis) and become dermal fissures. When that occurs they can be painful and bleed. Without the right treatment they can become infected and/or ulcerated which then increases the risk of sepsis.
Indeed just this month I had an 87-year old patient in clinic with a 1cm deep painful crack in her heel which had been treated twice by another “chiropodist” with no success. Fortunately at our clinic, we have lots of tools in our toolbox to help with the variety of foot conditions that are presented top us. So after just one treatment the patient was a lot more comfortable, and 10 days later the deep fissure had resolved completely.
As always in this series of articles, we will look at the costs of the specific foot condition being discussed. So here are the costs relating to cracked heels:
Physical costs – As long as the heel cracks/fissures are in the epidermis, then they don’t really incur a physical cost, other than the effort of carrying out self-treatments through the use of suitable products. We recommend regularly using a foot file & urea-based moisturising cream like E-45 (as long as there is no underlying fungal infection). If the heel cracks/fissures have gone deeper and causing pain, then they can cause reduced activity or limping which can then have more of a physical effect on fitness and can induce other heel pains. If they become infected especially in those with diabetes or poor circulation, then in the worse case scenario they could lead to hospital-admission and even amputation.
Emotional costs – Cracked heels are pretty unsightly so some people avoid exposing their feet for others to see. They become self-conscious of their feet at the beach or when sunbathing, so they avoid these situations. They can also get frustrated at being unable to resolve the cracked heels by themselves, especially if they snag on socks or tights. Then if they become painful, then there are all the emotions associated with having to cope with that pain with every step taken when walking / running.
Financial costs – The good news is that even the worse cracked heels can be resolved without too much expense if you get the right treatment for them. However, if you don’t then the cracks can perpetuate for years, needing regular professional treatment just to keep on top of them. Such ongoing treatment by a Podiatrist or Foot Health Practitioner could cost £30 – £70 every few weeks/months for life. Whereas, using the 1cm deep fissure patient as an example, the fissure was cured at our clinic for £300.
So if you would like to see an experienced foot specialist with any foot-related problem, please call 01926 811272 or book an appointment.
Jonathan Small, Lead Podiatrist, Health First Foot & Gait Clinic.