What do tomatoes have to do with heel cracks?
Earlier in the summer I was boastful about how good my tomato plants were looking. I was so smug, until the heat and smoke hit Canberra. When I ate the first tomato of the season it tasted awful. It wasn’t a delicious, juicy tomato. It wasn’t even a sundried tomato. It was a flourly, sunroasted tomato. Over the season the crop improved, thankfully the smoky summer didn’t taint the flavour and only a few ended up with cracks. Even better, they also came in handy for this crackin’ good article. To understand how to heal heel cracks, the most common causes of heel cracks will be discussed first.
What are heel cracks?
When the skin around your heels splits apart, they are called heel fissures or heel cracks. Deep cracks can be painful, bleed and become infected. They can also be a cosmetic concern to some people.
What causes heels to crack?
Skin with poor integrity is more likely to break under pressure compared to skin with good elasticity and suppleness. Poor skin quality can be
-dry
-peeling
-callused
-from skin conditions such as tinea, eczema, psoriasis
There are medical conditions that predispose people to dry skin. These include advanced diabetes, an underactive thyroid and the aging process. Reduced sweat gland function can increase the dryness of skin. Sweat glands release sebum, a natural skin lubricant. Less hydrating sebum means the skin won’t get as much natural moisturiser.
The body’s natural heel padding absorbs the forces of walking and standing. Heel padding that is thin won’t absorb much force so the skin is exposed to increased forces which can cause callus and splitting. Sometimes heel padding excessively displaces sideways. The padding directly under the heel is less and the skin has an internal force pressing it outwards.
Excessive body weight and pregnancy increases the load on the heels. Prolonged periods of standing and walking also expose the heels to increased forces.
Shoes with good cushioning help to absorb weightbearing loads. Shoes with a worn midsole, poor cushioning or hard soles don’t assist the feet with these pressures. Excessive barefoot walking, particularly on hard surfaces also expose the skin to high forces. In summer we are more likely to wear open backed shoes but these allow the heel pads to excessively expand sideways. Open shoes such as thongs and sandals expose the skin to dry air. Shoes with a strong, closed back hold the heel padding in place under the heel bone and prevent summer air from drying the skin out.
Dry, hot weather conditions when in direct contact with the skin causes increased moisture loss making the skin more vulnerable to splitting. In a way, our skin needs the same protection from the elements like tomatoes on the vine. If tomatoes don’t have the shade of its leaves protecting them, they are more prone to splitting. Our heel skin also needs protection, although shoes, sunscreen and moisturiser are much better forms of protection than leaves.
What can a Podiatrist do for my heel cracks?
Firstly, the contributing factors of the cracked heels need to be identified i.e. which tomato situations apply to you. An at home plan is tailored to you to address these causes.
During the consultation the podiatrist may skilfully remove callus and peeling skin with a scalpel blade. This skin is dead so there will be no to minimal discomfort. The podiatrist can also file off dry skin.
In advanced causes, tape or glue is applied to hold painful, deep cracks closed to allow for healing.
Heel cups may be issued to provide additional cushioning and prevent sideway movement of the heel padding. New Step Podiatry stocks Tuli’s heel cups.
A footwear assessment and recommendations which may include more cushioning, closed heels and a high heel drop.
What can I do at home?
Apply a urea-based ‘heel balm’ daily. Urea based creams have a 4 way action: they add moisture, prevent moisture loss by creating thin film around the skin, help to break down harden skin and encourage your skin to release more sebum. Care must be taken to not apply urea to deep fleshy cracks. There are some really greasy heel balms, avoid these as they can be too slippery. New Step Podiatry stocks a coconut oil-based heel balm, it smells great too!
At home filing with a hand file to reduce the harden skin and remove dry skin. Avoid using razor blades, sharp scissors or cheese grater type files as these can result in pulling on the crack, injury and infection.
Treat associated skin infections such as tinea with a broad spectrum antifungal cream.
Wear shoes with good heel cushioning and a closed heel.
