Practical Approach: What‘s the best way to treat cracked heels?

At the Update Pharmacy, a middle-aged woman has been perusing the foot aids section for some time and is looking rather confused. Hannah, senior medicines counter assistant, has noticed and approaches her.

“Hello Mrs Dunstone, she says. Can I help you?
“I’m looking for a good cream for sore heels and I don’t know which one of these to choose,Mrs Dunstone replies.
“Is the skin cracked? Hannah asks.
“A bit, but you can have a look for yourself, I’ve got no tights on and I’m wearing backless sandals,says Mrs Dunstone, bending a leg up behind her.

Hannah takes a look and says: “You’ve got a quite a lot of hard skin and a couple of quite deep cracks there. I think you ought to have a word with Mr Spencer. Take a seat in our consultation area over there and I’ll send him out to you.”

What I’d like to know,Mrs Dunstone says to pharmacist David Spencer as he is examining her heels, “is how I’ve come to get this. I think I look after my feet quite carefully.”

Well, David replies, “it’s a bit like if you push down on a tomato from above. It tries to expand sideways and eventually the skin cracks. That’s what happens to the pad of fat under your heel as your body weight pushes down on it.

Having dry skin makes cracking more likely, and there are several other contributory factors. I’ll tell you about those and we’ll see if we can find you something good to treat it with.”

Questions

1. What factors contribute to the likelihood of cracked heels?

2.  What treatments for cracked heels are available from the pharmacy?

3.  When should cracked heels be referred to a doctor or podiatrist?

Answers

1. Drying conditions, eg warm weather, central heating.

• Predisposition to dry skin conditions, eg atopic eczema, psoriasis.
• Paradoxically, wet skin from excessive sweating or spending a lot of time in water, which lowers tensile strength of skin and predisposes to cracking.
• Wearing open backed shoes no support provided to prevent heels from spreading under downward pressure from the body.
• Diabetes, causing autonomic neuropathy; hypothyroidism, causing lowered metabolic rate. Both lead to reduced sweating and dry skin.
• Peripheral vascular disease, causing loss of skin elasticity.
• Excessive weight, increasing downward pressure on heels.
• Prolonged standing, especially on hard floors.
• Thin soled shoes.
• Foot conditions, including heel spurs and flat feet, which affect gait.

2. Emollients, used regularly, to rehydrate the skin several products are marketed specifically for cracked heels. Ointments, being more occlusive, may be preferable to creams. Wrapping clingfilm over the heels further increases occlusion. Some products contain urea to increase hydration. There is also a hydrocolloid based product. A pumice stone can be used to reduce the thickness of hard skin.