Cracked heels, or heel fissures, are a very common problem.
However you can get a variety of "cracking". Some quite mild and some quite severe.
Pictures can say a thousand words so these pictures will explain a little bit better (picture 1):
The above picture shows a mild form of heel fissuring. Below is a little bit more extreme (picture 2):
However, again, this is not really the worst case of heel fissuring that you can see. We can go further (picture 3):
What Exactly Are Cracked Heels?
It depends really on how you look at it. In regard to all those pictures that you saw, they have one thing in common:
• When the cracking gets worse you get a bigger deposition of hard skin.
So when people say that heel cracking is due to dryness, that is not strictly true. The first picture (below) is definitely due to dryness, we also see very little hard skin.
But the other pictures do not look dry, especially the second picture (seen below):
As the hard skin increases we see more yellowing around the heel, and do you notice something?
It is the hard skin that starts to crack.
As the hard skin increases even more, the cracks become deeper.
So basically cracked heels are the break in the protective skin layer around the heel area caused by many factors.
That is really all we can say about cracked heels. There are many reasons why they occur and many ways on how to treat them.
Again, it is finding the right treatment to the right stage that will give us some help. But one thing is certainly clear, applying moisturising cream is not the golden key for all cracked heel problems. Because if you apply moisturising cream to pictures 2 & 3, it is not really going to do anything.
When we stand upon our feet we exert a lot of pressure upon a small area. The skin is a wondrous organ, in that it will keep its shape as best as possible, especially if it is in an optimum condition.
When the skin dries out it loses that suppleness, and therefore it loses its mechanical strength, so in areas of high pressure it weakens.
So you get the initial crack, basically because the skin can not take it anymore.
However the body is an amazing thing. It doesn't like to be broke and it will do everything it can to reduce anything that will likely lead to it being broke.
So it thickens up the skin in areas of high pressure or mechanical rubbing. This is evident when gardeners and trades people have “rough hands”. It is mainly due to the body thickening up the skin in various parts of the hand where it knows there are high stresses going on.
So the second picture in our heel crack gallery introduction shows this process.
Unfortunately this “skin build up mechanism” has a slight flaw in it. When hard skin gets laid down it itself adds pressure. Its hard- the title gives it away- so the body says “oh dear, there is more pressure there, lets add some more hard skin to help us out”.
Now you can see where this is leading. As you add hard skin, more hard skin gets put down, which increases the deposition of hard skin. It’s a cycle. And we get picture 3.
All the physical stresses playing a part upon the heel can be shown using a very simple diagram:
According to my extremely accurate work of art above :) stresses from above and from the ground cause the familiar pattern of cracked heels.
However, if the cycle is not broken, picture 3 can become bigger and worse.
Cracked heels can cause a lot of problems and most of them are avoidable- because cracked heels are treatable.
When the skin cracks because of lack of moisture, the crack stays within the skin. However if you keep on moving around on a mechanically reduced area, something is going to break. In time something usually does. The crack pushes past the skin and literally cracks the skin open to where the skin can bleed.
The skin is an amazing organ, and will stop just about most common harm coming to your body. However if it is broken to where blood can come out then this becomes a portal for infection. To us, it is a small crack with dry blood present but to bacteria it is like the Grand Canyon. But, as you walk on the fissure it opens and closes in time to your walking:
As the amazingly detailed picture from above shows :) pressure from the top and floor pushes the fissure (the triangle) out in 2 directions relieving the pressure on the skin.
So every time you walk on your fissures, you inadvertently make the fissure worse and run the risk of bacterial infections occurring.
Now when you add extra hard skin in the mix, it increases the pressure from the bottom of the foot and makes the crack worse.
Now as hard skin is added, it in itself is very inelastic. Again, the name says it all- hard skin. So the hard skin can split, forming fissures within itself because of the amount of pressure that passes through our heel when we walk (about 2 times our own body weight).
This comes about for 2 main reasons:
1- The increased layering down of hard skin causes the heel to become harder- not the soft cushion which we need when we walk. It can be painful. Some patients that we have seen will not walk or get exercise because their feet are so bad- which adds other complications to themselves. Some patients will even favour their other foot to relieve the pressure from the affected heel. This will then put extra pressure and mechanical forces onto the other limb increasing forces and in time making that foot sore.
2- As those fissures go deeper in the skin and bypass the skin, technically you are walking on your cut. This can be painful and also a cycle in itself. If you have a cut and you keep on aggravating it, it will not heal because the problems that are causing it are still there.Treatment options
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