Definition

Heel fissures, also known as cracked heels can be a simple cosmetic problem and a nuisance, but can also lead to serious medical problems. Heel fissures occur when the skin on the bottom, outer edge of the heel becomes hard, dry and flaky, sometimes causing deep fissures that can be painful or bleed. When ignored, heel fissures can lead to tissue breakdown and ulceration which is particularly risky in high risk patient groups such as those with diabetes and/or poor circulation.  

Cause

Heel fissures can affect anyone, but risk factors include: Living in a dry climate (such as Malta), obesity, walking barefoot or wearing sandals or flip- flops, inactive sweat glands, and lack of hydration (drinking water). Like many foot conditions, heel fissures can become more dangerous if they go untreated and become deep or infected. This is especially dangerous for people with diabetes or compromised immune systems.

Treatment and Prevention

Moisturizing the feet regularly can prevent heel fissures. Once they occur, you can use a pumice stone daily to gently decrease the thick and flaky layer of skin. Avoid going barefoot or wearing open-backed shoes, sandals or shoes with thin soles. Shoes with strong shock absorption can help to improve the condition. Moisturizing the feet using heel fissure emollients at least twice a day and wearing socks over the moisturizer while sleeping can also help. Some people may also find helpful the use of transparent wrapping plastic to use as a barrier coat after applying a thick layer of emollient for heel fissures. This should not be kept for a long period of time and should not be wrapped too tight around the heel and ankle. Drinking regular amounts of water is important to maintain healthy and hydrated skin. 

The Association of Podiatrists of Malta recommends the following emollients for heel fissures:
–    Uriage Bariederm cream for cracked heels and fissures
–    Dermatonics heel balm