Splits in the skin around the heel are frequent, are painful, and don’t look very good. This occurs when the fat pad under the heel expands out sideways under the heel and the dried-out skin cracks or splits to develop a heel fissure. A great way to fully understand these is to use the analogy of a tomato being compressed. As you apply force to the tomato to compress it, the skin around the tomato splits as the content forces outwards. So it is with the heel. As bodyweight compresses the fat underneath the heel it stretches out sideways from beneath the heel, it tries to tear the skin around the perimeter of the heel. If this succeeds or not will probably depend on how soft and strong that the skin is. If the skin is dry, thicker or callused, it is going to crack very easily. If the skin is thicker with a covering of callus, that skin will crack easily and put a strain on the good skin below that may become rather painful, perhaps bleeding. Each step which is taken with even further open the crack which will help prevent it from healing. Heel fissures are more prevalent in those that wear open heel type shoes, as a closed in shoe should help keep the fat pad beneath the heel in position and help avoid or decrease the effects of this.

The most efficient short term management of cracked heels is to have the callused skin debrided by a podiatrist and then use strapping to hold the edges of the crack together so that it can mend. The long term protection against cracked skin around the heel ought to be clear from the mechanism that was explained above. Firstly, weight loss will help decrease the issue, but this is a long term issue. To help prevent the fat pad under the heel from expanding out laterally and trying to crack the skin, a closed in shoe needs to be used and frequently the use of deep heel cup insoles will help. A podiatric doctor really should be consulted routinely to cut back any dry callused skin. Creams should be used regularly to keep the skin resilient so that it does not fissure. The use of filing tools to help keep the callus in check may also be used.

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