Cracked heels generally occur as a result of dry skin on the feet. This is often accompanied by hyperkeratosis (thickened skin) and callus formation around the edges of the heel, which is yellow or dark brown in colour. 1 When weight is applied to the fat pad in the heel, it expands sideways and creates fissures in the skin, which has become less elastic and more prone to cracking due to decreased moisture. Initially, small fissures can appear over the surface of the heel or callus and these may become larger and deeper resulting in pain and bleeding. Pain is typically worse on weightbearing and alleviated by rest. People with larger, deeper heel fissures have an increased risk of infection which may progress to cellulitis and ulceration, especially in those with additional risk factors such as diabetes.

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Risk factors include dry skin and systemic conditions There are a number of predisposing factors which make heel fissures more likely to occur. These include the presence of abnormally dry skin, corns or calluses, prolonged standing (especially on hard surfaces), excess body weight, going barefoot or regularly wearing sandals or open-backed shoes.

1 Underlying systemic conditions can also be associated with the development of cracked heels, and include: 1 • Atopic dermatitis – a family history of asthma, eczema or allergic rhinitis can be particularly useful in diagnosing atopic dermatitis (especially in infants) • Juvenile plantar dermatosis – characterised by dry, shiny, glazed skin on the sole of the foot due primarily to friction. It is most commonly seen in children who are atopic, particularly boys aged four to eight years. 2 • Psoriasis, particularly palmoplantar psoriasis – tends to be a chronic, recurrent condition • Other forms of palmoplantar keratoderma – which can either be hereditary or acquired and described as localised or diffuse thickening of the skin on the palms and soles • Any systemic condition that can cause dry skin, e.g. Maplestory V62 Gm Commands more. Hypothyroidism or diabetes. Topical treatments can be used for both prevention and management Preventing and treating dry skin to avoid cracked heels is preferable, but patients usually present for treatment after heel fissures have developed. There are a wide range of emollients available that can be used to both prevent and treat dry skin and cracked heels.