Cracked heels… Painful, embarrassing and sometimes a sign of trouble

Put a tomato on a kitchen bench, squash it slightly from above and watch it expand out sideways under the pressure before eventually cracking.
It may seem simplistic, but the process described above is exactly how the normal fat pad under your heel reacts when your body weight pushes down. The fat wants to expand sideways like the tomato, and the pressure on the skin to crack is increased. 
Add in excessive weight (such as prolonged standing), skin that is not supple (in other words, calloused and dry), and nothing helping to hold the fat pad under the foot (such as wearing open-backed sandals)…and you’ve got all the ingredients for cracked heels. 
A common foot problem, cracked heels are often caused by dry skin and made way more complicated if the skin around the rim of the heel is thick or calloused.   Cracked heels generally aren’t terribly dangerous, but cause nuisance, pain and embarrassment for sufferers throughout the year.
If the cracks are deep, there is pain on weight-bearing which eases off when the weight is taken away. Wearing open or thin-soled shoes usually makes the symptoms worse. In severe cases, however, cracked heels can become infected and lead to cellulitis, which must be treated with elevation of the foot, debridement of dead tissue and antibiotics.
When to Worry
Pedicurists are often the first port-of-call for sufferers of heel cracks, but they are not podiatrists and are unqualified to diagnose or treat nail and foot diseases.  This can cause confusion for clients, who often expect pedicurists to remove corns and callouses, but if you suspect any nail or foot disease, always advise the client to be diagnosed by a GP or podiatrist.
As Podiatry New Zealand executive officer Wayne Tucker says, podiatrists are generally very happy to discuss individual cases with pedicurists worried about a client.
“Podiatrists are trained over three years in the treatment and function of the lower limb, and anyone practicing podiatry in New Zealand must be registered with the New Zealand Podiatry Board,” he explains.
“One area podiatrists can help in is the treatment of heels which have become hard and dry. There are many ways of treating these, depending on the specific case. 
“Some heels are just a bit dry and would benefit from a light rub with pumice or similar, followed by an emollient to rejuvenate the skin. This treatment can be used regularly, and if possible your client can apply emollient twice a day at home.”
What to Do
General callous is the result of skin cells losing water. Man-made fibres found in shoes and tights dry out the surface of the skin and when general friction increases the heat over the skin surface nature begins to produce more skin cells.
The treatment of cracked heels with established remedies is mostly effective.  This includes removing dry thick skin by using items such as pumice or foot files, and using heavy duty emollients or pedicure oil to soften the skin. 
Under the Health Practitioners Competence Assurance Act 2003 however, regulations have been passed making some activities restricted to registered health practitioners.  This includes any procedure requiring the practitioner to go below the surface of the skin. 

 Written by Kathryn Calvert

Therefore, in cases where the heel skin requires the use of an instrument such as a scalpel, these clients should be directed to a registered practitioner such as a podiatrist.
“In some cases, fissures occur in the heel,” Wayne says.  “These are cracks which penetrate the full thickness of the epidermis and occasionally, these fissures will become painful and start to bleed. 
“People with fissures often have underlying medical concerns which ought to be addressed. The depth of these fissures is such that only a registered health practitioner ought to treat them.
“One condition podiatrists see a lot of is diabetes.  Diabetes affects the lower limb in many ways, one of which is to slow down the rate of healing. Should a patient with diabetes have a fissure which becomes infected, it is possible that without timely treatment the limb will need to be amputated, often just below the knee. 
“Therefore, it is crucial that you ascertain your client’s medical history, and if a condition such as diabetes is mentioned, you would be best advised to refer that person on to a podiatrist.  This advice also applies to clients who are on medication such as aspirin or warfarin – these types of medications slow the clotting ability so any cuts (even small ones) take a long time to stop bleeding and can easily become infected.
Your Course of Action
Foot specialists say pedicures should be done every three to five weeks for a start, and your clients should be warned that exfoliation of heels should never be done at home, due to the chances of cutting too deep.
Other benefits of a professional pedicure to impress on your clients is the fact that they remove dry skin effectively – encouraging feet to breathe and helping with perspiration control.  Cuticle care prevents ingrown toenails, regular pedicures can prevent the spread of foot fungus, and the obligatory foot massage will stimulate circulation.


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