SINGAPORE - You may not think twice about wearing open-back sandals or going barefoot, but such long-term habits can lead to cracked heels that are unsightly and sometimes, downright painful.
That is because the feet are not well-supported. It can also get dry easily and the skin around the rim of the heels may crack or split apart.
"Flip-flops or sandals often have no support at the heel. As the body's natural padding, the fat pads, which sit under the bones and help to disperse weight, are not supported," said Mr Greig Price, a podiatrist with PhysioActive.
As a result, excessive pressure builds up at certain spots, such as the heel. This, in turn, leads to callus formation, which is the skin's way of protecting itself against excessive pressure, said Mr Price.
"Too much callus and the heel will begin to crack," he added.
Generally, the soles of our feet have thicker skin as they need to withstand our body weight for activities that involve standing and walking, said Ms Jessie Phua, principal podiatrist at Changi General Hospital.
"The heels, being at the edge of the soles, will thicken as part of the body's natural protective mechanism," she said.
But when you have cracked heels, it often means that there has been excessive weight bearing on the heels and your skin is not supple, she added.
The problem can also be caused by standing too long on hard floors or just by being overweight - which puts more pressure on the heels.
Genetics and medical conditions such as thyroid disorders, diabetes or eczema can also give rise to cracked heels or heel fissures.
Some people have blamed the occurrence of cracked heels on particular brands of footwear, but if the culprit is open-back footwear, the exact brand or model makes little difference.
The material, though, can play a part, as a hard surface such as cork will allow calluses to form more quickly, said Mr Price.
"In contrast, a soft supportive shoe will hold the foot in place and reduce the amount of friction the heel receives," he said.
Cracked heels are usually a cosmetic problem, but in serious cases, the cracks can deepen and result in painful heels and cause pain when a person walks. They may even bleed.
Germs and bacteria may also enter the body through the cracks, causing infection, said Ms Phua.
Diabetics, in particular, have to regularly check for cracked heels, as uncontrolled blood sugar levels can damage the nerves in the feet, causing dry skin and cracked heels.
"There can be hidden wounds in the cracks which they are not aware of," she added.
Diabetics who have cracked heels should consult a podiatrist rather than treat the problem themselves, or worse, visit a nail salon for a pedicure and risk contracting an infection.
The podiatrist will assess the condition of their feet and the severity of the cracked heels and advise them on treatment and preventive measures.
Otherwise, if you find that you have unsightly cracked heels, here are some things you can do.
1. Moisturise your heels
Those with very dry feet and fine white lines on the heels can use any type of moisturiser to ease the problem, said Ms Phua.
Petroleum jelly can also be used to soften the skin on the heels. The emollient agent increases moisture levels by providing a physical barrier that stops water loss from the skin.
But once the hard skin forms and the cracks appear, you will need to get a cracked heel cream, said Ms Phua. Otherwise, you can look out for creams that are targeted at dry skin and which have a urea content of at least 10 per cent.
"Urea has a 'de-sloughing' action when it comes to dead skin cells, so it is recommended if the cracked heels are very dry," she said.
Urea is also a humectant which helps to draw water from deeper levels of skin cells to moisturise the top layers, added Ms Fiona Hu, a podiatrist with Orchard Clinic.
Mr Price said many common household items, such as olive oil, vegetable oil and honey, can be used to treat dry, cracked heels.
But "the most effective treatment, as used by the majority of medical practitioners, is moisturising creams designed specifically for the foot", he said. These products typically cost around $17 per tube.
2. Keep working at it
Cracked heels are not something that will disappear after short-term use of moisturisers.
Some people are predisposed to dry skin, while others may never get severe cracked heels.
But if you have cracked heels, it will be a recurring problem, as long as you continue to move around and put weight on your heels.
It is one thing to apply cream on your heels and another to keep at it, said Ms Phua.
It should be part of our lifestyle, just like how we would moisturise our face every day, she said.
3. Soak your feet
There are various home remedies for cracked heels. They involve soaking the feet in warm soapy water, honey water and water with lemon, or by covering the heels with a blended paste of banana and avocado.
These remedies do "provide a 'feel good' therapeutic effect but they will not get rid of cracked heels", said Ms Phua.
The important thing is to moisturise the heels as skin tends to get drier with age, she said.
Still, what you can do is to soak the feet in warm water for about 20 minutes to soften the skin. After that, scrub your heels with a foot file to remove the callused skin before applying a moisturiser, said Mr Price.
Diabetics, however, should not soak their feet as it may dry them out instead.
Some people like to use ready-made foot masks, but it is important to follow the instructions on the package.
Overzealous users may slather as much of the product as possible on their feet. But if the mask contains acid, using too much of it may thin the skin, especially for people in their 50s or above as their skin would be more fragile, said Mr Price.
Also, check the ingredients of the product to make sure it does not contain any zinc, aluminium or acid, which can cause allergic reactions, he added.
Exfoliation can help to reduce the thickness of the dry, hardened skin on the heels, but it will not help if the cracks are very deep.
By then, you will have to cut away the dead skin but there is a risk of injuring yourself in the process.
That is when you can visit a podiatrist, who can remove the dead, hardened skin on your heels for you.
"If the fissures are deep, no amount of cream on the surface will help," added Ms Phua.
"For effective treatment, one will need to have the heel areas pared or debrided. Only then can the creams do their job."
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