Q: I am a 44 years old man having cracks on my heels . I have tried many ointments as per the doctors’ advice but no cure. I feel very warm in my feet and want to put them in water. Please advise.

A:Cracked heels are a common foot problem that is often referred to as heel fissures. Cracked heels are commonly caused by dry skin (xerosis), and made more complicated if the skin around the rim of the heel is thick (callus). For most people this is a nuisance and a cosmetic problem but when the fissures or cracks are deep, they are painful to stand on and the skin can bleed - in severe cases this can become infected. The skin is normally dry and may have a thick callus, which appears as yellow or dark brown discoloured area of skin, especially along the inside border of the heel. Cracks in the skin are usually obvious. Some people tend to have a naturally dry skin that predisposes them to the cracks. The thickened dry skin (callus) around the heel that is more likely to crack is often due to mechanical factors that increase pressures in that area (e.g. the way you walk). Other factors that can be involved in the cause of cracked heels include:

• Prolonged standing (at work or home, especially on hard floors).
• Being overweight (this increases the pressure on the normal fat pad under the heel, causing it to expand sideways - if the skin is not supple and flexible, the pressures to crack are high)
• Open back on the shoes (this allows the fat under the heel to expand sideways and increases the pressure to crack).
• Some medical conditions predispose to a drying skin (e.g. autonomic neuropathy in those with diabetes leads to less sweating; an underactive thyroid lowers the body's metabolic rate and there is a reduction in sweating, leading to a dryness of the skin).
• Skin conditions (e.g. psoriasis and eczema).

Applying an oil based moisturizing cream twice daily is really important to get on top of this problem. A pumice stone can be used to reduce the thickness of the hard skin. After looking at the tomato analogy above it should be obvious why it is important to avoid open backed shoes or thin-soled shoes. Never try to reduce the hard skin your self with a razor blade or a pair of scissors. There is a risk of an infection developing and taking too much off. The podiatric treatment of cracked heels may involve the following:

• Investigating the cause of the problem, so this can be addressed.
• Removing the hard thick skin by debriding it (often the splits will not heal if the skin is not removed). This may need to be done on a regular basis. Regular maintenance may be the best way to prevent the problem.
• If very painful, strapping may be used to hold the cracks together while they heal (a maintenance program after this to prevent recurrence is very important).
• Prescription and advice regarding the most appropriate moisturizer or emollient. advice about footwear and self care of the problem.
• In-soles may be used to alter the way you walk to prevent the thick skin from developing (these are indicated in cases of heel callus and are not suitable for all cases).
• A heel cap may be used to keep the fat pad from expanding sideways. This is worn in the shoe and can be very effective at prevention if used regularly.