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Splits in the skin around the heel are frequent, are painful, and don't appear very good. They happen when the fat pad beneath the heel expands out sideways beneath the heel and the dried-out skin cracks or splits to create a heel fissure. A good way to understand these is to use the analogy of a tomato being squashed. 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 squashes the fat under the heel it expands out laterally from underneath the heel, it tries to tear the epidermis around the perimeter of the heel. If this succeeds or not will probably depend on how flexible and strong that the skin is. If the skin is dry, thicker or callused, it will split easily. If the skin is thicker with a covering of callus, that skin will split easily and place stress on the good skin underneath that can become very painful, even bleeding. Each step which is taken with further more open the crack which will help prevent it from healing. Heel fissures tend to be more prevalent in those that wear open heel type footwear, as a closed in shoe can help keep the fat pad under the heel in position and help prevent or reduce the effects of this.


The most efficient short term management of cracked heels is to have the thick skin debrided by a podiatrist and then use tape to hold the edges of the crack together so that it can heal. The long term protection against cracked skin around the heel should be clear from the mechanism that was described above. To start with, weight reduction will help decrease the problem, but this is a long term issue. To help stop the fat pad beneath the heel from broadening out laterally and trying to split the skin, a closed in shoe needs to be used and in some cases the use of deep heel cup inserts will help. A foot doctor should be consulted routinely to remove any dry callused skin. Emollients really should be used regularly to keep the skin flexible so that it does not crack. The use of pedicure files to keep the thick skin in check may also be used.

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