I have reoccurring cracks in my heels that are very painful, and over-the-counter skin moisture creams do not seem to help. What causes these skin cracks and how do you get rid of them once and for all?
Dry skin – what an irritating and noisome problem. Whether it be fine scaling and flaking of the lower legs, a tight dryness of the face, cracking and fissuring of the fingers or feet, or an itchy irritation of the shoulders and back, dry skin is a nuisance.
It is also ubiquitous: most people complain of dry skin problems at one time or another in their lives, while some people deal with it their entire lives. I have a newborn baby at home, nine weeks old, who has dry skin (a temporary newborn condition.) Her proud grandmother, who has been plagued with dry skin all of her life, is allergic to most skin moisturizers, which is an especially challenging situation for her. Alleviating dry skin conditions is a multibillion dollar industry of skin moisturizer manufacturers each vying to sell their products to eager, albeit irritated, customers.
What actually is going on with dry skin? Dryness would suggest a lack of water, yet studies comparing dry and normal skin fail to find a difference in water content in the outer skin layer called the stratum corneum. This is a bit counterintuitive, since the way in which dry skin is healed is by using remedies that increase the moisture content of the skin. It seems that the problem is not fully understood. One line of thought is that the problem is more one of excessive evaporation. Even when we are not sweating, water is lost through the skin. Doctors call this “insensible water loss” (insensible, as in we can’t very well measure it) which clinical studies estimate may be as much as half a quart of water per day. People with dry skin problems appear to have problems with their stratum corneum that lead to accelerated water loss.
We do know that there are many everyday activities that make dry skin worse. Chief among these is the use of soaps, detergents and disinfectants (such as rubbing alcohol). Daily bathing is a routine part of life for many of us, and plenty of soap is often used as part of the ritual. Soap does a nice job of cleaning the skin, and it smells great, but it is also capable of damaging the stratum corneum, causing an acceleration of water loss by up to 50 times the normal rate. The result is dry skin.
Environmental factors are also important. For example, in cold weather the atmosphere is unable to hold as much moisture as in warm weather. Thus, when the cold winter winds blow, moisture is sucked out of the body at a rapid rate and the skin dries out. The dryness of forced hot air heating systems, or of homes that heat with wood, make matters even worse since these kinds of heat seem to be especially drying. Age is also a factor. As one gets older, the number and activity of oil producing sebaceous glands are reduced and there is also a lower rate of perspiration in the elderly. This predisposes older adults to dry skin and extra care must be taken.
The problem with fissures of the hands or feet is that by the time those deep cracks reveal themselves to the eye, and by the time they become uncomfortable enough to want to do something about it, a lot of damage has already occurred. The hands and feet are places where thick calluses occur and where the skin in general has a very thick stratum corneum. Indeed, the outermost layer of cells in the stratum corneum are actually dead — microscopically, one can see a matted barrier of dense, dead skin cells. (This dead skin layer is also referred to as the “horny layer” of epidermis, in honor of true animal horns which are composed of the tough protein called keratin found in high concentrations in dead skin cells.) Therefore, by the time deep fissures appear, no amount of moisturizer is going to remedy the situation. You have to wait until the old dead layers of skin flake off and the new healthier skin takes its place. This takes weeks.
What can be done? A double-pronged approach using abrasives and moisturizers should eventually do the trick. Pumice stone may be used with each bath to rub callused areas and accelerate the removal of the thickened dead skin layer. Select a bath soap that is “moisturizing.” Moisturizing soaps clean while also returning some oil to the surface of the skin helping to lock in moisture. Immediately after bathing — and I mean immediately: as soon as you towel off — apply a heavy moisturizing cream or ointment. Vaseline (petrolatum) or Bag Balm do an excellent job but may be too greasy for some people.
Various proprietary brands contain varying concentrations of petrolatum, mineral oil, lanolin and glycerin, any of which will help. However, those with higher concentrations of heavy-duty moisturizers such as petrolatum and mineral oil will give the best results. Alpha-Keri lotion and Eucerin cream, Aquafor and Lubriderm are names of fairly good moisturizing lotions you may wish to try. The most potent moisturizer and emollient (an emollient is a softening and soothing cream that also acts as a barrier to moisture loss) is Lac-Hydrin, which is available over-the-counter, or in higher concentrations by prescription. However, your best bet for foot fissures is probably a heavy ointment such as petrolatum or Bag Balm.
Finally, a penny of prevention is worth a pound of cure. If you are prone to these fissures you may have to make a regular routine of light pumice stone sessions followed by a moisturizing cream just to keep the skin soft, pliable, and moist, and to prevent the cracking that occurs over time when the skin has been neglected.
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