Dear Doctor,

I  am a 23-year-girl in college. Lately I have developed a serious case of cracked feet though I do not spend much time in open shoes. I am a regular wearer of rubber shoes as they are comfortable and easy to pair with anything.

The cracks on my feet are not painful or itchy but they are not a pretty sight.

I have been advised to wear open shoes often to let my feet breathe but it has not changed anything. Previously I tried using a foot cream and even baby powder but it has never been a permanent solution.

How do I bring this to an end? What is the cause? If it persists, how ugly can it get?

Sophie Umutesi, Kicukiro

Dear Sophie, 

Cracked heels are a problem only the one suffering from it can understand. The heels look ugly when there are cracks and fissures. Moreover, they are painful if one has to stand or walk for a long time, particularly if the feet fall on a hard surface (like a stone or pebble.) 

Cold and dry weather can also lead to excess dryness of skin and cracked feet. Use of ill fitting shoes and sandals can precipitate and also aggravate the cracked heels. Improper care of the feet also results in cracks on heels. This is also caused due to exposure to dust.

Some metabolic disorders like hypothyroidism, deficiency of Vitamin B complex are some of the other conditions causing dry skin and precipitating cracked heels. 

A diabetic with poor glycemia control can develop cracks over the heels. The skin around the cracked heels becomes thick, what is known as callus formation, and adds onto the discomfort. 

If the crack is severe there is a risk of secondary bacterial or fungal infection setting in, which can cause local boils or itchy scales. The risk of infection is increased if one tries to use a blade or scissor to remove the dead skin.

Though it is a distressing situation, it is curable. One cannot change a job involving standing for long hours, or the texture of the skin, but can adopt measures which would be helpful. 

Keep the feet soaked in lukewarm water for 10-15 minutes at least three times a week. Avoid very hot water as that can increase dryness.  This should be done preferably at night when one is sure of not going out and being exposed to dust. 

One can put a skin softener like vinegar in the water. Rub heels daily with a pumic stone or wet thick cloth or sot brush or scrubber to remove the dead skin. After washing the feet, apply some good lubricating lotion or oil locally with gentle movements. 

Honey is also very good for this purpose as it is a natural moisturizer.  Urea is a natural moisturizer and tends to retain moisture within the skin. Therefore a body lotion containing urea is preferable. After applying some moisturizer one can put on cotton socks and wash the feet gently in morning.

Shoes worn should be comfortable. There should not be space for toes or heels to move freely excessively.  The base of the shoes should be soft as hard shoes will aggravate the condition. It is also better to get tests done to exclude hypothyroidism and diabetes.

Dr. Rachna Pande is a Specialist in Internal Medicine at Ruhengeri Hospital