JR wrote:
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Yuk! and Ouch!!
I did all the wrong things and now I have one heel that has 1-2 deep cracks. How can I heal them and start treating them? Is there a cleansing soak that I can get over the counter?
Thanks,
jr
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At the risk of offering far, far more than you had asked for . .
First of all, let me address soaks . . "cleansing" or otherwise. . . . In a word . . . N O !
Let me reiterate . . . NO, NO, NO, NO, NO.
Perhaps, very unintuitively, water when applied to skin it is DRYING . . . and the last thing you what to do is to cause further drying of cracked skin. Ever see what happens if you soak a piece of leather in water and set it out to dry?
Now, let's talk about the cracks which are more elegantly termed, "fissures." Cracks or fissures are generally secondary to dryness, and are caused by a relative scarcity of INTER-cellular water. You can't really cause your body to increase the amount of inter-cellular water, so the products called emollients, often used to "soften" skin do so, not by adding that moisture, but by putting a coating on the skin which "simulates" the effect that true moisture would create. As far as what type of topical preparations are placed on such skin. In dermatology there's a very simple principle. When you need to dry . . such as when there is weeping from the skin, use a CREAM formulation. A cream is a two-phase chemical product (oil and water emulsions), the outer phase is water miscible and the inner phase is oil miscible. Creams penetrate into the layers of the skin because of their external phase, and not only are they preferred when medication need to penetrate the outer horny layer of skin, but they are, as I've previously mentioned, DRYING. Although creams may be of any color, most often they are white. Ointments, on the other hand, generally have only one phase . . an oily one (water in oil emulsions are certainly possible but rarely is this the case with ointments ... hydrated lanolin being an exception. Ointments are good for delivering medication to the outer surface of the skin and are NOT drying. Notice that I didn't say they were moisturizing either. But because they stay on top of the skin where the dead and sometimes horny epipidermis exists, they have an emollient effect which simulates moisturization. Ointments generally have a Vaseline semi-translucent appearance. There are other topical delivery system such as gels and lotions which have some of the characteristics of both, and some newer high-tech delivery systems also, but I won't go into detail at this time.
So, clearly, ointments are the most appropriate delivery system for dry, fissured, cracking skin.
Now, let's discuss the etiology or underlying cause of the cracking, as treating only the external manifestation is ignoring that big elephant sitting in the middle of the living room.
Some people have primary skin diseases, such as ichthyosis (which in is true form is a relatively rare genetic disease) where there is a defect in the skin which causes it to lose moisture. Systemic diseases, such as thyroid disease, both 'hyper', where the skin is warm and dry and 'hypo,' where the skin becomes clammy with moisture and then cracks when it dries, diabetes, which, when there is cracking and fissuring of the skin below the external layer may heal poorly and/or lead to serious bacterial infection, psoriasis commonly presents as a reddened (erythematous) border ringing the heel along with psoriatic scales, vascular problems can lead to fissured skin, xerosis, in which the skin's hydration is diminished, perhaps due to diminished sebaceous activity or other systemic and nutritional disorders, and many other specific and non-specific conditions and diseases which have as their symptomatology, dryness of the skin. In addition, many internal medication may cause the dryness of skin, as either a desirable or sometimes desirable side effect. And do not fail to overlook the generally obese individual with swollen puddgy feet who wears slippers and/or shoes without firm counters (the portion of the shoe which cups the heel), leading to the squeezing of a ridge of tissue which rings the lower aspect of the sides of the heel and generally results in callous buildup and frequently fissuring of the skin thereon which can be extremely painful. (HEY . . WAS THAT A RUN ON SENTENCE OR WHAT??)
The skin is constantly renewing itself. As the deeper germinative layer produces new living skin cells, they eventually migrate up to the surface and slough off. The procedure is endless. Contact and rubbing of clothing, shoes, etc. against this outer layer helps to slough these dead epidermal cells off. That's why anyone who has had an extremity in a cast for any length of time has found thick broad sheets of dead skin when the cast is removed, as there had been no friction to remove these cells while the cast was in place. Weather can also be a fact, as cold dry environments as well as forced air heating systems tend to dry out skin, as does the excessive sweating of very climes
SO WHAT TO DO?
FIRST: Assess and address the underlying cause . . Is the dryness caused by a local, contact situation, by a systemic disorder, environmental condition or a specific medication?
NEXT: Avoid contact with water, external alcohol and other drying products (accept, of course for normal hygiene).
THEN TREAT: with appropriate topical medications, using OINTMENT formulations, lotions or other vehicles which have an external oil phase where available. Alpha hydroxyacid lotion are useful to dissolve the scales increase the moisture content of your skin. Products containing urea are said to help the skin absorb moisture.
Take care to see that the superficial cracks or fissures in the dead outer skin, known as the epidermis, do not extend deeper into the living skin beneath, opening up a portal for bacteria and an ensuing infection. Examine the area for signs of early infection such as redness, warmth, and increased discomfort, as well as @#$&! or even clear exudate or drainage. Do not pull at the scales and be especially careful if using any buffing type device, if you choose to use one, so that you do not damage the deeper tissues. Wear socks made of cotton or other natural fibers which breath as opposed to synthetic fibers which occlude. Change socks frequently before they become saturated with moisture. (Carry extra pairs with you if you have an excessive sweating problem). Avoid shoes with most synthetic leathers for the same reason. Finally see your physician in regard to the assessment and treatment of underlying medically and medication induced problems.
All that being said, one of my favorites is the generous use of vitamin A&D OINTMENT (not the cream), both during the day and an extra generous application at bedtime to a throughly dried foot, covered with socks to protect the bed closing from soilage. In many cases not complicated by medical problems, I have found this procedure to be just as effective, and certainly less costly, than many of the others.
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