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What is actually happening
The skin around the edge of the heel thickens under load, the same way it does anywhere it is squeezed repeatedly. Thick skin is stiff skin. Every time you take a step, your heel spreads sideways slightly, and stiff skin cannot stretch with it. Eventually it splits, usually along the rim where the thickening is deepest.
This is why cracks commonly appear around the edge of the heel and may worsen in summer or when wearing open-backed shoes, which provide less support around the heel.
Why cream on its own stalls
Moisturiser softens the skin it touches. A thick callus is made up of tightly packed dead skin cells, which can make it more difficult for cream to reach the skin underneath. You end up softening the surface of a barrier while the deep, stiff layer underneath carries on splitting.
It is not that cream is useless. It is that the order is wrong.
The order that works
- Reduce the thickened skin first, using a scalpel or file during an appointment. This is usually a quick and comfortable procedure.
- Then use a urea-based cream daily. Urea helps retain moisture in the skin and soften the hard build-up, helping to maintain the results between appointments.
- Dress any deep crack that is open or bleeding, so it is protected while it closes.
- Keep the heel enclosed while it heals. Open backed shoes let the skin spread and reopen the split.
Many people notice an improvement once the callus has been reduced, with regular use of a suitable cream and appropriate footwear helping to maintain the results.
Choosing a cream
Look for urea on the ingredients list. A concentration of between 10% and 25% may be suitable for heels. A general body lotion is too light for this job. Apply it at night, when your feet are not about to go into shoes, and give it a minute to sink in.
Avoid applying cream between your toes, as excess moisture in this area can increase the risk of fungal problems.
Reduce the hard skin, then moisturise. Getting the order right can make a real difference.
When to come in
A crack that is bleeding, weeping or painful to walk on needs looking at rather than waiting. So does one that keeps reopening in the same place, or a heel where the build up is thick enough that you cannot make progress with a file at home.
If you have diabetes or reduced circulation, please have heel cracks seen promptly rather than treating them at home. An open crack is a break in the skin, and on a foot that heals slowly it is worth dealing with properly and early.
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