What to do about cracked heels?

Cracked heels develop when the dried skin of the heels split. While it is often the hard, thicker callused outer skin layer (epidermis) that cracks, it can also occur to softer, non-callused (and often dry) skin that is repetitively placed under high pressure when walking. If heel cracks are not, they can progress into fissures, which split the skin at a deeper level and can be very painful.

Dry skin is the reason most people assume they have cracking heels, but there are other factors involved as well such as increased weight, diabetes, neuropathy, poor circulation and poor nutrition can also cause poor foot health.

Symptoms of heel cracks and fissures vary from none to mild to severe. The most apparent sign is the actual cracks in the epidermis of the heels. Other symptoms may include:

Dry, itchy heels
Hard skin on the heels
Pain when standing or walking
Bleeding or infection

With proper treatment, cracked heels should not evolve into the more serious fissures. Moisturizing with cream applied to the feet two times a day will help the cracks in most cases. If the outer skin layer is thick, it will need to be reduced by a Podiatrist.

Heel Pain on the Rise among Americans in Quarantine

Press Release:

BETHESDA, Md., May 27, 2020 /PRNewswire/ — Members of the American Podiatric Medical Association (APMA) have noted an increase in reports of heel pain from patients stuck and home as a result of the COVID-19 pandemic. APMA member podiatrists are physicians and surgeons who treat the foot, ankle, and related structures of the leg, and they say footwear—or lack thereof—may be to blame for the upsurge in cases.

“Adults are shifting routines and adapting to new working environments, and it’s easy to neglect proper care and support for your feet,” said APMA member podiatrist and spokesperson Priya Parthasarathy, DPM. “Many podiatrists now have telehealth and in-person appointments. Foot and heel pain is never normal, so see your podiatrist right away!”

Plantar fasciitis, one of the most common causes of heel pain, is inflammation of the band of fibrous connective tissue (fascia) running along the bottom (plantar surface) of the foot, from the heel to the ball of the foot. This condition may cause intense pain in the heel, along with redness, swelling, or heat. This pain may be most acute when a patient takes the first step in the morning or after sitting. Many Americans in quarantine are wearing unsupportive shoes—or wearing no shoes at all—which can contribute to inflammation.

“The top priority when treating plantar fasciitis is to reduce the mechanical strain on the plantar fascia with arch supports and supportive footwear,” said APMA President Seth A. Rubenstein, DPM. “Most cases of plantar fasciitis respond well to conservative (non-surgical) treatment, including anti-inflammatory measures and stretching. However, podiatrists are also well-trained to provide advanced, cutting-edge treatments, including EPAT therapy, platelet-rich plasma injections, and surgical intervention, for more complex cases.”

Although some patients assume all heel pain is attributable to plantar fasciitis, many conditions can cause similar symptoms. Seeing a local APMA-member podiatrist at the first sign of heel pain allows for proper diagnosis and treatment. Other causes of heel pain include heel spurs, Achilles tendinitis, stress fractures, and excessive pronation.

Custom-made foot orthoses appear to be no better than over-the-counter insoles or other treatments

Press Release:

Doctors advised to refrain from prescribing foot orthoses for patients with plantar heel pain

Foot orthoses specifically moulded to help people with plantar heel pain appear to be no more effective than cheaper over-the-counter insoles or other treatments, suggests a study published in the British Journal of Sports Medicine.

Plantar heel pain accounts for between 11% and 15% of all foot symptoms that require medical attention in adults and for 8%-10% of all running-related injuries.

The most commonly prescribed treatments for plantar pain include modified footwear, taping, stretching exercises, anti-inflammatory agents, extracorporal shock wave therapy, strengthening exercises and cortisone injections, but there is still a lack of consensus on which treatments are most effective.

Foot orthoses are often recommended in the treatment of the condition, despite a lack of evidence.

Dutch and Danish researchers led by the Erasmus Medical Center, Universitair Medisch Centrum, Rotterdam, in The Netherlands, therefore, set out to investigate the effects of different orthoses on pain, function and self-reported recovery in patients with plantar heel pain and to compare them with other conservative interventions.

They carried out an analysis of 20 existing randomised controlled trial studies on this issue that had investigated eight different types of foot orthoses. Collectively, the studies had looked at 1,756 patients with the condition.

Analysis revealed that pooled data from six studies showed no difference between prefabricated orthoses and “sham” orthoses (simple insoles bought over the counter) for pain in the short term.

In addition, no difference was found between sham orthoses and custom orthoses for pain in the short term, nor was there a difference between prefabricated orthoses and custom orthoses for pain in the short term.

Overall, for the majority of other interventions, no significant differences were found.

Most of the studies analysed had reported a significant improvement over time in patients treated with orthoses as well as patients treated with other conservative interventions – probably due to the fact that plantar heel pain tends to improve after 12 months.

However, the authors said orthosis interventions did not appear to be superior in improving pain, function or self-reported recovery when compared with other conservative interventions in patients with plantar heel pain.

They concluded: “Foot orthoses are not superior for improving pain and function compared with sham or other orthoses, or other conservative interventions in patients with PHP [plantar heel pain].

“We conclude that clinicians should be reserved in prescribing foot orthoses in all patients with PHP and take factors like patient preference and adherence into account.”

Fat Injections Provide Long-Term Solution for Foot Pain

Press release:

PITTSBURGH – Fat grafting to the foot can provide long-lasting improvements in foot pain and function for patients suffering from pedal fat pad atrophy, or the disintegration of fat in the ball of the foot. Results of a clinical trial led by experts at the University of Pittsburgh Department of Plastic Surgery are available online and published today in the December issue of the journal Plastic and Reconstructive Surgery.

Jeff and Beth Gusenoff feature“Forefoot fat pad atrophy is common because the fat pads in the foot are used constantly for shock absorption when walking,” said lead author Jeffrey Gusenoff, M.D., professor of plastic surgery at Pitt. “We typically see this condition in patients with specific foot structures, a history of long-term aggressive activity, and those who have experienced surgery, foot trauma or multiple forefoot steroid injections.”

Gusenoff led a multidisciplinary team that included podiatry and plastic surgery clinicians as they examined 31 patients divided into two groups over a span of two years. The overall purpose of this outcomes study was to “assess whether fat grafting to the forefoot in patients with fat pad atrophy will reduce foot pressure during gait, increase the soft tissue thickness of the foot pad and ultimately reduce pain.”

All patients participating in the trial received the minimally invasive pedal fat grafting surgery, with the first group undergoing the procedure immediately with two years of follow-up and the second group managing the condition conservatively for one year and then undergoing the procedure with one year of follow-up.

Study results show that fat grafting is a safe, minimally invasive approach to treat pedal fat pad atrophy and that undergoing the procedure sooner prevents worsening symptoms that would occur as a result of conservative management. Fat grafting currently is the only minimally invasive treatment method that has proven to be effective for this condition.

“We are happy that we can finally bring relief to people who have been living with pain and a decreased quality of life,” said Gusenoff. “The positive responses we’ve heard from our patients have made all of our research worthwhile.”

Additional authors on the study were Beth Gusenoff, D.P.M., and Danielle Minteer, Ph.D., both of Pitt. This work was funded by 2013 and 2014 Plastic Surgery Foundation Pilot Research Grants, and the treatment is available at UPMC.