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Proper Care for Dry & Cracked Heels

Dry and cracked heels aren’t uncommon, particularly in diabetic patients. Poor circulation and sustained high blood sugar over time can contribute to a variety of skin conditions, and any accompanying neuropathy can make it difficult for the patient to identify the severity of the issue.
In addition to diabetes, dry and cracked feet can be the symptom of dehydration, vitamin deficiencies or extremely dry weather. These are often exacerbated through excessive foot soaking, particularly in hot water, and through the use of harsh soaps that dry out skin.

Moisture is the vital ingredient to repairing dry skin. However, not all moisture is created equal. As we discussed in this article, foot soaking actually counteracts the positive effects of moisture by causing the skin to be more susceptible to infection and dryness while making proper skin debridement difficult. A quick cleanse or shower is recommended over bathing and soaking.

To clean the skin, use only gentle cleansers such as this Medline product. This cleanser contains phospholipids. These are composed of fatty acids and form a natural oily barrier around cells. This layer prevents TWEL (transepidermal water loss).

How is soap different?

While soap is effective at removing dirt, it can't differentiate between good oils and bad. That's because on a microscopic level, soap consists of one hydrophobic (hates water) and one hydrophilic (loves water) end. As soap molecules combine, they form clusters to keep their hydrophobic tails away from water, sweeping up dirt and oils in the process. When soap is rinsed away, every bit of moisture goes with it, leaving skin much drier than before.

What’s a phospholipid?

Phospholipids, on the other hand, are both hydrophobic and hydrophilic at the same time. Phospholipid molecules don’t organize into clusters like soap, rather, they will form a layer that's similar to the body's natural cell structure. This layer is natural and protective, keeping valuable oils where you need them the most.

How are phospholipids different from Vaseline?


The protective layer of phospholipids is unlike the layer formed by an occlusive, such as Vaseline. Phospholipids occur naturally, making up the primary constituents of a cell.

Petroleum jellies are created as a byproduct of oil refinement and may contain carcinogens. While popular brands undergo a stringent refining process, we do not recommend occlusive for the treatment of severely dry or cracked skin, especially on the feet.
Here, bacteria and residues can become trapped against the skin to cause irritation and infection. Excess moisture held close to the skin can additionally lead to skin maceration similar to what we see in excessive foot soaking, ultimately breaking skin down and causing painful irritation and infection.

What moisturizers are appropriate?

To moisturize dry and cracked skin, we recommend using a humectant. While occlusives trap moisture, humectants are products that attract it. There are a variety of humectants available, from aloe vera to honey. One of the strongest and most effective humectants is urea. Urea is also a keratolytic, making it effective in removing dead tissue to promote better healing. Its anti-itch and anti-microbial properties offer relief from dermatitis, eczema and psoriasis. A product such as RevitaDERM 40 Percent Urea can be used to treat dry and rough skin, and is effective for the care of corns and calluses.

Additional corn & callus care

Corns, calluses and thick nails should always be properly debrided by a professional to avoid ingrown nails, ulcerations and lesions. To make this process less difficult, we recommend a hyperkeratotic concentrate solution such as 3-WEA. 3-WEA is designed to soften thickened skin without compromising safety like soaking does. Unlike foot soaking, 3-WEA forms a protective antiseptic field designed to prevent infection. 3-WEA additionally does not affect normal tissue, providing complete control for proper foot care.