Dry skin is obvious in appearance. The reason dry skin becomes such a problem is that lack of moisture makes the skin much less elastic and flexible.
It does not seem to bother everyone that has it, or we would see greater compliance in foot care. If the dryness is not addressed it can cause other symptoms such as redness, itching, scaling and flaking.
The skin may crack and split. This becomes a problem as it becomes an easy entry point for an infection and the warm moist environment of footwear will encourage the infection growth. Other conditions such as psoriasis and fungal infections may occur with the dry skin and can complicate the treatment options. The correct combination of creams should be prescribed by your doctor or advised by your podiatrist. Dry skin may thicken around the heel and further pressure causes splits and cracks to appear.
Causes of Dry Skin
Skin dryness varies from person to person. A combination of factors is probably responsible for your dry skin. Factors that contribute to dry skin include:
- Some people have genetic disposition to dry skin.
- Lack of adequate hydration. Drink at least 8 glasses of water per day.
- Aging will thin and dry the skin.
- Exposure to the environment. Wind, sun, heat, cold and air conditioning can quickly cause or worsen dry skin conditions.
- Use of soap and various chemicals can all dry out the skin.
- Long, hot baths and showers also ten to make the skin drier.
- Caffeine, smoking, and alcohol increase dryness with a diuretic effect.
- Prescription drugs such as those prescribed for blood pressure and fluid tables can have a drying effect on the skin.
- The adequate intake of Essential Fatty Acids in your diet is essential to maintain moisture in dry hair and skin. These include: Fish oils, Walnut and Flaxseed oils and any sources rich in omega-3 fatty acids.
- Modify any of the contributing factors that you can.
- Regular moisturizing of you feet should be part of daily health care. Many types of cream and lotions are available. Your podiatrist can recommend an appropriate one.
- If you have difficulty getting to your feet to apply cream try adding some water dispersible bath oil to a bath or foot bath. Soak for approx 5 min and pat dry. The oil helps seal in the absorbed water.
Corns and Callous (hyperkeratosis)
Corns and callus are one of the most common problems seen by Podiatrists. They can occur on any part of the foot and vary in symptoms from a mild callous under the foot, to an infected ulcer that can develop under a corn on a toe. Infection of corns on the toe is more common than callus. This can be a serious complication for those with poor circulation, peripheral neuropath and the need for diabetes foot care.
Corns and callous, what are they?
Corns and callous can only be caused by excessive pressure and friction. Pathologically they are all the same the skin has thickened in response to pressure. They are the body’s protective mechanism gone wrong. The skin responds to excessive pressure and grows more quickly, forming a thick outer layer of calloused skin. More focused pressure will cause the development of a hard centre, known as a corn. A corn can develop without a thick layer of callous. It can eventually become painful and debilitating. Dry skin has reduced elasticity, hence is more susceptible to developing corns and callous.
There are four main types of corns.
- Hard corns
- Soft corns (between toes)
- Seed corns (tiny hard corns, usually embedded in callous)
- Neurovascular corns (painful corns with nerve endings and blood vessels)
Corns and Callous should really be viewed as symptoms of an underlying condition or irritation that is causing the excessive pressure.
The reason for excessive pressure can be varied:
- Footwear that is too tight or the incorrect style for the foot type. Also wearing the wrong footwear for the job i.e.: high heels for jobs that require long periods of standing.
- Aging skin loses elasticity and fatty tissue, making it more prone to the thickening effect on the skin of excessive pressure.
- Soft corns develop not just from friction and pressure but often as a result of excessive moisture from sweat or not during properly between the toes.
- Conditions such as bunions, hammer toes and joints changed by arthritis often produce bony prominences. These are susceptible to rubbing against shoes or pressure from other toes.
- Biomechanical or gait abnormalities that cause incorrect alignment of the foot during walking, allowing the overloading of weight on various parts of the foot, with the subsequent development of corns and callous.
- Calloused or cracked heels are often caused by open backed shoes such as sandals that lack support around the heel and very dry skin. Excessive weight may also be the cause of callous or corns.
Most corns and callous are easily treated by a podiatrist. More than one treatment may be necessary. Painful corns may take some time to settle down, especially if they are very inflamed. Corns and callus that are not treated will generally become painful.
The only satisfactory treatment is to remove the source of excessive pressure. This may be more complex than at first appears.
Home treatments for corns such as corn paint, cure or plasters will generally only burn away the skin surrounding the corn and remove the top layer of skin. Rarely do you get long term relief with the use of these products and in fact if not applied carefully they can excessively burn due to their acid content. While this can be risky in healthy people, it can be much more so for those with poor circulation, diabetes or thin frail skin, with the possibility of causing an ulcer (a breakdown of the skin) which could become infected. Cutting corns or calluses yourself can be risky, especially if you cut yourself. Again if you are a person whose health puts you at risk infection can easily develop into a serious wound. This is accelerated by the warm and moist environment of enclosed shoes.
Podiatry Treatment should be approached on two levels:
- Removal of the corn or callous to reduce the pain by a podiatrist.
- Prevention strategies to stop corns and callous returning will involve:
- Regular treatments to keep the corn and callous reduce.
- The podiatrist will apply padding and deflective devices to cushion the painful areas and reduce pressure.
- Advice regarding appropriate footwear. The use of padded socks (preferably cotton or wool) and well fitting shoes is recommended, particularly for those with ageing, more delicate skin.
- Advice on daily preventative foot care, such as applying moisturiser daily.
- An appropriate assessment to determine the cause of the corn and or callous. This will reveal if a biomechanical imbalance when walking is causing increased pressures that contributes to the development of the corns and callous. The prescription of orthotics may be required. These will be designed to balance the foot during walking and thereby reduce uneven overloads of pressure.
- Surgical correction of the bony pressure areas such as hammer toes and bunions may be necessary for extreme and painful cases.
- It is especially important that those with diabetes or poor circulation see a podiatrist for the management of corns and callous
Cracked heels are a common foot problem that is often referred to as heel fissures. Cracked heels are commonly caused by dry skin, and aggravated if the skin around the edge of the heel is this (callous). For most people this is a nuisance and a cosmetic problem but even the everyday acts of standing and walking on our feet places enough pressure onto dry, brittle skin that small cracks open in the top layer of the skin. When the splits are cracks are deep, they can be painful to stand on the skin can bleed in severe cases leading to infection. Wearing open backed or thin soled shoes can aggravate the condition.
What causes cracked heels?
Some people tend to have a naturally dry skin that predisposes them to the cracks. The thickened dry skin (callus) around the heel that is more likely to crack is often due to mechanical factors that increase pressures in that area (egg the way you walk).
Other factors that can be involved in the cause of cracked heels include:
- Increased pressure on the heels from an imbalance in the way you walk.
- Prolonged standing (at work or home, especially on hard floors).
- Being overweight (increasing pressure on the fat pad of the heel with a squashing effect). When the skin is dry and brittle it is likely to crack and split.
- Wearing of open back shoes.
- Certain medical conditions will predispose skin to dryness e.g. autonomic neuropathy in those with diabetes leads to less sweating and a dryness of skin)
- Skin conditions such as psoriasis and eczema will exacerbate the effect of the dry skin around the heels.
If the skin of cracked heels is extremely thick and hard, moisturizing creams will not be able to penetrate to be absorbed. If you are treating your feet at home try softening first with a scrub or exfoliating cream. Alternatively, rub the heels with a pumice stone or emery foot paddle to reduce the thickness. Follow with a cream that has a base of urea, glycolic or lactic acid, to soften and increase rate of absorption of moisture.
For general care of cracked heels, apply the appropriate moisturizing cream twice daily. Get advice from your podiatrist, doctor or pharmacist regarding the best cream for your skin problem. Daily application of moisturizer can be reduced to once a day when the heel cracks have healed. Importantly, avoid open backed shoes or thin soled shoes.
Don’t try to reduce the hard skin your self with a razor blade or a pair of scissors. There is a risk of an infection developing and taking too much off.
How can a podiatrist help?
The podiatrist will look at the causes and treatment may include the following:
- If a fungal infection is suspected the podiatrist will recommend an anti-fungal cream. Some are available with an exfoliating base which may enhance the treatment process. Antifungal therapy should continue for at least 10 days after all symptoms appear clear.
If deep cracks have opened up enough for a bacterial infection to develop, an antibiotic ointment may be needed. Apply antibiotic ointment (such as Neosporin) to the deep cracks at night. Neosporin also contains cocoa butter, olive oil, and petrolatum, all of which help soften skin by preventing water loss.
- Removal of hard skin around the heels. This may be needed on a regular basis as a means of prevention, if no other causative factors can be improved upon.
- In painful cases, some taping may be required to hold the edges of cracks together while they heal.
- Advice regarding the most appropriate moisturiser or emollient.
- Advice about footwear and self care of the problem.
- Orthotics may be prescribed to address biomechanical problems that may be causing increased pressure on your heels when walking.
- A silicone heel cup may be suggested for use in the shoe. It will help keep the fat pad of the heel from expanding sideways.