Cracks on the feet: between the toes, on the feet

It is extremely unpleasant when cracks in the skin appear on the feet, which can be not only a consequence of wearing unsuitable shoes and dry skin, but also a symptom of some dermatological diseases, as well as metabolic disorders and systemic pathologies.

Epidemiology

According to statistics, 25-38% of women after 45-50 years develop cracks in the heels of their feet.

According to experts from the Journal of Dermatological Treatment, splitting and cracking of toenails affects almost 20% of older adults with brittle nails – onychoschisis.

And in patients with diabetes, similar problems with the skin of the feet and nails are observed in almost half of the cases.

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Causes cracked feet

In most cases, cracks on the feet do indeed form when the skin on the feet is very dry due to environmental factors: hot or cold weather, low air humidity, excessive use of hot water, and high chlorine content in tap water.

However, xerosis may indicate a deficiency of vitamins (A, E and D), leading to a disruption of the barrier function of the stratum corneum and its increased keratinization. And most often the heels suffer, more details - Causes of dry, deep cracks on the heels in children and adults.

Very often – as symptoms of hormonally conditioned keratoderma – severe peeling of the stratum corneum of the skin on the soles of the feet and cracks on the heels of women’s feet appear. And if they also wear open-heeled shoes in the summer, this inevitably aggravates the problem.

Also, cracks in the skin on the feet can be caused by atopic dermatitis, eczema (dry or dyshidrotic, as well as callus-like forms).

In addition, skin problems and cracks on the hands and feet occur with:

• dermatophytosis or mycosis of the feet, when cracks and itching occur between the toes;
• hypothyroidism;
• diabetes mellitus.

Due to genetically determined palmoplantar or palmoplantar keratodermas, cracks form on the feet of a child - against the background of abnormal thickening of the skin, including in congenital ichthyosis. In children under 14 years of age, juvenile plantar dermatosis is observed (the so-called winter boot syndrome or sweaty sock dermatitis), when desquamation of the skin of the distal part of the plantar surface of the foot and painful cracks on the toes of the child appear.

Also read the article - Cracked Heels in Children

Risk factors

Podiatrists cite the following risk factors for cracked skin on the feet:

• walking barefoot for long periods on hard surfaces;
• narrow shoes, very high heels or too thin soles, which cause a gradual reduction in the plantar fat pads with increased stress on the toes, and cracks may form on the little toe or big toe;
• dermatological diseases;
• deficiency of vitamins, minerals and zinc;
• obesity with overweight;
• flat feet and heel spurs, as well as traumatic foot deformities;
• pregnancy and postpartum period, for more details see – Cracked heels during pregnancy and after childbirth.

Pathogenesis

The skin of the feet differs from other human skin tissues by its more pronounced keratinization, which is due to their anatomy and functional loads. Firstly, the layer of its keratinizing epithelium is thicker and denser. Covalently bound corneocytes (non-nuclear keratinocytes of the stratum corneum) in the skin on the soles of the feet form up to two dozen layers that are tightly connected by the so-called intercellular lipid cement, consisting of ceramides (N-acylsphingosines) and cholesterol.

Secondly, there are no sebaceous glands on the feet and palms that produce sebum. But it is sebum that helps maintain the necessary level of skin moisture, softens it and protects it from drying out.

Why do people with excess weight develop dry cracks on their feet? Because the load on all plantar fat layers increases, which leads to their syneresis (compression) and simultaneous lateral expansion, resulting in mechanical overstretching of the skin with a violation of its integrity. With excess weight, plantar keratinization is often combined - calluses and cracks on the feet.

Vitamin D3 regulates the level of positively charged calcium ions (Ca2+) in skin cells and the entire process of epidermal keratinization. With a deficiency of this vitamin, the process of keratinocyte differentiation is disrupted with increased division. And retinol stimulates the formation of new skin cells and collagen synthesis.

Cracks in the feet in diabetes are associated with neuropathy, which results in decreased skin sensitivity and a deterioration in its general condition: the physiological shape of the feet and toes can also change.

Congenital palmoplantar keratodermas are the result of inherited mutations in genes encoding transcription factors (E2F series proteins) that ensure cell proliferation and differentiation, which disrupt the normal process of keratinocyte keratinization.

The pathogenesis of athlete's foot or mycosis is caused by a fungal infection of the skin, in particular by the dermatophyte fungi Trichophyton rubrum or Trichophyton interdigitale. Mycoses of the nails often cause them to crack, as the nails not only thicken and peel off, but also become more brittle.

The mechanism of development of hormonally conditioned keratoderma in women is associated with a reduction in estrogen production and, accordingly, a decrease in the synthesis of fibrillar proteins elastin and collagen. This makes the skin less durable and elastic, which affects the structure of skin tissues, including the feet.

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Symptoms cracked feet

The very first signs of small cracks on the heels and toes appear against a background of rough, thickened skin, often with yellow or brown calluses around the edge of the heel.

Symptoms vary in severity: from small cracks to larger and deeper ones. Vertical dry cracks on the feet localized on the skin of the heels become deep quite quickly, and the integrity of the skin is damaged. Dermatologists call such cracks fissures, and they can be painful when walking, and sometimes they can bleed.

In fungal infections of the feet or palmoplantar keratodermas, deep cracks on the toes and fingers occur in the transverse fold lines on the soles and palms - flexor grooves. In cases of mycosis, weeping cracks also form between the toes, and itching of the skin is noted.

Complications and consequences

The consequences of cracks are their pain and bleeding. However, in some cases the condition can be more serious when the cracks become infected. Then there can be a complication in the form of inflammation of bacterial etiology - with redness, swelling of soft tissues and the formation of serous or purulent exudate. For people with diabetes or weakened immunity, this is especially dangerous.

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Diagnostics cracked feet

As a rule, diagnosis does not cause difficulties and clarification of the anamnesis with a comparison of the clinical picture allows a dermatologist or podiatrist to determine the etiology of the appearance of cracks.

Skin culture tests may be required if the physician has doubts about a specific fungal infection. See Skin examination

In the case of fairly rare congenital palmoplantar keratodermas, differential diagnostics are carried out to distinguish them from common keratoses, atopic dermatitis or dermatophytosis.

Treatment cracked feet

Treatment of cracks is carried out at home using external medications prescribed by a doctor.

Pharmaceutical remedies for cracked feet include:

• keratolytic and emollient ointments that reduce keratinization of the skin - medical petroleum jelly, Carboderm and Keratolon (with urea), Kerasal (urea + salicylic acid), etc.;
• various creams and ointments for cracked feet, more about them in the publications:
• Ointment for cracked heels
• Creams for cracked heels
• such healing creams against cracked feet as Bepanten or D-Panthenol (with vitamin B5 – pantothenic acid), Rescuer (with beeswax, tocopherol, sea buckthorn, tea tree and lavender oils), Calendula, etc.

In the presence of mycosis of the feet, it is imperative to use the antifungal ointment Terbinafine (other trade names: Lamisil, Lamiphen, Exifin), as well as other effective ointments for fungus.

Homeopathy includes external remedies: Traumeel C gel, Cikaderma and Calendula ointments, Boro Plus cream.

For deep cracks and hereditary keratodermas, physiotherapeutic treatment is prescribed in the form of:

• electrophoresis with anti-inflammatory drugs of the corticosteroid group;
• applications with peloids (sulfide silt muds).

Folk remedies

Folk treatment of cracked feet primarily includes hot foot baths for cracks with sodium bicarbonate (baking soda) or table salt (two tablespoons per three liters of water). After each bath, which is done every other day, the softened keratinized layer of skin is treated with pumice or a special pedicure grater, and then the problem areas of the skin are generously lubricated with medical petroleum jelly or oil. Olive, castor or sea buckthorn oils are best suited for this. Cotton socks are required.

Instead of oil, you can apply and rub a mixture of melted beeswax and lanolin (1:1) with a few drops of shea, eucalyptus, rosehip or tea tree essential oil onto the skin. More information – Oils for cracked heels

Herbal treatment is the same baths, but with decoctions of medicinal plants such as chamomile, plantain, toadflax, sage or succession.

Useful information is also in the material - How and what to treat cracked heels: ointments, foot creams, folk recipes

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Prevention

Preventive measures in this case are considered to be:

• selection and wearing of comfortable shoes (in case of flat feet – use of orthopedic insoles);
• proper foot care using emollients or moisturizers;
• normalization of body weight;
• blood glucose monitoring (for early detection of diabetes);
• mandatory treatment of fungal diseases of the feet;
• consumption of foods containing polyunsaturated omega fatty acids and vitamins, primarily beta-carotene, ascorbic and pantothenic acid, tocopherol, biotin, ergocalciferol.

If you have dry skin, you should wash with warm water rather than hot water and limit your time in the bath or shower to ten minutes; detergents should be mild and preferably fragrance-free.

Diabetics should inspect their feet daily because cracks may go unnoticed due to decreased sensitivity in the lower extremities.

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Forecast

Cracked skin on the legs can be quickly and easily treated at home, but it should be borne in mind that with age, the skin loses its ability to stretch, so this problem becomes more common and relevant.

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