What are the recommended ointments for treating cracked heels?

Recommended Ointments for Cracked Heels

Urea-based ointments (10-40%) are the most effective treatment for cracked heels and should be applied twice daily after bathing when skin is slightly damp to enhance absorption. 1, 2

First-Line Treatment Options

• Urea-based preparations:

  • 10-20% urea cream for mild to moderate cases 1
  • 40% urea for severe cases with significant hyperkeratosis 2, 3
  • Apply twice daily, rubbing in until completely absorbed 2
  • Most effective when applied after bathing when skin is slightly damp 1
  • Higher concentration (20%) urea creams show significantly better hydration compared to placebo and 5% urea creams 3

• Emollient creams:

  • Apply after bathing to improve skin hydration 4
  • Can alleviate pain, dryness, and improve appearance of heel cracks 5
  • Should be applied at least twice daily 4

Adjunctive Treatments

• For cases with fungal involvement:

  • Consider adding Ciclopirox olamine cream/gel (0.77%) applied twice daily for 4 weeks 1
  • Terbinafine 1% cream applied daily for 1-2 weeks (60-85% mycological cure rates) 1

• Foot hygiene measures:

  • Daily foot powder application after bathing to reduce fungal infection risk 1
  • Daily lukewarm baths (30 minutes or more) to soften scales 4
  • Gentle removal of scales using sponges, microfiber cloths, or pumice stone 4

Special Considerations

For Diabetic Patients

• Careful monitoring is essential as diabetic patients have higher risk for complications 1
• Avoid high concentrations of salicylic acid due to potential tissue damage in patients with neuropathy 1
• Regular follow-up to ensure healing and prevent infection 1

For Severe Cases

• For deep fissures, protection of fissures with petroleum jelly may be beneficial 4
• Manual removal of excess callus may require podiatrist intervention 4
• Debridement of hyperkeratotic lesions by a podiatrist is recommended for painful lesions 4

Footwear Recommendations

• Wear appropriate footwear and avoid walking barefoot 1
• Select socks that improve ventilation (silver-fibred cotton socks, bamboo socks) 4
• Shoes should have: comfortable fit, rounded toe, flexibility, flat heel, heel support, and flat or absent seams 4
• Leather or fabric mesh uppers are preferred over plastic or synthetic materials to allow air circulation 4

Common Pitfalls to Avoid

• Failure to distinguish between simple dryness and fungal infection can lead to treatment failure 1
• Neglecting underlying conditions like diabetes or obesity that may contribute to heel cracking 1
• Inconsistent application of moisturizers (daily repetitive application is necessary for optimal results) 6
• Using inappropriate footwear that increases friction and pressure on heels 4