Callouses, cracked heels – a summer (and winter) issue

Hello Dr Irwin My 80 year old overweight father suffers from cracked heels. I am trying to help him since the pain keeps him from getting enough daily walking and exercise, which seems to be sending him on a downward spiral. My dad also has diabetes which is controlled with metformin (sp?) I am using a battery powered callous removing device to remove the dead skin around the cracks and then putting a steroid cream that was prescribed to him by his dermatologist. After that I use bandaid tape to keep the skin together to withstand the pressure when he stands on his foot. If I can get to him every day and bandage his foot the cracks start to heal. But there are setbacks. Is there a cream or lotion that I can use to help him heal faster? Thank you so much for your help. Cheri

Cheri  – thank you for reminding me to write about this! Callouses are a common problem.

Importance of treating callouses when you have diabetes

Also, with diabetic feet, it’s especially important that these cracks heal. Infections on the feet or lower legs in diabetics can lead to cellulitis (a spreading infection in the skin). When circulation is poor, as it is in most diabetics, these infections can be especially hard to control. Diabetic foot care is super important. I know you already know this, and it’s so great that you’re helping him. A good podiatrist, or diabetic care center, can also be helpful, if any questions or problems.

Tips to reduce callouses, which will reduce the splitting on heels and help healing!

  1. Thinning the callouses. You’re on the right track with this, but there’s a much more gentle way to do it. The problem with using abrasion or friction to remove callouses is that it actually sends a signal to the skin to grow thicker. The more it gets rubbed, the thicker it will get. Using a 20-40% urea cream every day works well, and really lessens the need to rub. There is a prescription form (40%) called X-Viate. Use the cream daily, and then just use a pumice stone once a week to rub gently. They will gradually soften, over about a month, and that should help them heal. Actually trimming the callouses surgically by having a podiatrist do it (too dangerous to do yourself!) is also helpful.
  2. Treating foot fungus. Almost every diabetic, and many non diabetics, have nearly invisible foot fungus (Tinea Pedis). It shows up as a slightly reddening of the entire bottom of the foot, sometimes itching (many diabetics don’t have this symptom), and cracks. This form is not so much between the toes. The best non prescription antifungal cream is Lamisil OTC (terbinafine generic), but can be hard to find. Prescription creams also work well. A thin layer of the cream needs to be smeared all over the bottom of the foot, including the heel, and between the toes. Those thick toenails are toenails that have been infected with this fungus, but sadly, the cream won’t work for the nails. Follow the instructions for use on the tube. See a dermatologist if any questions.
  3. Preventing bacterial infection. Important in everyone, but especially diabetics. When there are cracks you can swab around and in the crack, with Hibiclens (drugstore non prescription) to keep bacteria counts down. If any sign of infection, see a doctor right away.
  4. Steriod creams. You might ask his doctor/derm, at some point, what purpose this is serving?? A steroid cream is an antiinflammatory cream. Some steroid creams also thin the skin, but the X-Viate works better on callouses.

Hope this helps,  Dr. I

Dr. Brandith Irwin, MD

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