In this month's Cosmetic Conundrums column, Zoe Diana Draelos, MD, participates in a Q&A about dry and cracked feet.
Cracked heels are a common debilitating problem in mature adults. Due to the trauma of walking, which can increase with advancing age and orthopedic issues, the skin on the heels can thicken. In addition, skin desquamation does not proceed with its youthful fervor in maturity. Although seemingly innocuous, cracked heels can become a major medical issue in patients with diabetes as the crack can extend into viable skin and provide an entry for infection. The pain of cracked heels can also interfere with ambulation. I have an instruction sheet I give my patients to assist with cracked heels because I get asked so frequently about this problem. I thought I would share my time-saving instructions with you.
Thickened toenails can be very challenging to cut. The same procedure described above can also be used to soften thickened toenails by hydrating the keratin. Hydrated keratin is more ductile and softer, making it much easier to cut with scissors or toenail clippers. The same instructions as above can be used, except after step 9 add the following: Use scissors or toe-nail clipper to trim your softened nails on both feet. Then resume with step 10, instructing the patient to apply petroleum jelly and wear thin socks to bed. The lukewarm water penetrates the nail plate better when the dishwashing detergent is added. The surfactant aids in water penetration by removing any oily debris from the surface and slightly denaturing the keratin protein, thus opening up water-binding sites. This allows extra hydration to occur, which softens the keratin and decreases the cutting force. This is important so the nail does not crack.
A number of companies have launched products specifically for diabetic skin, including foot products. This segmentation of the moisturizer market has led to products for eczema, itchy skin, rough skin, bumpy skin (keratosis pilaris), and diabetic skin. This is a way of creating more sales through expanded product offerings with descriptions that encourage sales by speaking to certain populations that may not be traditional users of moisturizer. An individual may purchase the moisturizer because “it is just for me and my unique skin condition.” The question remains whether these segmented moisturizers contain different ingredients from those in nonsegmented moisturizers. The answer is “maybe.” Diabetic foot products tend to have a higher viscosity and more moisturizing ingredients that occlude the skin surface to encourage hydration, such as petrolatum, shea butter, and dimethicone. Although these ingredients are indicative of the extra dry skin found in diabetic feet, they are not unique to diabetic foot products.
This procedure is best done in the evening just before going to bed: