Topocal 2010 Crack
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Heels often become cracked due to a lack of foot care and shoe wear. Heels are vulnerable to cracking due to loss of protective skin and a reduction in moisture content. Cracking can also be caused by an increase in the pressure on the feet. It is important to understand how to prevent and treat cracked heels. Management of the crack can include bandaging of the heels and wearing shoes with adequate room in the toe box to allow full dorsiflexion.2 If the crack becomes infected, it is important to treat it as soon as possible with the appropriate medication. Often a small hole in the heel will heal with a bandage and some time off the foot. A layered compression bandage can hold the wound closed until it heals. If the crack becomes infected, the wound will need to be cleaned and debrided (removed of any dead tissue). This is done using an antiseptic solution and a sterile gauze or cleansing sponge.
As the crack deepens, it can be more difficult to heal and may eventually become infected. It may be necessary to apply a wound dressing. If the crack is large, an antibiotic ointment can be applied to treat an infection, and it may be necessary to use an antiseptic ointment or cream to control the smell and irritation. If the crack is infected or near the ankle joint, an antibiotic may be necessary.1
Cracked heels tend to occur in older adults (over 40) who have undergone weightbearing or walking for an extended period of time. Often these individuals have had diabetes for many years and have developed diabetic neuropathy (which affects the nerves and can lead to a loss of sensation). The accumulated trauma to the skin on the heel and formation of callus on the edges will eventually begin to crack and ulcerate. A history of neglected cracked heels that have been allowed to heal by secondary intention (without dressing) is a risk factor for the subsequent development of a wound and/or an infection in the heel.1
The crack in the heel may sometimes affect a nerve which controls the foot and toes. In these cases, the nerve can be compressed or trapped which can cause numbness and tingling in the toes. The nerve may also be pinched causing pain or cramps, particularly in the calf, thigh or buttocks. These symptoms can be treated by applying a cold pack to the area.
The idea that crack cocaine causes abnormalities in the brains of babies, especially in utero exposure, gained wide currency. The fear was justified by a high number of babies born with low birth weight and mental retardation after being exposed to cocaine in utero. The fear was used by the government to justify its ban on cocaine use while pregnant.
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