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

It is extremely unpleasant when there are cracks in the skin of the legs, which can be not only the result of wearing inappropriate footwear and drying of the skin, but also a symptom of certain dermatological diseases, as well as disorders of metabolic processes and systemic pathologies.

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Epidemiology

According to statistics, 25-38% of women after 45-50 years old have cracks on their heels.

According to the experts of the Journal of Dermatological Treatment, almost 20% of adults in the older age group who have brittle nails, onychosciechs, are worried about splitting and cracks in the toenails.

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

[2], [3], [4], [5], [6], [7]

Causes of the cracks in the legs

In most cases, cracks on the feet are indeed caused by very  dry skin of the feet  due to environmental factors: hot or cold weather, low air humidity, abuse of hot water, as well as high chlorine content in tap water.

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

Very often - as symptoms of hormonally caused keratoderma - there is a strong flaking of the stratum corneum on the soles of the feet and cracks on the heels of the feet in women. And if they also wear open heel shoes in summer, this inevitably aggravates the problem.

Also, skin cracks in the legs can produce atopic dermatitis, eczema (dry or dishydrotic, and also corn-shaped forms).

In addition, skin problems and cracks in the arms and legs occur when:

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

As a result of genetically determined palm- planar or  palm-plantar keratoderma  , cracks in the child's legs are formed against the background of abnormal thickening of the skin, including congenital  ichthyosis. Children up to 14 years old have juvenile plantar dermatosis (the so-called winter boot syndrome or sweaty socks dermatitis), when skin desquamation of the distal part of the plantar surface of the foot and the child’s painful cracks appear.

Also read the article -  Cracked heels in children

[8], [9]

Risk factors

Podiatrists refer to such risk factors for skin cracking as:

• long barefoot walking on hard surfaces;
• narrow shoes, very high heels or too thin soles, due to which there is a gradual decrease in plantar fat pads with an increase in the load on the fingers, and cracks may form on the little finger or on the 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 the postpartum period, for details, see -  Crack on the heels during pregnancy and after childbirth.

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Pathogenesis

The skin of the feet differs from other human skin tissues by more pronounced keratinization, which is due to their anatomy and functional loads. First, the layer of its keratinizing epithelium is thicker and more dense. Covalently bonded corneocytes (nuclear-free 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-acylsphingozins) and cholesterol.

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

Why do dry cracks in my legs appear in overweight people? Because it increases the load on all plantar fatty layers, which leads to their syneresis (compression) and simultaneous lateral expansion, as a result of which a mechanical overstretching of the skin occurs with a violation of its integrity. With excess weight, plantar keratinization is often combined - natoptysh and cracks in the legs.

Vitamin D3 regulates the level of positively charged calcium ions (Ca2 +) in the skin cells and the whole process of keratinization of the epidermis. With a lack of this vitamin disrupts the process of differentiation of keratinocytes with an increase in their division. And retinol stimulates the formation of new skin cells and collagen synthesis.

Cracks in the legs in diabetes are associated with neuropathy, as a result of which the sensitivity of the skin decreases and its general condition worsens: the physiological shape of the feet and toes may also change.

Congenital palm plantation keratoderma is the result of inherited mutations of the genes encoding transcription factors (E2F proteins), which ensure the proliferation and differentiation of cells, due to which the normal process of keratinocyte keratinocytes is disrupted.

The pathogenesis of foot dermatophytosis or mycosis is caused by skin lesions with a fungal infection, in particular, Trichophyton rubrum or Trichophyton interdigitale dermatophytes. Mycoses of nails often cause their cracking, since the nails not only thicken and peel off, but also become more brittle.

The mechanism of development of hormone-induced keratoderma in women is associated with a decrease in estrogen production and, accordingly, a decrease in the synthesis of elastin and collagen fibrillar proteins. As a result, the skin becomes less durable and elastic, which affects the structure of skin tissues, including on the feet.

[11], [12], [13], [14]

Symptoms of the cracks in the legs

The very first signs of small cracks on the heels and toes appear on the background of coarse 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. Vertical dry cracks in the legs, localized on the skin, quickly become deep deep, and the integrity of the skin is disturbed. Such cracks are called dermatologists fissures, and they can be painful when walking, and sometimes they can bleed.

In case of fungal lesions of the feet or palm-plantar keratoderma, deep cracks in the toes and hands occur in the transverse fold lines from the soles and palms - flexor grooves. In cases of mycosis also weeping cracks are formed between the fingers, itchy skin is noted.

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Complications and consequences

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

[16], [17], [18], [19], [20], [21], [22]

Diagnostics of the cracks in the legs

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

Analyzes in the form of a baccose skin scraping may be required if the doctor has doubts about a specific fungal infection. See -  Skin Examination

With fairly rare congenital palm-transplant keratoderma, differential diagnosis is performed to distinguish them from ordinary keratosis, atopic dermatitis, or dermatophytosis.

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Treatment of the cracks in the legs

The treatment of cracks is carried out at home with the use of external medicines prescribed by the doctor.

Pharmaceutical remedies for cracks in the legs include:

• Keratolytic and emollient ointments that reduce skin keratinization - medical petrolatum, Carboderm and Keratolone (with urea), Kerasal (urea + salicylic acid), etc.;
• various creams and ointments for cracks in the legs, details about them in the publications:
• Heel Crack Ointment
• Creams from cracks on heels
• such healing creams against cracks in the legs, 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, Terbinafine antifungal ointment (other trade names Lamisil, Lamifen, Exifin), as well as other effective ointments from the fungus, must be used .

Homeopathy includes external remedies: Traumeel C gel, Tsikaderma and Calendula ointments, Boro cream plus.

With deep cracks and hereditary keratoderma, physiotherapy treatment is prescribed in the form of:

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

Alternative treatment

The popular treatment of cracks on the feet, first of all, includes hot foot baths from 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 keratinous layer of the skin is treated with pumice or a special pedicure grater, and then abundantly lubricate the problem areas of the skin with medical petroleum jelly or oil. Olive, castor or sea buckthorn are best suited for this. Be sure to wear cotton socks.

Instead of oil, you can apply to the skin and mix into it a mixture of melted beeswax and lanolin (1: 1) with the addition of a few drops of shea essential oil, eucalyptus, dog rose or tea tree. More information -  Heel crack oils

Herbal therapy is the same bath, but with decoctions of medicinal plants such as chamomile, plantain, flax, sage, or a string.

Useful information is also in the material -  How and how to treat cracks on the heels: ointments, foot creams, alternative recipes

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Prevention

Prevention measures in this case are:

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

When dry skin should be washed not with hot, but with warm water and limit the time in the bath or shower to ten minutes; detergents should be mild and better without fragrances.

Diabetics should inspect their legs daily because the cracks may go unnoticed due to the lower sensitivity of the lower limbs.

[25], [26], [27], [28]

Forecast

Cracks in the skin of the legs can be quickly and easily cured 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 urgent.

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