Cold weather can affect the feet in many ways. The skin of the feet is one of the areas affected. Cold dry air outside and dry heat in our homes can result in excessive dryness of the skin. In some people, severe thickening of the outer layers of the skin can occur, termed hyperkeratosis. This is commonly found around the edge of the heel. Occasionally this thickened skin can develop cracks, called fissures. These cracks can extend into the deeper layers of the skin causing pain. This is one of the other causes of heel pain other than the more common plantar fasciitis and heel spurs. Patient often think they stepped on a foreign body. If someone is prone to hyperkeratosis, it is tough to prevent it from occurring. Controlling the degree to which it occurs and promptly treating fissured skin is the goal of management. Regular moisturizer application is essential to control hyperkeratosis. There are many over the counter creams that can be tried. Once daily application at bed time is a good starting point. 2-3 daily applications may be needed during the winter months. Should OTC preparation be in effective, prescription moisturizers like ammonium lactate cream can be used. If there is already established thick skin, a urea based preparation can be used to loosen and exfoliate the thickened calloused skin. 20% preparations can be found over the counter. 40-50% preparations are available by prescription for more severe thickening. Reduction of skin thickness can also be performed by a podiatrist using a blade and/or a sanding bit on an electric drill. Full thickness fissures should be treated as any skin wound. Daily cleansing and application of an antibiotic cream with a bandage is good first aid. Hydrocortisone cream can be helpful in fissures that don’t heal right away. Stubborn fissures may require prescription higher potency steroid creams to help them heal. Chronic fissured skin, especially when accompanied by itching and redness is termed dermatitis or eczema. Long term anti inflammatory topical medications may be needed in these cases. the non cortisone prescription topical cream Elidel is a good option. Take care of your feet this winter and they will take care of you!