Reader needs new strategy for heel cracks

DEAR DR. ROACH: I am a 76-year-old male in excellent health. The skin on my heels tends to be dry and callous, and at times develops cracks that can become surprisingly painful and take time to heal.

I shower and change my socks daily. I’ve tried applying Vaseline or Aquaphor as a preventive measure with some success, but the cracks still occur.

Could there be bacteria or fungi involved that contribute to this problem? Can you recommend a medication that might provide superior value? — R.L.

ANSWER: Many people experience cracking in the skin of the heel. Dry skin is the most common cause, and proper footwear, regular moisturizing and avoiding excess washing with harsh soaps and hot water all may help.

If the problem continues, it is more likely an inflammatory condition like eczema than it is a fungal or bacterial infection.

Making the proper diagnosis will help guide treatment, which may include steroid ointments or even glue to repair the cracking. A podiatrist or dermatologist would be a good first stop.

DEAR DR. ROACH: My 80-year-old wife recently began to have tremors in her left leg while walking with her walker. After looking at several MRIs of her back, her orthopedic doctor said everything appeared to be OK and recommended she see a neurologist. Can a neurologist somehow help to eliminate or reduce the tremor in her left leg?

— B.R.

ANSWER: Tremor in one body area should indeed be evaluated by a neurologist.

The list of possibilities is too long to summarize, but knowing that the tremor is restricted to one leg and only occurs with movement will help the neurologist start to narrow down the possibilities.

Once she has a diagnosis, then the neurologist can discuss the options for treatment.

DEAR DR. ROACH: I need a hip replacement. The orthopedic surgeon does not want to perform the surgery because I have E. coli in my urine (greater than 100,000 in the culture).

The E. coli started four years ago when I had Foley catheters and intermittent self-catheterization.

After many antibiotics, we still can’t beat the E. coli. I had TURP 11 months ago. Is the ortho surgeon being reasonable? While you’re at it, any comments on E. coli? — R.X.

ANSWER: The orthopedic surgeon wants to minimize risk of infection to the hip prosthesis, which is potentially disastrous. However, the risk from a person with bacteria in the urine and no symptoms — I’m not clear whether you have symptoms — is low.

Consultation with an infectious disease specialist may help.

Often, a dose of antibiotics is given preoperatively, so that any bacteria that might have happened to come out of the urine and into the blood will be killed and unable to spread to the joint prosthesis.

Persistent bacteria in the urine for such a long time should prompt an evaluation as to why. This includes looking for stones, strictures and tumors, which your urologist should have done. Enlarged prostate is one cause, but the prostate surgery should have helped that.

I’m not clear why you required a Foley catheter and intermittent self-catheterization. Bacteria in the urine is a frequent complication of these procedures. They should not be started without a clear reason.

DR. ROACH WRITES: A recent column on supplements generated many comments from readers.

Many wrote that American diets are not healthy and therefore vitamin supplements should be helpful; however, study after study has failed to show a benefit in supplementing with vitamins at preventing critical events, such as heart attack and death.

When there are good data to guide recommendations, I use them.

I continue to believe that, with the exception of vitamin D in people at risk for deficiency, vitamin supplementation in apparently healthy people is unlikely to have any significant benefits and is likely a waste of money.

Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, Fla., U.S.A., 32803.