Cracked heels, medically known as heel fissures or xerosis pedis, is a common dermatological concern where the skin on the heel becomes severely dry and thickened. This condition begins when the outermost layer of skin, the stratum corneum, loses its natural moisture and elasticity. When this dry, inelastic skin is subjected to the daily pressure of walking, it is unable to stretch and accommodate the necessary changes in foot shape. The lack of flexibility causes the skin to split, forming painful linear cracks that can sometimes deepen and bleed, creating a chronic problem.
Mechanical and Environmental Factors
The skin on the soles of the feet lacks the oil-producing sebaceous glands that maintain suppleness elsewhere. When environmental conditions include cold, arid air or low humidity, the skin’s moisture barrier is easily compromised, accelerating the drying process.
The physical mechanics of walking place immense stress on the heel’s fatty pad, which is designed to cushion impact. When the skin around this pad is thick and dry, it cannot expand sideways as the foot makes contact with the ground. This sideways expansion, particularly in individuals carrying more weight, forces the unyielding skin to crack under the strain.
Footwear choices significantly contribute to this mechanical stress. Wearing open-backed shoes, such as sandals or flip-flops, allows the heel’s fat pad to expand without lateral containment. Similarly, spending prolonged periods standing on hard, unforgiving surfaces forces the heel to bear excessive pressure, further compacting and thickening the skin over time.
Associated Health Conditions
While external factors are often the trigger, persistent or severe heel cracking may signal an underlying systemic health issue that compromises the skin’s ability to repair itself. One of the most significant links is with diabetes, where sustained high blood sugar levels can damage nerves, a condition called neuropathy. This nerve damage can impair the function of sweat glands, resulting in profound skin dryness and a loss of the protective moisture barrier.
Poor circulation, another complication of diabetes, means that blood flow to the feet is reduced, slowing the delivery of nutrients and immune cells needed for healing. If a fissure develops, this compromised circulation and reduced sensation make the crack more susceptible to infection and slower to heal.
Inflammatory skin conditions also contribute to chronic cracking. Psoriasis and eczema cause rapid skin cell turnover or severe inflammation, leading to hyperkeratosis, which is a significant thickening of the skin. This thick, hardened skin is inherently less flexible and more likely to split under pressure.
Other systemic conditions, such as hypothyroidism, can also manifest as dry, thickened skin (xerosis) because the underactive thyroid gland reduces the production of natural skin oils. Furthermore, a fungal infection like Tinea Pedis, commonly known as athlete’s foot, can cause the skin on the heel to become scaly, dry, and prone to cracking, often mimicking simple dryness.
At-Home Remedies and Long-Term Prevention
Effective treatment focuses on exfoliating the thickened, dead skin and restoring moisture to the underlying layers. Topical creams containing keratolytic agents are highly effective because they actively break down the protein keratin that forms the tough outer skin layer. Ingredients like urea, often used in concentrations between 10% and 40%, act as both a humectant to draw in moisture and a keratolytic agent to soften the hardened tissue.
Salicylic acid, typically used in concentrations up to 6%, serves a similar function by chemically exfoliating the excess skin cells, helping to reduce the thickness and hyperkeratosis. Alpha-hydroxy acids, such as glycolic acid, also promote the shedding of dead cells, improving the skin’s texture and allowing moisturizers to penetrate more effectively.
For existing fissures, a method known as occlusion therapy can significantly speed up healing by locking in moisture. This involves applying a thick emollient, such as petroleum jelly or lanolin, to the heels and immediately covering the feet with cotton socks before bedtime.
Preventative maintenance is centered on establishing a consistent foot care routine. This includes soaking the feet to soften the skin, followed by gentle, not aggressive, exfoliation using a pumice stone or specialized foot file to remove superficial calluses. Daily application of a maintenance moisturizing cream, even after the cracks have healed, is necessary to prevent recurrence. Choosing supportive, closed-back shoes, especially when standing for long periods, helps contain the heel fat pad and minimizes the mechanical stress that leads to splitting.