Cracked heels are a common dermatological condition where the skin on the heel becomes dry, thickened, and forms deep splits under pressure. This process typically begins with the formation of a hard, thickened patch of skin called a callus, which then loses its natural elasticity. When the heel’s fat pad expands with body weight during standing or walking, the dry, inflexible skin cannot stretch and ultimately splits. While often viewed as a cosmetic concern, these fissures can become painful, bleed, and lead to more serious issues if left unaddressed. Understanding the factors that cause this problem is the first step toward effective treatment and prevention.
Common Factors Leading to Heel Fissures
A primary cause is xerosis (severe dry skin), which results in a compromised stratum corneum barrier that loses moisture and flexibility. This loss of elasticity means the skin is unable to withstand the mechanical forces placed upon the heel. Environmental conditions, such as cold, dry weather or a lack of humidity, also contribute to the skin’s dehydration and subsequent hardening.
The mechanical stress of standing is a significant contributor, especially for individuals who spend long periods on hard floors or have increased body weight. This continuous pressure forces the heel’s fat pad to expand laterally, pushing against the skin and causing it to split. Inappropriate footwear further exacerbates this issue by failing to contain the fat pad. Open-backed shoes, like sandals and flip-flops, allow the heel to expand sideways without support, directly increasing tension on the skin. This lack of support accelerates the cracking process.
Systemic Health Conditions That Increase Risk
Internal health conditions can compromise skin integrity and increase susceptibility to heel fissures. Diabetes is a common condition that increases risk, primarily due to peripheral neuropathy and poor circulation. Nerve damage can reduce sweat gland function, leading to significant skin dryness (xerosis) and a diminished ability to heal, raising the risk of infection and diabetic foot ulcers.
Hypothyroidism slows the body’s metabolism and often results in systemic dry skin. This dryness makes the skin on the heels brittle and less able to flex under pressure. Autoimmune skin conditions such as psoriasis and eczema involve chronic inflammation and accelerated skin cell turnover, producing thick, scaly patches on the soles of the feet that are prone to cracking. Tinea pedis (Athlete’s foot) is a fungal infection that can present as severe, flaky dryness and cracking, requiring specific antifungal treatment.
Effective At-Home Management Strategies
Treating cracked heels involves softening the skin and restoring moisture. The process should begin with soaking the feet in warm water to soften the calloused skin. After soaking, gentle exfoliation using a pumice stone or foot scrubber helps remove the buildup of thickened skin, preparing the area for moisturizing. Exfoliate gently to avoid irritating the underlying healthy skin.
The most effective treatment involves maximizing hydration. Immediately after drying the feet, a heavy, oil-based cream or occlusive agent, such as petroleum jelly or a thick balm, should be applied to the heels. This occlusive layer creates a barrier that prevents water evaporation. Wearing cotton socks over the applied moisturizer helps the product penetrate more deeply overnight and protects bedding.
Specialized heel balms containing keratolytic and humectant ingredients are effective at breaking down thick skin and drawing in moisture. Ingredients like urea act as both a humectant to hydrate and a keratolytic agent to dissolve the hard, dry skin. Alpha-hydroxy acids, such as salicylic acid and lactic acid, function as chemical exfoliants to smooth the skin’s surface and improve moisturizer absorption. Preventative measures should include a transition to closed-back shoes with proper cushioning, which limits the lateral expansion of the heel fat pad and reduces mechanical stress.
Knowing When to Seek Professional Care
While most cases of heel fissures respond well to consistent home care, professional medical attention may be needed. If home treatments fail to provide noticeable improvement after one to two weeks, a podiatrist or dermatologist can debride the hard skin and offer prescription-strength creams. These specialists can also assess whether an underlying condition is the root cause of the persistent problem.
Seek immediate care if any signs of infection develop in the fissures. Symptoms such as increasing redness, warmth, swelling, pus, or a fever indicate that bacteria have entered the broken skin barrier. If the cracks are so deep that they bleed or cause significant pain that limits walking, professional intervention is necessary to prevent complications. Individuals with systemic conditions like diabetes should consult a podiatrist at the first sign of cracking, as minor fissures pose a heightened risk for severe foot ulcers.