What Causes Cracked Heels?
Cracked heels (heel fissures) develop when the skin of the heel becomes excessively dry, thickened, and loses its natural elasticity—eventually splitting under the mechanical stress of weight-bearing. The skin at the heel normally receives less sebaceous (oil) gland activity than other body areas and is subjected to repetitive compressive and shear forces with every step. When the stratum corneum (outer skin layer) becomes abnormally thickened (callus formation) and dehydrated, it loses flexibility and cracks, particularly at the edges of the heel where the skin folds under pressure.
Mild cracked heels are a cosmetic concern; severe deep fissures that penetrate through the dermis cause significant pain with walking and bleed. In diabetic or immunocompromised patients, deep heel fissures are serious—they create entry points for bacterial infection and can progress to cellulitis or deep tissue infection requiring hospitalization. Any diabetic patient with cracked heels should have them professionally managed rather than attempting home treatment alone.
Risk Factors
Factors that increase heel fissure risk include: prolonged barefoot walking or open-back sandals/clogs (which allow the heel pad to splay outward without lateral support, promoting callus formation), obesity (increases heel pad pressure), dry climate or low humidity environments, prolonged standing, hot showers (strip natural skin oils), age (skin becomes drier and less elastic with aging), and systemic conditions including diabetes, hypothyroidism, and psoriasis. Athletes and those who spend extended periods in water also develop cracked heels from repeated wet-dry cycles.
Treatment
Professional Debridement
For thick callus buildup with deep fissures, professional debridement by a podiatrist is the most effective first step. Using a scalpel and debridement tools, the podiatrist safely removes the thickened callus tissue to reduce the depth and extent of fissures and allow topical treatments to penetrate. Home attempts to cut deep fissures are hazardous—particularly for diabetic patients—and risk infection.
Urea-Based Emollients
Urea is the most evidence-supported active ingredient for treating dry, thickened skin. Urea at 20–40% concentration acts as both a humectant (draws moisture into the skin) and a keratolytic (breaks down thickened skin). Apply a 20–40% urea cream or lotion to thoroughly dried heels twice daily, particularly after bathing while the skin is still slightly moist. Cover with socks overnight for maximum penetration (the “socks therapy” technique significantly improves results). Lower-concentration urea products (10–20%) are available over-the-counter; 40% products may require a prescription.
Footwear and Mechanical Prevention
Wearing closed-back shoes with cushioned heels supports the heel pad and prevents excessive splaying. Silicone heel cups worn inside shoes add cushioning and reduce the lateral pressure that causes the heel to crack. Avoiding prolonged barefoot walking on hard surfaces and switching from open-back clogs or flip-flops to enclosed footwear are the most impactful behavioral changes. Using a pumice stone or heel file on wet skin (after bathing) removes mild callus buildup before it becomes severe enough to crack—maintenance is much easier than treating established deep fissures.
Frequently Asked Questions
How do I heal deep cracked heels quickly?
For deep, painful heel fissures: start with professional debridement by a podiatrist to reduce the callus thickness and clean the fissure edges. Apply a 40% urea cream or O’Keeffe’s Working Hands/Healthy Feet type moisturizer twice daily. At bedtime, apply the cream generously and wear thick cotton socks overnight—this “socks therapy” significantly accelerates healing by maintaining moisture under occlusion. Liquid bandage products (like New-Skin) applied to deep fissures seal them and reduce pain while healing. Avoid hot showers (use warm water), and switch from flip-flops or bare feet to closed-back cushioned shoes. Most patients see significant improvement within 2–4 weeks with this regimen. Without addressing footwear and maintaining regular moisturizing, fissures will recur.
Can cracked heels be a sign of diabetes?
Yes. Diabetes causes reduced sweating in the feet (due to autonomic neuropathy), which accelerates skin dryness and cracking. Diabetic patients are also more prone to callus formation due to altered gait and foot pressure patterns. Importantly, cracked heels in diabetic patients are a significant health concern because they can become portals for infection—diabetic foot infections can progress rapidly to serious complications including osteomyelitis (bone infection) and amputation. Any diabetic patient with cracked heels should have them professionally managed. If you are diabetic and notice new cracking, redness around a fissure, drainage, or odor—seek same-day podiatric evaluation. Do not attempt aggressive home treatment of heel fissures if you have diabetes.
What is the best cream for cracked heels?
The most effective OTC creams for cracked heels contain high-concentration urea (20–40%), which both moisturizes and breaks down thickened skin. Products include Eucerin Intensive Repair (10% urea), Flexitol Heel Balm (25% urea), and Atrac-Tain (10% urea, 4% lactic acid). O’Keeffe’s Healthy Feet is highly rated for general heel moisturization. For severe cases, 40% urea cream (Uremol, Carmol 40) is available from pharmacies with or without prescription. Petrolatum-based products (Vaseline) alone are occlusive moisturizers that work well overnight under socks for mild cases. Avoid products with alcohol or fragrance, which dry the skin further. Consistent daily application—not just when the heels feel dry—is the key to both treatment and prevention.
Medical References & Sources
- PubMed Research — Heel Fissure Treatment
- American Podiatric Medical Association — Dry Skin
- PubMed Research — Diabetic Foot Fissures and Infection Risk
Dr. Tom Biernacki, DPM is a board-certified podiatric surgeon at Balance Foot & Ankle in Howell and Bloomfield Hills, Michigan. He treats cracked heels and heel fissures with professional debridement, topical therapy, and footwear guidance—with special attention to diabetic patients.
Dr. Tom’s Recommended Products for Dry & Cracked Feet
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Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.
These are products I personally use and recommend to my patients at Balance Foot & Ankle.
- Flexitol Heel Balm 4oz — 25% urea with emollients — the highest-concentration urea heel cream available OTC for deep fissure treatment
- O’Keeffe’s Healthy Feet Foot Cream — Concentrated glycerin formula creates a protective barrier — heals severe cracked heels within 1 week of daily use
- Moisturizing Heel Socks (SOXO) — Wear overnight with heel balm — occlusion amplifies cream penetration 10× for severe fissure healing
Affiliate disclosure: As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. We only recommend products we trust for our own patients.
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For women who want comfort without giving up their shoes — Foot Petals cushions work in heels, flats, and sandals.
- Foot Petals Heavenly Heelz — Cushioned heel insert for pumps and heels — eliminates slipping and ball-of-foot pain in dress shoes.
- Foot Petals Tip Toes — Metatarsal cushion for the toe box — stops forefoot pain in heels and narrow shoes.
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Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.
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