Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Understanding Cracked Heels

Cracked heels — medically called heel fissures — range from a minor cosmetic nuisance to deep, painful cracks that bleed and carry infection risk. While anyone can develop cracked heels, they are particularly concerning in patients with diabetes, peripheral arterial disease, or immune compromise where even small skin breaks can lead to serious infections.

Why Heels Crack

The heel skin is normally the thickest skin on the body, designed to absorb impact. When the heel fat pad expands laterally under weight-bearing pressure and the surrounding skin is insufficient in elasticity, cracks form at areas of greatest lateral stress. Contributing factors include dry skin from inadequate hydration or low ambient humidity (particularly in Michigan winters), prolonged standing on hard surfaces, obesity that increases lateral heel expansion, going barefoot or wearing open-backed shoes that allow heel expansion without containment, skin conditions including psoriasis and eczema, nutritional deficiencies (vitamin E, zinc), and thyroid disease.

Home Treatment for Mild Fissures

Moisturizing is the foundation of heel fissure treatment. Urea-based creams (20-40% urea) are particularly effective at breaking down thickened keratin and drawing moisture into the skin. Apply immediately after bathing while the skin is still moist. A heel balm containing alpha-hydroxy acids (lactic acid, glycolic acid) chemically exfoliates thickened skin. Soaking feet in warm water for 10 minutes followed by pumice stone use on thickened areas, then immediate moisturizer application provides mechanical exfoliation. Wearing closed-back, cushioned shoes reduces heel expansion that promotes fissuring.

Professional Treatment for Deep Fissures

Deep, painful fissures — particularly those that bleed or show signs of infection — require podiatric care. Debridement of thickened skin removes the tissue that anchors fissure edges apart. Liquid bandage or medical-grade adhesive closure brings fissure edges together to promote healing. For diabetic patients, any heel fissure requires professional evaluation and should never be self-treated aggressively.

Prevention

Daily moisturizing as part of foot care routine is the most effective prevention. Wearing shoes that enclose the heel prevents lateral expansion that causes fissures. Avoiding prolonged barefoot walking on hard surfaces, staying well-hydrated, and managing systemic conditions that contribute to dry skin all reduce fissure risk. Annual podiatric check-ups for diabetic patients include heel skin assessment and preemptive treatment of developing dryness before fissures form.

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Cracked Heels? More Than a Cosmetic Problem

Severely cracked heels can lead to infections, especially in diabetic patients. Dr. Tom Biernacki treats stubborn heel fissures with medical-grade debridement and helps identify underlying conditions like thyroid disease or diabetes that contribute to dry, cracked skin.

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Clinical References

1. Hashmi F, et al. The evaluation of three treatments for heel fissures: a randomized controlled trial. British Journal of Dermatology. 2016;174(6):1378-1380.
2. Silverberg NB. Cracked heels: dermatologic considerations. Cutis. 2019;103(4):E14-E16.
3. Parker J, et al. Diabetes, heel fissures, and preventive strategies. Podiatry Today. 2020;33(8):34-40.

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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.