Cracked heels treatment

What causes cracked heels, and how can you treat them?

Cracking often starts with dry, thick skin around the heel rim, called a callus. Pressure makes the fat pad beneath the heel spread sideways, splitting the less flexible skin above it. Long periods standing on hard floors, increased body weight and shoes without heel support can contribute. Open backed sandals leave the heel without support, even if the footwear has very strong opinions about summer.2

Cold, dry weather, walking barefoot and long, hot showers can also contribute. Persistent cracking can accompany eczema, psoriasis, diabetes or an underactive thyroid. Repeatedly treating the surface will not address an underlying condition that needs its own care.124

How do you treat dry, cracked heels?

For uncomplicated dry heels, use this daily routine:

1. 1Wash gently with lukewarm water and a fragrance free cleanser. Avoid scrubbing and long soaks. Keep baths and showers to 5 to 10 minutes, then gently blot dry.
2. 2Apply heel cream within five minutes of bathing, while the heel skin is still damp. Choose a cream with 10% to 25% urea, or one containing alpha hydroxy acid or salicylic acid.
3. 3Reapply moisturizer whenever the heels feel dry. At the first signs of cracking, moisturizing two to three times daily can be enough to help the heel heal.
4. 4During the day, protect cracks with a liquid bandage. The protective barrier can reduce pain, support healing and help keep germs out.
5. 5Before bed, apply plain petroleum jelly. If applying it over moisturizer, let the moisturizer sink in for a couple of minutes first. Thin cotton socks help retain moisture overnight.

During the day, wear shoes that fit properly and avoid worn out shoes, flip flops and slingbacks while treating cracked heels.1

Which heel cream should you choose?

Heel balms can combine humectants, which hold water in the skin, with keratolytics, which loosen thickened skin. Urea, salicylic acid and alpha hydroxy acids are common options. A cream containing ceramides is another moisturizing option: ceramides help trap water and restore the skin's natural barrier. Petroleum jelly serves a different role, forming a seal over moisturizer to limit moisture loss.24

For home treatment, a cream with 10% to 25% urea is a practical starting choice. Once heels are healthy, exfoliating moisturizers, including urea creams at 20% or 40%, can help remove dead skin and maintain softness. Stronger softening treatments are also used by podiatrists for severe cracking; strength alone is not a reason to choose a product.14

Should you use a pumice stone or foot peel?

A pumice stone can gently remove some hard callus before moisturizing. Do not file inflamed, itchy or sensitive areas, and never cut thick heel skin away with scissors or a razor. Chemical foot peels can soften rough skin, but avoid them if you have broken skin, rashes, sores or wounds, or have or are prone to eczema, psoriasis, contact dermatitis or athlete's foot.24

How long does treatment take?

Exfoliating moisturizers take about two weeks of regular use to show a response. That is not a reason to wait with worsening cracks: arrange a podiatrist visit if self care has brought no improvement after one week. Keep moisturizing after the heels recover, because regular care helps keep the skin supple and prevent new cracks.24

How do you treat severely cracked heels?

Seek professional care for deep, bleeding or painful cracks. A podiatrist can remove thick skin safely, use dressings to reduce movement, prescribe stronger softening agents or recommend heel cups and insoles to redistribute pressure. Special tissue glue can hold crack edges together while they heal. Infected cracks can lead to cellulitis, a skin infection that needs medical treatment.2

Do not assume all heel pain comes from cracked skin. Pain beneath or behind the heel can have other causes. Get assessed if pain makes walking difficult or you have severe swelling, inflammation or stiffness.5

What changes if you have diabetes?

Diabetes can damage foot nerves and blood vessels, reducing feeling and making injuries harder to heal. A crack can become a foot ulcer, and lack of pain does not mean the foot is unharmed. Contact your provider right away for cracks, sores, redness, increased warmth, swelling, tingling, burning or pain.3

Follow your provider's foot care plan:

• Inspect your whole foot daily, including the heel, sole and between the toes. Ask someone to help if you cannot see well.
• Wash daily with mild soap and lukewarm water. Check the water temperature with your hand or elbow and dry carefully between the toes.
• Moisturize dry skin, but do not apply lotion, oil or cream between the toes unless your provider directs you to.
• Have calluses treated by a podiatrist. Use a pumice stone only with their permission, and do not use medicated callus pads or shave calluses yourself.
• Wear comfortable shoes and clean, dry socks. Check inside shoes for stones or rough areas before putting them on, and avoid walking barefoot.