What causes dry, cracked heels and feet?

Why do heels become thick and split?

Repeated stress makes heel skin thick and hard; cracks in that skin are called heel fissures. Shoes that rub and exposure to a dry climate contribute to dryness. Ageing also reduces oil production and changes skin thickness. Cracks can hurt and leave the skin more vulnerable to infection.1

Could a skin condition be causing the cracks?

Eczema, psoriasis and fungal infections can cause dry, flaky feet. Contact dermatitis can produce inflamed, blistered, thickened and cracked skin, so cracking with irritation deserves attention rather than more filing. Check between your toes for athlete's foot or infection and ask a pharmacist for advice early.123

Can menopause cause dry, cracked heels?

Menopause can contribute to dry skin because oestrogen helps maintain skin hydration. Lower limbs are particularly vulnerable to reduced oestrogen. A condition called keratoderma climactericum causes thick skin on the palms and soles after menopause, sometimes with itchy, painful cracking and splitting around the heels. Moisturisers help with menopausal dryness, but painful thickening and splits warrant medical assessment rather than assuming ordinary dryness is the whole explanation.4

Could an underactive thyroid be involved?

An underactive thyroid, called hypothyroidism, means the thyroid gland makes too little thyroid hormone. Dry skin is one possible symptom, alongside fatigue, constipation, weight gain and difficulty tolerating cold. Symptoms can develop slowly over months or years. If dryness comes with these other changes, contact a healthcare professional. Assessment includes your symptoms, a physical examination and blood tests to check thyroid hormone levels; heel appearance alone is not a way to diagnose it.56

How can you care for dry skin on your feet?

Daily moisturising includes your heels, even if the face has already claimed the entire bathroom shelf. Choose an unscented moisturiser; a pharmacist can help you select one.3

1. 1Wash daily with lukewarm water and gentle, fragrance free soap. Avoid scrubbing and long soaks.
2. 2Dry your feet, then apply moisturiser. Ceramides help retain water and support the skin barrier.
3. 3Let moisturiser absorb for a few minutes, then add petroleum jelly to seal in moisture.
4. 4Wear thin cotton socks overnight to help retain moisture.

Should you file or exfoliate cracked heels?

Once heels are healthy, an exfoliating moisturiser such as urea cream can help maintain them; regular use takes about two weeks to show a response. Use files moderately, never on inflamed, itchy or sensitive skin. Avoid foot peels with eczema, psoriasis, athlete's foot or broken skin.1

What changes if you have poor circulation?

Peripheral arterial disease, or PAD, reduces blood flow to the legs, so even small foot wounds take longer to heal. Check your feet daily for redness, swelling, blisters, bleeding, colour changes, splits or discharge. Use a mirror to see the soles if needed. Wash with mild soap, limit soaking to five minutes and dry carefully between the toes. Apply a simple moisturiser daily, but keep cream out of the spaces between your toes. Do not remove corns or hard skin yourself, use acid corn plasters or walk barefoot. Contact your GP, podiatrist or nurse immediately about an injury or abnormal change.7

Shoes need enough width, length and depth to fit properly, a detail that should not count as a luxury feature. For PAD, secure fastenings help prevent slipping and rubbing. Check inside shoes for rough areas or sharp objects, change socks daily and avoid socks that are tight around the legs.7

When should you get medical help?

• Seek urgent advice for increased redness, a hot area with or without pus, sudden swelling of one leg or sudden severe leg pain. In the UK, contact NHS 111.
• Get advice early for breaks in the skin. An open wound that has not healed within 10 days needs assessment by a nurse or lower limb service.
• Arrange a dermatology assessment if your heels keep cracking despite home care. Diabetes and other underlying conditions can be involved.