Cracked Heels: Causes and How to Treat Them

Cracked heels are not just a cosmetic problem: when a crack is deep it can hurt when you put your foot down, bleed from the rubbing of your shoes or become infected. In most cases they clear up with a consistent moisturising routine and the right use of a pumice stone, and only in specific situations do you need to see a professional.

Why the skin on the heel cracks

With every step the heel bears far more pressure than the rest of the foot, and it responds to that pressure by thickening the skin: this is known as hyperkeratosis, or callus. That callus is useful while it stays flexible, but when the skin dries out it loses elasticity and, as it is stretched by your body weight, it splits into cracks instead of giving.

The factors that most encourage this process are:

• Walking barefoot or in open-backed shoes (flip-flops, mules), which leave the heel without side support and concentrate all the pressure in the middle.
• Standing for long periods, especially on hard surfaces.
• Being overweight, which increases the pressure on the heel with every step.
• Cold, dry weather, which reduces the skin’s natural moisture, and very hot showers, which strip it away even more.
• Age, because skin produces less protective oil over the years.
• Some skin conditions, such as atopic dermatitis or psoriasis, which already dry out and crack the outer layer of skin.
• Diabetes, an underactive thyroid or circulation problems, which reduce sweating and the elasticity of the skin on the feet and make cracks slower to close.

It is worth telling them apart from cracks between the toes, which are usually due to a fungal infection and itch and flake rather than only hurting when you walk; that case is treated with an antifungal, not a moisturising cream.

A routine to treat them at home

With consistency, most heel cracks improve in one or two weeks by following these steps, ideally at night:

1. Soak your feet in lukewarm water for about 10 minutes to soften the thickened skin.
2. Gently file the callus with a pumice stone or foot file, always on damp skin and without reaching healthy skin or areas that are already open: the aim is to reduce the thickness, not to scrape until it hurts.
3. Pat dry, without rubbing.
4. Apply a thick urea cream to skin that is still slightly damp, so the active ingredient locks in that moisture.
5. Wear cotton socks to bed; they help the cream soak in and stop it getting everywhere.
6. Repeat every night. If there is no improvement after two weeks, it is time to rethink the treatment or get advice.

If there is an open crack that hurts when you walk, a liquid plaster or skin glue (sold in pharmacies) seals the edge temporarily and reduces the pain while it heals underneath.

Which urea strength to choose

Urea is the ingredient with the most support for this problem: it holds water in the skin, strengthens the skin barrier and, above a certain concentration, acts as a gentle exfoliant by helping to dissolve the keratin that makes up the callus. The right strength depends on the state of the heel:

Urea concentration	Main effect	Suitable for
2–10%	Moisturising, strengthens the skin barrier	Dry skin without cracks, daily maintenance
10–30%	Moisturising and gently exfoliating	Rough heels with shallow cracks
≥30% (usually 40%)	Intense exfoliation, helps remove thick callus	Marked callus and established cracks

40% urea creams are often combined with lactic acid or other gentle keratolytics. One comparative trial found a similar improvement in dryness with a formulation containing less urea combined with other moisturisers as with 40% urea alone, so what matters is not just the percentage but applying it every day.

What to avoid

• Don’t cut or scrape cracked skin with blades, scissors or nail clippers. It is the most common way of turning a crack into an infected wound.
• Don’t soak your feet for more than 10 to 15 minutes. Too much water softens the skin instead of repairing it.
• Don’t use a pumice stone on skin that is already open or bleeding.
• Avoid fully open-backed shoes if you already have cracks, at least while they heal; the heel needs that side support.

When to see a doctor

Most cases clear up at home, but it is worth booking an appointment with your doctor, a podiatrist or, if you have diabetes, whoever looks after your diabetic foot care, when any of these signs appear:

• The crack bleeds or is so deep that it hurts to put your foot down normally.
• It doesn’t improve after one or two weeks of a consistent moisturising routine.
• There are signs of infection: pus, spreading redness, local warmth, a bad smell or fever.
• You have diabetes, neuropathy or poor circulation: in these cases you shouldn’t treat any crack yourself, however small it seems, because it heals less well and the risk of infection is higher.
• You suspect a fungal infection (itching, flaking between the toes) that doesn’t respond to a pharmacy antifungal within two weeks.

This article is for information only and does not replace an assessment by a healthcare professional. Sources: Mayo Clinic: Cracked heels treatment, MedlinePlus: Diabetes foot care, Comparative Efficacy of Novel Skin Barrier Repair Cream and Urea 40% for the Management of Pedal Fissures (MDPI).