Cracked Heels: Causes, Treatment, and Prevention
Cracked Heels: Causes, Treatment, and Prevention
By Sylke Bommel Ā· Updated August 2026 Ā· 7 min read
Key Takeaways
- Cracked heels, or heel fissures, affect an estimated 20-40% of the general population
- They start with plain dry skin (xerosis) that thickens under pressure and eventually splits
- Urea-based creams are the best-studied topical treatment, with randomized trials showing meaningful improvement over placebo
- Diabetics are at much higher risk, with xerosis and fissures reported in roughly 75-82% of diabetic patients
- Deep, bleeding, or painful cracks warrant a podiatrist visit rather than home treatment alone
What Are Cracked Heels?
Cracked heels, known clinically as heel fissures, are linear splits in thickened, dry skin around the rim of the heel that form when the skin loses flexibility under everyday pressure.
They typically begin as ordinary dry skin, or xerosis, that hardens into a callus along the heel's edge. Once that thickened skin loses enough moisture, it can no longer stretch with normal weight-bearing, and it cracks.
Most cases stay superficial and cosmetic, but deeper fissures can be painful, bleed, and, in rare cases, become infected.
What Causes Cracked Heels?
Cracked heels are caused by a breakdown in the skin's outer moisture barrier combined with the mechanical stress of standing and walking.
Prolonged standing, open-backed shoes like sandals and flip-flops, hot showers, and harsh soaps all strip moisture from the skin faster than it can be replaced. Naturally dry skin, aging skin, and cooler or low-humidity weather add to the effect.
Certain health conditions raise the risk substantially. Diabetes is the clearest example: nerve damage and reduced circulation impair the skin's ability to stay hydrated, and studies report xerosis and fissures in roughly three-quarters of diabetic patients. Thyroid conditions, psoriasis, and obesity are also associated with higher rates.
How Are Cracked Heels Diagnosed?
Cracked heels are usually a straightforward visual diagnosis based on the linear cracks and surrounding thickened, dry skin at the heel's edge.
A professional exam becomes more important when cracks are deep, painful, or not improving, since it helps rule out fungal infection, contact dermatitis, or a skin condition like psoriasis that can look similar. For diabetics, a podiatrist may also check circulation and nerve sensation, since fissures can be an early marker of broader foot health issues.
Signs and Symptoms
The hallmark sign is one or more visible cracks in thickened skin at the back or sides of the heel, ranging from surface-level to deep and painful.
| Severity | What it looks like |
|---|---|
| Mild | Dry, flaky skin with fine surface lines, no pain |
| Moderate | Visible cracks into thickened callus, mild discomfort when standing |
| Severe | Deep splits that bleed or hurt with every step, risk of infection |
Treatment Options for Cracked Heels
Urea-based creams are the most extensively studied topical treatment for cracked heels, with randomized controlled trials showing significant improvement in skin hydration and fissure healing compared with placebo.
Urea works by loosening the bonds between dead skin cells and drawing moisture into the stratum corneum, which softens hardened callus so it can be gently smoothed away rather than cracking further. Concentrations in the 10 to 20% range are generally used for daily maintenance, with higher concentrations reserved for more stubborn, thickened skin.
This is the mechanism behind Imperial Feet's Foot Fissure Cream: its urea-based formula rehydrates and gently exfoliates cracked heel skin, applied consistently to soften the callus rim and let it heal rather than keep splitting under pressure.
Prevention and Long-Term Management
Preventing cracked heels means keeping the skin consistently hydrated and reducing the mechanical stress that causes thickened skin to split.
Apply a moisturizing or urea-based cream daily, ideally right after bathing while skin is still slightly damp. Choose closed-back shoes with cushioned support over flip-flops for daily wear, and use a pumice stone gently, not aggressively, to keep callus from building up too thick.
For diabetics or anyone with reduced sensation in the feet, routine professional foot checks matter more than home care alone, since fissures can progress without being felt.
20-40%
of the general population is affected by heel fissures, rising to 75-82% in diabetic patients (Ramadan et al., Austin J Dermatolog, 2025)
When to See a Podiatrist
- āThe crack is deep, bleeding, or very painful to stand on
- āYou have diabetes, poor circulation, or reduced foot sensation
- āThere are signs of infection such as redness, swelling, or discharge
- āHome treatment has not improved the skin after a few weeks
- āCracks keep recurring in the same spot despite regular moisturizing
ā ļø Important: Diabetics and those with poor circulation should see a professional before self-treating deep or persistent heel fissures.
Foot Fissure Cream
Foot Fissure Cream uses a urea-based formula to rehydrate and gently exfoliate cracked heel skin, softening the callus rim so fissures can heal instead of reopening.
View Foot Fissure CreamFrequently Asked Questions
What is the fastest way to heal cracked heels?
Daily application of a urea-based cream after bathing, paired with gentle callus removal and closed-back shoes, gives the most consistent results; clinical studies show measurable improvement within two to four weeks of regular use.
Why do heels crack more in diabetics?
Diabetes can damage nerves and reduce circulation to the feet, which impairs the skin's ability to stay hydrated, and research shows xerosis or fissures affect roughly 75-82% of diabetic patients, well above the general population rate.
Is urea cream better than regular lotion for cracked heels?
Yes, for established cracks. Urea both hydrates and gently breaks down thickened, hardened skin, while standard lotions mainly add surface moisture without softening the callus that is causing the cracking.
Can cracked heels get infected?
Yes, deep fissures can allow bacteria to enter, especially in people with diabetes or poor circulation, so redness, swelling, warmth, or discharge around a crack should prompt a professional evaluation rather than continued home treatment.
How often should you moisturize cracked heels?
Once or twice daily is typical, ideally right after bathing while the skin is still slightly damp, since this helps the cream lock in moisture rather than applying it to already-dry skin.
Clinical Sources
- Ramadan E, Saleh Z, Awada S, Yassine A, Jaber W. Heel Fissures: A Comprehensive Review of Pathophysiology, Risk Factors, and Evidence-Based Management Strategies. Austin J Dermatolog. 2025;12(1):1116.
- Draelos ZD, et al. Efficacy of an Emollient Containing 10% Urea in the Treatment of Dry Skin Associated With Diabetes. J Drugs Dermatol. 2017;16(9):890-896. PMID: 28876936.
- LodƩn M, et al. Treatment of xerosis with a topically applied cream containing 10% urea: a clinical study. Int J Cosmet Sci. 2004;26(4):171-177. PMID: 18492160.
- Martini J, Huertas C, Turlier V, Saint-Martory C, Delarue A. Treatment by a moisturizer of xerosis and cracks of the feet in men and women with diabetes: a randomized, double-blind, placebo-controlled study. J Eur Acad Dermatol Venereol. 2017;31:743-747.
Related Reading
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- How to increase blood flow on your feet?
- Foot Care Matters: November is Diabetes Awareness Month
Owner, Imperial Feet ā Third-Generation Foot Care
Sylke Bommel is the owner and third-generation leader of Imperial Feet, the Dutch professional foot care brand her grandfather founded in 2001. Raised in Aruba and based in Haarlem, just outside Amsterdam, she has led the brand's international expansion for over a decade, growing Imperial Feet from a single Dutch distributor to a professional range used by pedicurists, podiatrists, and pharmacies in more than 20 countries, including the United States.
Editorial note: Sylke writes from the perspective of a foot care brand owner and formulator, not a medical practitioner. Content is educational and does not replace individual medical advice from a qualified foot care professional.
Disclaimer: This article is for informational purposes only and does not replace individual medical advice from a qualified foot care professional. If you have diabetes, poor circulation, or a persistent infection, consult a podiatrist before self-treating.
