Dry, Cracked Heels: Causes And Treatments

  • Regina LopesSenior Nursing Assistant, Health and Social Care, The Open University

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Overview

Are your heels feeling rough, cracked and uncomfortable? Dry, cracked heels are more than just a cosmetic problem. What begins as minor inconvenience causes pain, bleeding, and even becomes infectious if left untreated. They create major discomfort and serious complications particularly for those with conditions like diabetes. Understanding the causes and being aware of the treatments of cracked heels is essential for maintaining healthy feet and preventing further problems.

Dry cracked heels

Cracked heels are also known as heel fissures. The condition starts with dry, thickened skin (corn and callus) around the rim of the heel. Increased pressure on the fat pad under the heel causes it to expand sideways, leading to the splitting or cracking of the callus. The affected area often shows a yellow or brownish discolouration. 

The cracks deepen with repeated pressure, leading to deep fissures that may itch and bleed.

The breaks in the skin can serve as entry points for bacteria, potentially leading to infection. Indications of infection may include redness or red streaks, swelling and warmth to the touch. The affected area may be tender to the touch or painful when pressure is applied. 

Cracked skin along with calluses, foot fatigue and general foot pain is among the top five foot issues reported by adults age 21 and older. Women are more likely than men to report suffering from cracked skin.

Grading of heel fissures

Three grades of xerotic (dry) heel skin severity with fissures were formulated as follows:1

  • Grade 1: Xerotic skin with indistinct fissures
  • Grade 2: Shallow fissures
  • Grade 3: Moderate to deep fissures

Causes of dry, cracked heels

Skin conditions

Hyperkeratosis

Plantar skin (skin on the sole of the feet) has unique structural adaptations, particularly in the stratum corneum [outer layer of the skin (epidermis)], to withstand physical stresses. Hyperkeratosis is the hypertrophy (thickening) of the stratum corneum.

It is a primary protective response to increased mechanical stresses.1 Palmoplantar keratoderma, a heterogeneous group of disorders marked by abnormal thickening of the stratum corneum of the palms and soles, predisposes individuals to cracked heels.

Diabetes

Autonomic neuropathy in diabetes can result in decreased perspiration (sweating), leading to dry skin.4 This dryness can contribute to cracked heels. If left untreated, this may lead to infection and ulcers.

Thyroid disorders

One of the skin manifestations in people with hypothyroidism is dry, flaky, and coarse skin, which can also affect the feet.

Nutritional deficiency

Deficiencies in vitamins can impact the health of the skin, including those on the heels making them dry and scaly. This could potentially lead to cracked heels.

Age

As people grow older, their skin undergoes changes. There is increased susceptibility to sun damage, decreased oil production, and reduced thickness. All of these contribute to dryness of skin on the feet.3

Obesity

It increases the pressure on the normal fat pad under the heel, causing it to expand sideways. This pressure can cause cracks or fissures.2

Sjogren’s syndrome

Sjogren’s syndrome is a rare autoimmune condition that causes dry skin by attacking the body's sweat and moisture-producing glands.2

Environmental factors

Low humidity and cold temperatures in dry and cold weather contribute to a general decline in skin barrier function. This makes the skin more susceptible to mechanical stress which can cause cracks in heels.3

Lifestyle factors

  • Dehydration 
  • Trauma due to repeated increased friction (eg: from back of the shoes)
  • Improper footwear (open-back sandals or shoes)
  • Standing for long periods, especially on hard floors
  • Prolonged hot showers or baths 
  • Lack of foot care routine2,3

Treatment for dry, cracked heels

At home remedies for dry, cracked heels

Initial management of thick calluses leading to heel cracks involves at-home remedies.5

1. Heels can be moisturised twice daily using products containing skin-softening agents like alpha hydroxy acids (AHAs), salicylic acids, or urea.6 They may cause slight stinging or irritation.7 Once the callused area thins, creams with ceramides, petroleum jelly, or natural oils can be used to maintain skin softness.

2. Before bedtime, feet can be soaked in warm water (plain or soapy) for 10 minutes and patted dry. This can be followed with the application of a thicker, oil-based cream, cream with ceramides or petroleum jelly. Also, a pair of thin cotton socks can be worn over the moisturised feet to help lock in moisture overnight.7

3. Occasional foot peels can be done with a consultation of a dermatologist. But it should be avoided if the individual has or is prone to certain skin conditions, including athlete’s foot, atopic dermatitis, contact dermatitis, psoriasis, or any other broken skin such as rashes, sores, or wounds.2

4. Manual exfoliation with a scrub brush or pumice stone can be done using gentle pressure to remove excess dead skin. Individuals with diabetes and/or neuropathy should avoid using a pumice stone, as this can the increase the risk of infection and should instead consult a podiatrist or dermatologist.2,5

5. Properly designed shoes or boots with good solid heel counters in the rear of the shoe or boot can help protect the heel. Open-heeled shoes should be avoided. Wearing any inserts or orthotics (devices placed inside footwear) prescribed by a podiatrist or orthopaedic specialist is also recommended for optimal feet protection.2

    Professional treatment for dry, cracked heels

    If the at-home approaches are ineffective or if the feet are swollen,red, painful, and inflamed, consultation with a podiatrist or dermatologist is recommended. They may assess for any underlying pathology like a microbial involvement (fungal or bacterial).5 Treatment may include prescription creams with heavy moisturisers and steroids.8 

    Surgical intervention is seldom required for cracked heels if addressed early. However, if fissures progress to open wounds, the risk of infection increases. In such cases, surgical debridement may become necessary.5 For the cracks to heal, bandages or a special tissue glue can be prescribed to protect and hold the edges of the cracks together.8

    FAQs

    Why do dry, cracked heels occur?

    Cracked heels, also known as heel fissures, are caused by factors such as dry skin, diabetes, thyroid disorders, nutritional deficiencies, age, obesity, lifestyle and environmental factors can contribute to their occurrence.

    What are the symptoms of cracked heels?

    Symptoms include dry, hard, and thickened skin around the heel, often with yellow or brown discolouration. Small cracks can develop and deepen with pressure, leading to deep fissures that may itch, bleed, and become painful. In severe cases, cracks can become infected, indicated by redness, swelling, warmth, and tenderness.

    How can I treat cracked heels at home?

    Moisturise your feet twice daily with products containing alpha hydroxy acids, salicylic acids, or urea. Soak your feet in warm water for 10 minutes before bedtime, apply a thick cream or petroleum jelly, and wear cotton socks overnight. Use a pumice stone gently to remove excess dead skin, and wear properly designed, fully closed shoes with solid heel counters.

    When should I see a doctor for cracked heels?

    If your feet show signs of infection or if the at-home remedies are not effective consult a podiatrist or dermatologist. Professional assessment may be needed to rule out underlying conditions like fungal or bacterial infections. Prescription creams and in severe cases, surgical debridement may be necessary. People with medical conditions like diabetes should always consult a healthcare professional to avoid complications.

    Can cracked heels be prevented?

    Cracked heels can be prevented by maintaining good foot hygiene, moisturising regularly and wearing properly fitted shoes. Staying hydrated, eating a well-balanced meal and managing underlying health conditions, such as diabetes or thyroid disorders, can also help prevent cracked heels.

    Summary

    Dry, cracked heels are a common foot problem characterised by dry, thickened skin and fissures around the heel area. They are caused by age-related changes, trauma, medical conditions like diabetes, skin problems and environmental factors. Home remedies such as moisturising, exfoliating, and wearing properly fitted footwear can help manage mild cases.

    Severe cases may require professional treatment, including debridement, prescription creams, and surgical intervention if infections occur. It's important to seek medical advice, especially for those with diabetes or other underlying health conditions, to prevent complications and promote healing.

    References

    1. Hashmi F, Nester C, Wright C, Newton V, Lam S. Characterising the biophysical properties of normal and hyperkeratotic foot skin. Journal of Foot and Ankle Research [Internet]. 2015 [cited 2024 Jun 2]; 8(1):35. Available from: https://doi.org/10.1186/s13047-015-0092-7.
    2. Cracked Heels | Institute for Preventive Foothealth (IPFH) [Internet]. [cited 2024 Jun 2]. Available from: https://www.ipfh.org/foot-conditions/foot-conditions-a-z/cracked-heels.
    3. The Quickest Way To Heal Dry, Cracked Heels. Cleveland Clinic [Internet]. [cited 2024 Jun 2]. Available from: https://health.clevelandclinic.org/dont-let-dry-heels-ruin-sandal-season.
    4. Oe M, Takehara K, Noguchi H, Ohashi Y, Fukuda M, Kadowaki T, et al. Skin hydration of the heel with fissure in patients with diabetes: a cross-sectional observational study. Chronic Wound Care Management and Research [Internet]. 2018; 5:11–6. Available from: https://doi.org/10.2147/CWCMR.S158139.
    5. Cracked Heels - Fissures | Foot Health Facts - Foot Health Facts [Internet]. [cited 2024 Jun 2]. Available from: https://www.foothealthfacts.org/conditions/cracked-heels.
    6. Parker J, Scharfbillig R, Jones S. Moisturisers for the treatment of foot xerosis: a systematic review. J Foot Ankle Res [Internet]. 2017 [cited 2024 Jun 2]; 10(1):9. Available from: http://jfootankleres.biomedcentral.com/articles/10.1186/s13047-017-0190-9.
    7. Sparks D. How to heal cracked heels. Mayo Clinic News Network [Internet]. 2021 [cited 2024 Jun 2]. Available from: https://newsnetwork.mayoclinic.org/discussion/how-to-heal-cracked-heels/.
    8. Torborg L. Mayo Clinic Q and A: At-home treatments often heal dry, cracked heels. Mayo Clinic News Network [Internet]. 2015 [cited 2024 Jun 2]. Available from: https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-at-home-treatments-often-heal-dry-cracked-heels/.

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    Nirainila Antony Joseph

    Bachelor of Dental Surgery (BDS), Tamil Nadu Government Dental College and Hospital, India

    Master of Science (MS), Institute of Oral Medicine, National Cheng Kung University, Taiwan

    Dr. Nirainila is a general dentist with extensive experience in comprehensive dental care and patient education. She is also a dedicated researcher focusing on dental aerosols, investigating their implications and control strategies within dental settings. Alongside her clinical and research endeavors, she is a medical content writer who simplifies complex medical information into reader-friendly articles, making health education accessible to a broader audience.

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