What causes cracked heels?

Cracked heels, also known as heel fissures, are a common foot problem that can affect people of all ages. They usually begin as dry, thickened skin around the edge of the heel, but if left untreated, the skin can split and form painful cracks.

While mild cracks may simply be uncomfortable, deeper fissures can bleed and increase the risk of infection. A crack in the skin creates an opening through which bacteria and other microorganisms can enter the underlying tissues.

Although most cracked heels do not become infected, the risk increases if the fissures are deep, contaminated or left untreated.

People with diabetes, poor circulation or a weakened immune system are at greater risk of developing complications from an infected heel fissure and should seek professional advice promptly if their skin breaks down. (1–3)

The good news is that most cracked heels can be successfully managed once the underlying cause has been identified.

What causes cracked heels?

Cracked heels develop when the skin around the heel becomes dry (xerosis) and loses its elasticity. As pressure is placed on the heel during standing and walking, the skin stretches sideways. If the skin is dry and inflexible, it is more likely to split, resulting in heel fissures. (1,2)

Several factors can contribute to this, including:

• Dry skin (xerosis)

• Thickened hard skin (callus)

• Standing for long periods

• Open-backed footwear such as sandals or flip-flops

• Walking barefoot regularly

• Excess body weight, which increases pressure on the heels

• Increasing age, as the skin naturally becomes less elastic

• Reduced flexibility of the skin due to environmental factors such as cold weather or low humidity (1–3)

  
  

Can a medical condition cause cracked heels?

Yes. Although many cases are simply caused by dry skin and pressure, cracked heels can sometimes be associated with an underlying medical condition.

These include:

• Diabetes

• Eczema

• Psoriasis

• Hypothyroidism

• Reduced sweating (anhidrosis)

• Athlete's foot (fungal skin infection)

These conditions may make the skin drier, thicker or slower to heal, increasing the likelihood of heel fissures developing. If your cracked heels are persistent, severe or repeatedly return despite appropriate self-care, it is worth seeking a professional assessment. (2–5)

Did You Know?

Your skin acts as your body's natural protective barrier. When a heel develops a deep crack (fissure), that barrier is broken, allowing bacteria to enter the skin. Although many cracked heels heal without complications, untreated fissures can become infected, particularly in people with diabetes or poor circulation. Early treatment can help reduce discomfort and lower the risk of complications. (2,5)

Can I treat cracked heels at home?

If your heels are only mildly dry, regular use of a suitable foot moisturiser may improve skin hydration and reduce dryness. Moisturisers containing urea have been studied extensively and are effective at improving hydration in dry foot skin. However, there is currently no strong evidence that one moisturising ingredient or product is consistently superior to another. (1)

Avoid attempting to cut away hard skin yourself using blades, razors or other sharp instruments. This can damage healthy tissue, increase the risk of infection and potentially make the problem worse.

If you have diabetes, poor circulation or reduced sensation in your feet, you should seek professional advice before attempting any self-treatment. (5)

When should I see a podiatrist?

It is advisable to arrange an assessment if:

• Your heels are painful.

• The cracks are deep or bleeding.

• You notice redness, swelling, warmth, pus or an unpleasant smell, as these may indicate infection.

• Your heels continue to crack despite regular moisturising.

• You have diabetes, poor circulation or reduced sensation in your feet.

• You are unsure what is causing the cracks.

At Brandon Podiatry, we can safely reduce hard skin, assess for any underlying causes and provide personalised advice to help relieve symptoms and reduce the risk of your cracked heels returning.

How can I help prevent cracked heels?

Although cracked heels cannot always be prevented, the following measures may help reduce your risk:

• Moisturise your feet regularly using a suitable foot cream.

• Wear supportive footwear that holds the heel securely.

• Avoid walking barefoot for prolonged periods.

• Reduce excessive pressure on your heels where possible.

• Avoid allowing hard skin to build up.

• Attend routine podiatry appointments if you are prone to recurring callus or heel fissures.

• Check your feet regularly, particularly if you have diabetes.

What does the evidence say?

Current evidence suggests that cracked heels usually develop due to a combination of dry skin and mechanical stress, rather than a single cause. Moisturisers improve skin hydration and reduce dryness, with urea-containing creams having the strongest body of evidence, although no single moisturiser has been shown to be consistently superior. (1)

For persistent or painful heel fissures, management should focus on treating both the symptoms and the underlying contributing factors, such as excessive pressure, footwear, hard skin or associated medical conditions. Professional assessment is particularly important when fissures are deep, recurrent or show signs of infection. (2–5)

Frequently Asked Questions

Are cracked heels dangerous?

Most cracked heels are not serious. However, deep fissures can become painful, bleed and increase the risk of infection, particularly in people with diabetes or poor circulation.

Why do my heels keep cracking?

Recurring cracked heels are often caused by a combination of dry skin, pressure, hard skin build-up, footwear or an underlying medical condition that has not yet been addressed.

Is it safe to remove hard skin yourself?

It is not recommended to use blades or sharp instruments to remove hard skin at home, as this can cause injury and increase the risk of infection.

Can moisturiser cure cracked heels?

Moisturisers help improve skin hydration and reduce dryness, but they may not be enough on their own if excessive pressure, thick callus or an underlying condition is contributing to the problem.

References (Vancouver)

1. Parker J, Scharfbillig R, Jones S. Moisturisers for the treatment of foot xerosis: a systematic review. J Foot Ankle Res. 2017;10:9.

2. Bhattacharya S, Bhattacharya K, Bhattacharya N, et al. Walking on Cracks: A Study of Heel Fissures and Their Management. Int J Aesthetic Plast Surg. 2026.

3. American College of Foot and Ankle Surgeons. Heel Fissures (Cracked Heels). Foot Health Facts. Available from: https://www.foothealthfacts.org/conditions/cracked-heels

4. Harvard Health Publishing. Why are my heels cracked? 2023. Available from: https://www.health.harvard.edu/diseases-and-conditions/why-are-my-heels-cracked

5. National Institute for Health and Care Excellence (NICE). Diabetic foot problems: prevention and management (NG19). London: NICE; 2023.

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