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Cracked Heel (Calcaneal Fissure)

What is Cracked Heel?

A cracked heel, also known as a heel fissure or calcaneal fissure, is a split or longitudinal break in the skin of the heel’s surface. The outer layer of skin becomes dry, thickened, and loses its elasticity, eventually cracking under pressure. Small cracks may be painless, while larger fissures can bleed, become painful, and increase the risk of infection.

Cracked heels are common in adults of all ages but are especially prevalent in older adults, people who stand for long periods, and individuals with certain medical conditions that affect skin hydration or blood flow.

Common Causes

Most heel fissures develop from a combination of external and internal factors. Below are the most frequently reported causes.

• Dry skin (xerosis): Lack of moisture makes the skin less pliable.
• Prolonged standing or walking: Increases pressure on the heel pad.
• Improper footwear: Open‑backed sandals, high heels, or shoes that do not support the arch can place excess stress on the heel.
• Obesity: Extra body weight adds pressure to the calcaneus.
• Diabetes mellitus: Alters skin hydration and impairs circulation, making fissures more likely and slower to heal.
• Hypothyroidism: Leads to generalized dry skin.
• Psoriasis or eczema: Inflammatory skin disorders cause scaling and cracking.
• Peripheral vascular disease (PVD): Poor blood flow reduces nutrient delivery to the skin.
• Fungal infection (tinea pedis): The “athlete’s foot” fungus can spread to the heel, softening skin and predisposing it to cracks.
• Age‑related skin changes: As we age, the skin’s natural oil production declines, increasing susceptibility.

Associated Symptoms

Cracked heels rarely occur in isolation. Patients often notice other signs that may help identify the underlying cause.

• Dry, flaky skin surrounding the fissure
• Itching or burning sensation
• Pain when walking, especially after prolonged standing
• Bleeding from deep cracks
• Redness, warmth, or swelling → possible infection
• Foul odor (often linked to fungal overgrowth)
• Callus formation around the fissure
• Visible thickening (hyperkeratosis) of the heel pad

When to See a Doctor

Most small heel fissures can be managed at home, but you should seek professional care if you experience any of the following:

• Severe or persistent pain that interferes with walking
• Bleeding that does not stop after applying pressure for 10–15 minutes
• Signs of infection: redness, swelling, warmth, pus, or fever
• Cracks that are deeper than 2 mm or that expose underlying tissue
• Repeated fissuring despite proper foot care
• You have diabetes, peripheral neuropathy, or peripheral arterial disease – these conditions raise the risk of complications

Diagnosis

Evaluation is usually straightforward. A clinician will:

1. Take a focused history – duration, footwear habits, medical conditions, diabetes control, and any prior foot problems.
2. Perform a visual inspection – assess the depth, length, and presence of surrounding callus or infection.
3. Palpate the heel – check for tenderness, warmth, or underlying bone abnormalities.
4. Assess peripheral circulation – capillary refill, ankle‑brachial index in high‑risk patients.
5. Consider adjunct tests if infection is suspected (e.g., wound culture) or if a fungal cause is likely (KOH prep, fungal culture).

Most diagnoses rely on clinical appearance; imaging is rarely needed unless an underlying bone problem (e.g., calcaneal stress fracture) is suspected.

Treatment Options

Treatment aims to re‑hydrate the skin, relieve pressure, and treat any underlying condition. Options fall into three categories: self‑care, over‑the‑counter (OTC) products, and prescription‑level interventions.

Home & Self‑Care Measures

• Moisturize daily: Apply a thick, occlusive cream (e.g., urea 10‑20%, petroleum jelly, lanolin) after bathing while the skin is still damp.
• Soak and exfoliate: Soak the foot in warm (not hot) water for 10–15 minutes, then gently rub with a pumice stone to remove thickened skin. Avoid aggressive scrubbing.
• Footwear adjustments: Choose shoes with a cushioned heel counter and adequate arch support. Use heel cups or orthotic inserts to redistribute pressure.
• Hydration & nutrition: Drink adequate water and consider omega‑3 rich foods or supplements that support skin health.
• Weight management: Reducing excess body weight lowers mechanical stress on the heels.

Over‑the‑Counter Products

• Urea‑based creams (10‑40%): Break down keratin and hydrate skin.
• Salicylic acid pads (2‑3%): Gently dissolve callus; use sparingly to avoid over‑drying.
• Antifungal powders or sprays: If tinea pedis is present, treat the fungus to prevent spread.
• Silicone gel sheets: Provide a moist wound environment for deeper fissures.

Prescription Treatments

• Topical steroids: Low‑potency (e.g., hydrocortisone 1%) for inflamed, itchy skin; avoid prolonged use.
• Prescription‑strength keratolytics: Higher‑dose urea (40%) or topical tretinoin for stubborn hyperkeratosis.
• Systemic antifungals: Oral terbinafine or itraconazole if extensive fungal infection is confirmed.
• Antibiotics: Oral or topical antibiotics when bacterial infection is documented (e.g., Staphylococcus aureus).
• Advanced wound care: For deep or chronic fissures, a podiatrist may apply hydrocolloid dressings, silicone gel, or plate dressings to promote healing.

When Surgery Is Considered

Surgical intervention is rare but may be required for:

• Recurrent deep fissures despite optimal medical therapy
• Severe callus that cannot be managed conservatively
• Underlying structural problems (e.g., heel spur) contributing to chronic stress

Procedures include partial excision of the thickened skin or debridement under local anesthesia, often combined with orthotic therapy.

Prevention Tips

Most heel fissures are preventable with consistent foot care and lifestyle modifications.

• Moisturize regularly: Apply a thick emollient after each shower.
• Wear supportive shoes: Choose footwear with a cushioned heel and arch support; replace worn‑out shoes every 6–12 months.
• Use heel inserts or pads: They reduce pressure points, especially for people who stand long hours.
• Avoid walking barefoot on hard surfaces: This eliminates direct shear forces on a dry heel.
• Keep nails trimmed: Short toenails reduce the risk of accidental skin tearing.
• Manage chronic conditions: Good glycemic control in diabetes, thyroid hormone replacement in hypothyroidism, and treatment of peripheral vascular disease lower risk.
• Address fungal infections promptly: Treat athlete’s foot before it spreads to the heel.
• Maintain a healthy weight: Even modest weight loss (5–10%) can substantially reduce heel pressure.
• Schedule regular foot exams: Particularly for diabetics or individuals with neuropathy, to catch early skin changes.

Emergency Warning Signs

Key Take‑aways

Cracked heels are often a benign sign of dry skin and mechanical stress, but they can become painful or infected, especially in people with diabetes, vascular disease, or skin disorders. Simple daily moisturizing, proper footwear, and attention to any underlying medical conditions usually keep the skin healthy. When fissures are deep, painful, or show signs of infection, prompt medical evaluation is essential to prevent complications.

References:

• Mayo Clinic. “Heel fissures.” Accessed May 2026.
• American Diabetes Association. “Foot Care Guidelines.” 2024.
• Cleveland Clinic. “How to Treat Dry, Cracked Heels.” 2023.
• National Institute of Arthritis and Musculoskeletal and Skin Diseases. “Skin Conditions – Xerosis.” 2022.
• World Health Organization. “Guidelines for the Management of Skin Conditions.” 2021.

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