Foot Conditions A-Z

Cracked Heels

Cracked heels, also called “heel fissures,” are a fairly common foot issue.  For many people they are merely a nuisance or a cosmetic problem, but if the cracks are deep, they can be painful when you’re on your feet. Cracked heels may also bleed.

Cracked heels generally are caused by dry skin (xerosis) and are more difficult to treat if the skin around the rim of the heel is thickened or callused. In severe cases, the cracks or fissures can become infected. According to the 2012 National Foot Health Assessment conducted by the NPD Group for the Institute for Preventive Foot Health, 20 percent of US adults ages 21 and older (about 44 million people) have experienced cracked skin on their feet. The problem is more severe among women who report the condition at a rate more than 50 percent higher than males.

Causes

Beyond dry skin, other causes for cracked heels include:

• Biomechanical problems that increase pressures in the heel area.
• Prolonged standing, especially on hard floors.
• Obesity, which increases the pressure on the normal fat pad under the heel, causing it to expand sideways. If your skin is not supple and flexible, the pressure can cause cracking or fissures.
• Open backs on shoes or sandals, which allows the fat pads in the heel to expand sideways and increase pressure on the skin, causing it to crack.

Some medical conditions predispose people to dry skin. For example, neuropathy can cause people with diabetes to lose the ability to perspire, which leads to skin dryness. “Sjogren’s Syndrome” is a rare condition, seen mostly in women, that creates dry skin as the body’s autoimmune system attacks perspiration and moisture-producing glands. In addition, certain skin conditions such as psoriasis, eczema and fungal infections cause drying of the skin and increase the likelihood of cracking.  

Prevention and Treatment

Properly designed shoes or boots can help prevent heel cracks. Good solid heel counters in the rear of the shoe or boot help protect the heel. Avoid open-heeled shoes. If your skin is very dry, applying moisturizing creams can protect the heel as well.

To ensure that feet are optimally protected, IPFH suggests that you wear only properly selected and fitted, as part of an integrated approach, padded socks with shoes with non-slip outsoles and any inserts or orthotics prescribed or recommended by a doctor or foot health professional.  Peer-reviewed, published studies have shown that wearing clinically tested padded socks can help protect against injuries to the skin/soft tissue of the foot.

A pumice stone can be used to reduce the thickness of calluses and hard skin caused by the condition.  However, people with diabetes and/or neuropathy should not attempt to abrade the skin of their feet with pumice stones, razors or scissors due to the risk of infection. Instead, see a medical professional such as a podiatrist or dermatologist. The medical professional may remove (debride) dead skin and/or use mechanical treatments such as gait adjustment to address excessive pressure that may be causing or worsening the issue.

Medical Considerations

Although pain is a common symptom of cracked heels, the condition normally is not harmful. However, in the absence of proper care and attention, the cracks can become infected. You should consult your physician if you have soreness, pain, redness, swelling or other indications of problems in any area of your feet that persist for more than a few days.