Dry, cracked skin on the heels, also known as xerosis, occurs when the skin thickens (forming calluses), and fissuring (cracking on the bottom of the heel) occurs. Cracked heels can become a serious problem and can cause significant pain if left untreated.
Almost anyone can develop cracked heels, but people who live in dry climates, walk around barefoot, or wear shoes that expose their heels are more prone to developing this problem. Remember, the heel is the first part of the body to hit the ground.
It can also be a manifestation of other skin conditions like psoriasis. Obesity also seems to be a factor, as the extra body weight applies extra pressure to the feet, especially the heel.
Because cracked heels are not always painful, many people put off seeking medical attention.
Most people are initially concerned only about the cosmetic aspect of the problem, as the skin thickens and becomes unsightly.
If treatment is delayed, however, the condition progresses. The thickened skin will dry further, which leads to additional and more severe or painful cracks (fissures), which deepen and grow longer, and may bleed or become infected.
The dermis is the thicker of the skin’s two layers, except on parts of the body where pressure and friction are greater—e.g., our heels. In these areas, the epidermis is thick and full of active cells.
These cells die and accumulate on the surface of the skin, where they are shed or rubbed away.
Under normal circumstances, this process takes approximately one month. But in skin that is subject to excessive pressure and friction, or in patients suffering from skin conditions such as psoriasis, new cells accumulate at a faster rate than the old cells are shed, causing the epidermis to become unusually thick.
As this thicker layer of skin dries, it becomes brittle, and is prone to cracking or splitting.
Cracked Heel Symptoms You Should Look For
The most common symptoms associated with cracked heels are:
- Itchy skin
- Dry, flaky skin
- Pain while walking
- Redness of heel
- Hard growth of skin on outer edge of heel
- Yellow or darkened skin on heel
- Pain that increases when wearing thin soles or open-backed shoes
- Cracks progressively worsen, deepening and growing longer
During the early stages you will notice your skin thickening. The skin may become dry, flaky, and itchy. As the problem worsens, you will notice small cracks appearing around and on the bottom or fatty pad of your heel.
As the cracks begin to develop more, you will see an increase in redness and soreness, and you will experience pain and difficulty walking. The thickened skin will split and create grooves, which are often painful and may bleed. These are called fissures.
Why Do I Have Cracked Heels?
There are many different causes of cracked heels. Some are more common than others:
- Decreased function of the sweat glands
- Dry skin
- Heel spurs
- Walking barefoot
- Wearing sandals or open-back shoes often
- Athlete’s foot
- Foot deformities
- Faulty foot mechanics, such as may be caused by excessively high arches or flat feet
- Thyroid disease
- Psoriasis or other types of skin conditions
- Prolonged standing, especially on hard surfaces
- Improper footwear
- Aging: our skin becomes thin and dry with age
Diabetes can interfere with your body’s ability to produce oils, making your skin susceptible to dryness. Standing for long periods can create extra stress on your heels.
If you are overweight, it is important to begin losing weight immediately. Obesity is a leading cause of foot problems. Going barefoot or wearing open-backed shoes on a regular basis can cause your fat pad to expand more than usual.
After a period of expansion, the heel becomes susceptible to cracking and fissuring. To see how this happens, take a ripe tomato and place it on your kitchen counter. With the palm of your hand, apply pressure to the tomato by pressing down on the top.
As you continue pressing, you will notice the sides of the tomato beginning to crack, allowing juice to squirt out. The same thing happens to your heel if too much pressure is put on it. This excessive pressure may cause bleeding in the deeper fissures.
How Are Cracked Heels Diagnosed?
Diagnosing your cracked heels may be simple, especially if you wait until the cracks have turned into deep, long fissures. Your podiatrist may want to take a skin sample for biopsy to be sure there are no infections or diseases present.
Your doctor will also inquire about any of your daily activities that may have led to the cracking. He or she will ask you about your grooming habits, past medical history, and what type of shoes you wear.
How Are Cracked Heels Treated?
Treatment plans are often dictated by the severity and cause of the cracked heels. Initial treatment is often focused preventing fissures, which are vulnerable to infection.
As these wounds heal, relieving symptoms and preventing them from recurring becomes the long-term objective. Treating cracked heels is easiest before the cracks become deep, painful, and bloody.
Treatment options for cracked heels include:
- Removing the hard, thick skin with a scalpel to promote healing
- Special creams to moisturize (usually recommended twice daily)
- Special socks that provide cushioning and promote moisture control
- Wound-care measures such as topical antibiotics and bandage changes (usually only in severe cases)
- Orthotics or arch supports to improve foot mechanics to decrease friction
- Pumice stone, to be used daily after soaking
- Wearing shoes that have closed heels
- Wearing shoes that have added support in the arch and heel
You should always have your condition evaluated by a podiatrist before self-medicating. At-home remedies can be helpful, but your doctor will be able to determine the severity of your condition and create an appropriate treatment plan.
Moisturizers can be prescribed by your doctor or bought over-the-counter at a drugstore. Prescription medications that peel away the extra layers of skin are often necessary. Topical antibiotics or antifungals may also be required if your condition is more serious.
For the best results, you should soak your feet in warm water for a minimum of fifteen minutes to hydrate the skin. After that, pat-dry your feet completely and apply the moisturizer. Doing this at night and wearing socks to bed after moisturizing can help to “lock in” the moisture.
Pumice stones can also be used to scrub away dead skin. Generally, you should soak your feet in warm water first to soften the skin and to make dead-skin removal easier.
If you wear open-backed shoes such as sandals or high heels, you should take extra care of your feet, especially the parts that are exposed.
You should also consider limiting how often you wear these types of shoes, especially if you are at risk for developing this problem because of an underlying skin condition such as psoriasis, eczema, or athlete’s foot. Remember, lotion should be applied two or three times daily.
How Can I Prevent Cracked Heels?
Here are a few tips to help you prevent cracked heels:
- Always apply lotion to your heels after bathing or swimming.
- Apply lotion before bed, and wear socks to lock in moisture.
- Remove excess skin from your heel.
- Do not wait to see a doctor if your heels begin to crack.
- It is okay to occasionally wear shoes that expose your heel, but you need to give your feet a break from the harmful conditions imposed by these shoes.
- Wear shoes that control excessive pronation; this helps prevent friction.
Questions to Ask Your Doctor
Here are some questions you may want to ask your doctor about cracked heels:
- What are the chances the cracks will recur?
- How will I have to change my daily habits to prevent them from recurring?
- Will treatment interfere with my normal activities?
- During my next visit, will there be additional diagnostic tests?
- Should I consider changes in shoe gear or activities?
- What home remedies can benefit me most?
- Which over-the-counter medications can relieve my symptoms?
- Do I need a prescription-strength topical medication?