What Causes Cracked Heels? Treatment and What They Can Signal, by a Dermatologist
Cracked heels (heel fissures) are a condition in which the outer skin of the heel becomes dry, thickened and splits into grooves under pressure when standing or walking. Most cases come from dry skin combined with pressure, and can improve within 2–4 weeks with urea cream plus an occlusive layer to lock in moisture.
If you have done all of this and there is no improvement, look-alike conditions need to be considered: fungal infection of the sole, eczema, psoriasis and thickened palmoplantar skin, which are treated with different medicines. For people with diabetes or numb feet, a crack in the foot counts as a wound that a doctor needs to examine, and should not be managed alone.
What causes cracked heels
Heel skin has 3 particular features that make it crack more easily than skin elsewhere.
No oil glands: The soles have many sweat glands but no oil glands, so the skin has no natural oil coating and loses water easily in dry weather.
Thick outer skin: The horny layer at the heel is several times thicker than elsewhere. When the water content of the skin falls below about 10%, this layer becomes hard and loses its elasticity.
Sideways pressure: With every step, the fat pad under the heel spreads outward. Hard skin cannot stretch with it and splits into grooves, usually starting at the edge of the heel.
Cracks that stay in the outer layer are painless and do not bleed. Cracks that reach the dermis hurt when you put weight on them, bleed, and become a way in for germs.
How to tell ordinary cracked heels from another condition
The location and accompanying symptoms give fairly good clues.
Cracks only at the heel edge, no itch, no redness: usually dry skin combined with pressure.
Fine white scale in the creases of the sole, covering the whole sole like a moccasin: think of dry-type fungal infection.
Very itchy, red, with clear small blisters: think of eczema or shoe allergy.
Thick, sharply bordered plaques with silvery scale, pitted nails: think of psoriasis.
Thick yellow skin across the whole sole: think of palmoplantar keratoderma.
Numb feet, diabetes: treat this as more urgent than the other groups, however small the crack looks.
Dry skin all over, easily tired, feeling cold, weight gain: think of an underactive thyroid.
Cracked heels from dry winter skin
Appearance: The heel edge is dry with shallow white or pale yellow grooves, no itch and no redness. It is usually on both feet and gets worse in the dry season, in winter or in air-conditioned rooms.
Causes: Low humidity, very hot showers, harsh soap, not applying cream to the feet, age over 60 when skin holds less water, and some medicines such as oral retinoids (isotretinoin). To read more about the mechanism, see Dry cracked skin (xerosis): causes and care
Severity/urgency: Not dangerous. Can be cared for at home.
When to see a doctor: You have followed the full plan for 2–4 weeks with no improvement, the cracks get deeper, or itching and a red rash begin.
Cracked heels from long standing, open-heeled shoes and body weight
Appearance: The heel skin is thickened in a ring around the edge, with deeper grooves than dry skin alone, keeps coming back even with cream, and hurts after standing for long periods.
Causes: Standing or walking on hard floors for many hours a day, walking barefoot, wearing sandals or open-heeled shoes that let the heel fat spread outward, and a higher body weight that adds pressure with every step. The skin builds thicker hard skin to protect itself.
Severity/urgency: Not urgent, but it can come back if the pressure is not addressed. If there is a thick, painful spot in one place, it may be a corn on the foot, which is treated differently.
When to see a doctor: The pain makes walking difficult, the hard skin is too thick to manage yourself, or the foot shape is abnormal so weight is not borne evenly.
Cracked heels in people with diabetes: small wounds at risk of infection
Appearance: Very dry foot skin with little sweating, together with numbness, stabbing pain, or not feeling that there is a wound, so blood may show on a sock before any pain is felt.
Causes: Long-term high blood sugar damages nerves, both those that carry sensation and those that control sweating. Blood flow to the feet is reduced, so wounds heal slowly and become infected easily. About 19–34% of people with diabetes develop a foot ulcer at least once in their lifetime. Read more at Skin conditions from diabetes
Severity/urgency: Higher than every other group in this article, because a small crack can be the start of a diabetic ulcer, a spreading infection, and amputation of a toe or foot.
When to see a doctor: If there is a crack that bleeds or has opened into a wound, see a doctor within 24 hours. If there is pus, spreading redness, swelling and warmth, darkening skin, or fever, go to the emergency room immediately.
Rules for people with diabetes or numb feet:
Do not scrape, cut or file the skin yourself, and never use a blade.
Do not use salicylic acid creams or patches, and do not use lime juice or vinegar.
Do not soak the feet for long, and test the water temperature with your elbow or ask someone else to, because numb feet may not sense heat.
Moisturize only the soles and tops of the feet, not between the toes.
Check your feet every day with a mirror or ask someone at home to help, and do not walk barefoot even indoors.
Have your feet examined by a doctor at least once a year, and more often if your feet are numb or you have had a wound.
Cracked heels from an underactive thyroid
Appearance: Dry, rough skin all over the body, not just the heels, together with easily feeling tired, feeling cold, weight gain, constipation, thinning hair or a puffy face.
Causes: Lower thyroid hormone makes the sweat glands work less and slows the shedding of skin cells.
Severity/urgency: Not an emergency, but the cause should be found because it affects the whole body. Cracked heels alone, without other symptoms, rarely point to the thyroid.
When to see a doctor: You have whole-body symptoms as well. The doctor will check blood for TSH and free T4. If abnormal, treatment is with replacement hormone levothyroxine, and the skin usually improves gradually over several weeks to several months.
Dry-type fungal infection of the sole (moccasin tinea)
Appearance: Fine white scale in the creases of the sole and at the edges of the foot, slight redness, little or no itch. It often spreads to cover the whole sole like a moccasin. Some people have it on both feet and one hand, or have thick yellow toenails as well, so it is mistaken for plain dry skin.
Causes: Dermatophyte fungi, especially Trichophyton rubrum, which like the damp inside shoes. It is in the same group of conditions as athlete's foot, but in a dry, thick form.
Severity/urgency: Not an emergency, but it does not go away on its own and can spread to people in the household. Cracks are a way in for bacteria that cause a red, swollen, inflamed leg.
When to see a doctor: The scale does not go away after moisturizer, the scale is on one side only, or the nails are abnormal as well. The doctor will scrape the scale and examine it under the microscope for fungus (KOH) in a few minutes before deciding on medicine. Do not apply steroids yourself, because they hide the look of the rash and let the fungus spread.
Cracked heels from eczema and shoe allergy
Appearance: Itching is the main symptom, with red rash, small clear blisters at the edge of the foot, oozing, and thickening from chronic scratching. If it is a shoe allergy, the rash usually follows the shape of the shoe and spares the spaces between the toes.
Causes: Atopic dermatitis, dyshidrotic eczema, or contact dermatitis from rubber, glue or tanning chemicals in shoes.
Severity/urgency: Not dangerous, but it disturbs sleep and walking. Blisters that break can become infected again.
When to see a doctor: The itching is so bad you cannot sleep, there is oozing or yellow crusting, or the rash flares again after wearing the same pair of shoes. The doctor may arrange an allergy test with a patch test.
Psoriasis of the sole
Appearance: Thick red plaques with sharp borders and silvery or yellow scale, on both feet, with painful cracks. Some people have sterile pustules, pitted nails, and rashes on the elbows, knees or scalp.
Causes: The immune system drives skin cells to multiply faster than normal. Genetics play a part, and pressure on the sole makes the rash thicker. Smoking is linked to the pustular type. Read more at What causes psoriasis and early symptoms
Severity/urgency: Not an emergency, but it is chronic and can greatly affect walking or work even when the rash area is small.
When to see a doctor: Thick, sharply bordered plaques that do not respond to moisturizer, pustules, or joint pain, which needs assessment for psoriatic arthritis.
Palmoplantar keratoderma (thickened skin of the palms and soles)
Appearance: Thick yellow skin across the whole sole or only at the weight-bearing points. The border may be distinct, with deep cracks, and the palms may be affected as well.
Causes: If it began in childhood and runs in the family, it is usually genetic. If it begins in adulthood, it may be seen in postmenopausal women, people with fluid build-up in the legs, or an underactive thyroid, or, very rarely, together with an internal cancer.
Severity/urgency: Mostly not dangerous, but it disturbs walking and needs ongoing care.
When to see a doctor: It starts for the first time in adulthood, spreads quickly within a few months, or comes with unexplained weight loss.
What to do when a cracked heel is bleeding
Appearance: A groove reaching the dermis, painful when weight is put on it, with blood seeping out, and a hard thick edge that splits again with every step.
Causes: Hard skin built up over a long time, dry skin, and repeated pressure, especially after a lot of walking or after scrubbing too hard.
Severity/urgency: Moderate, and urgent if you have diabetes, numb feet, low immunity, or narrowed peripheral arteries.
When to see a doctor: The wound is not better within 5–7 days, there is pus, spreading redness, swelling and warmth, fever, or you are in one of the risk groups above. The doctor will trim the hard edge, close the groove, give antibiotics only if there is infection, and review tetanus vaccination.
First-aid care for people with no risk factors
Wash with clean water and mild soap. Press with a clean cloth for 5–10 minutes to stop the bleeding.
Apply a thin layer of petrolatum and cover with gauze or a hydrocolloid dressing.
Avoid urea, salicylic and lactic creams on the open groove until the wound closes, because they sting and irritate.
Reduce standing and walking, and wear closed-heel shoes in the meantime.
Treating cracked heels: choose by cause and skin thickness
There are 3 principles: add water to the skin, reduce the thick skin, and seal it so water does not evaporate. If another condition is the cause, that condition must be treated as well. The medicines and strengths below are what doctors use to explain options to patients. Choosing and prescribing medicine is the decision of the examining doctor.
Urea cream (urea) 20–40%: the mainstay for thick heels
Urea both draws water into the skin and breaks down the bonds of the horny layer. The concentration affects how it works.
10%: focuses on adding moisture, suitable for keeping symptoms under control.
20–25%: starts to clearly reduce thick skin, suitable for ordinary cracked heels.
40%: used for very thick skin, and should be applied only to the thick spots.
How to use: Apply twice a day, after a shower and before bed. The skin usually softens within 1–2 weeks and the grooves become shallower within 2–4 weeks. Once improved, lower the concentration or frequency to maintain control.
What decides the result: Consistency and relieving the pressure. Urea can sting on open grooves, so start after the wound has closed. For how to read labels, see Moisturizers for dry skin: how to choose
Salicylic acid (salicylic acid) 6–10%: when thick skin does not respond
Salicylic acid helps the horny cells to shed. It is usually used as a 6–10% cream or ointment applied only to the thick spots once or twice a day, in courses of 1–2 weeks, then reassessed.
What decides the result: Apply only to thick spots and keep it off normal skin. Do not use on wounds. Do not use in people with diabetes or narrowed peripheral arteries, and do not use widely in pregnant women or young children without consulting a doctor, because the medicine can be absorbed into the body.
Lactic acid and ammonium lactate 12%
Lactic acid is an alpha hydroxy acid (AHA) that both adds water and exfoliates the skin. The best-studied form is ammonium lactate 12%, applied twice a day and assessed at 2–4 weeks. It suits people with dry skin over a wide area of the sole.
What decides the result: Keep applying it, and avoid open grooves because it stings. Treated skin should avoid strong sun, because this type of acid makes skin more sensitive to light.
Petrolatum (petrolatum) as an occlusive layer, with socks at night
Petrolatum does not directly reduce thick skin, but it greatly reduces water evaporation from the skin, so it is used as the final layer after urea cream or moisturizer. Before bed, apply it thickly to the heels and put cotton socks over it. Do this every night for 2–4 weeks.
Petrolatum alone suits skin that is not yet very thick, and is a non-stinging option while grooves are open.
Treatment when it is a fungal infection: terbinafine (terbinafine)
When tests confirm fungus, terbinafine (terbinafine) 1% cream is the main choice, applied once or twice a day over the entire sole and slightly beyond the edge of the rash for 2–4 weeks. Clotrimazole (clotrimazole) 1% is an alternative, applied twice a day for about 4 weeks.
What decides the result: The moccasin type has thick skin and the cream is poorly absorbed, so doctors often add urea to reduce the thick skin, and many cases need oral medicine such as terbinafine 250 mg once a day for 2–6 weeks, for which the doctor will consider liver disease and other medicines being taken. If there is also nail fungus and it is not treated, the fungus often returns to the sole.
Treatment when it is eczema or psoriasis: steroids and other medicines
Sole skin is thick, so stronger steroids are needed than those used on skin elsewhere.
Eczema: betamethasone valerate (betamethasone valerate) 0.1% or mometasone (mometasone furoate) 0.1% once or twice a day for 2–4 weeks, and avoid the shoes or substances that cause the allergy.
Psoriasis: clobetasol (clobetasol propionate) 0.05% once or twice a day, no more than 2 weeks per course and no more than 50 grams per week, under a doctor's supervision. It may be alternated with calcipotriol (calcipotriol) 0.005% for long-term control.
Severe cases: The doctor may consider phototherapy, acitretin (acitretin), methotrexate (methotrexate) or biologic medicines, which require blood tests and follow-up. Acitretin must not be used by people who are pregnant or planning pregnancy.
Palmoplantar keratoderma: urea 20–40% or salicylic acid 6–10% as the mainstay, and retinoids only in some cases as prescribed by a doctor.
What decides the result: A correct diagnosis before starting medicine. Strong steroids used for too long thin the skin, and used on fungus they make the disease spread.
Home care for cracked heels over 2–4 weeks
This plan is for people who do not have diabetes, numb feet, open wounds, or an itchy or red rash.
1–2 times a week: Soak the feet in warm water for 10 minutes, then gently buff with a foot file or pumice stone, only the thick skin, without scrubbing until it hurts or turns red.
Every day, morning and before bed: Apply urea cream 20–25% after a shower. Pat the feet until just damp before applying.
Every night: Apply petrolatum over it, then put on cotton socks.
During the day: Wear closed-heel shoes or shoes with a heel strap. Avoid standing barefoot on hard floors.
At 2 weeks: You should see softer skin and less pain.
At 4 weeks: If the grooves are not shallower, or a rash appears, see a doctor to look for another condition.
Once improved, use urea cream 10% once a day to maintain control.
What not to do: lime, blades and hard scrubbing
Lime juice: Concentrated acid irritates cracks. If the skin is in the sun after applying it, phytophotodermatitis (burns from plant compounds plus light) can occur, with stinging redness or blisters within 24–48 hours and dark marks lasting for months. No research supports its use for cracked heels.
Blades or scissors: It is easy to cut too deep, which opens the way for germs.
Hard scrubbing every day: The skin will build thick skin back even faster, and abrasions form.
Very hot water, vinegar, strong salt: They draw moisture out of the skin and sting wounds.
Applying steroids yourself without knowing the cause: If it is fungus, it will get worse.
Are cracked heels related to vitamin deficiency
There is no good evidence that a deficiency of any one vitamin causes cracked heels in the general population. Some nutrient deficiencies can genuinely cause skin abnormalities, such as vitamin B3, zinc and vitamin A, but they come with other clear symptoms, such as a rash in sun-exposed areas, a rash around the mouth, diarrhea, or night blindness.
So it should be considered only in people with a very restricted diet, heavy alcohol use, stomach surgery, or abnormal intestinal absorption, for whom the doctor will choose blood tests case by case. Taking vitamin supplements yourself when you are not deficient does not improve the heels, and high-dose vitamin A is harmful to the liver and to an unborn baby.
Preventing cracked heels from coming back
Apply foot cream every day, especially from November to February when the air is dry.
Wear closed-heel shoes with good sole support, or use silicone heel pads if you have to stand for long periods.
Bathe in moderately warm water, use mild soap, and pat the feet dry.
Lose weight if above the healthy range, to reduce pressure on the heels.
Dry between the toes and change socks every day, to reduce fungus.
Keep blood sugar controlled if you have diabetes, and have your feet checked at appointments.
When to see a dermatologist
You have diabetes, numb feet, narrowed peripheral arteries or low immunity, and you have a crack or wound.
There is pus, spreading redness, swelling and warmth, an unusual smell, or fever.
Bleeding keeps recurring, or the pain makes walking difficult.
You have followed the care for 2–4 weeks with no improvement.
Scale spreads across the whole sole, with itching, blisters, thick sharply bordered plaques, or abnormal nails.
You have a rash on both palms and soles together with whole-body symptoms or a rash on the trunk, which requires ruling out conditions that need blood tests, such as secondary syphilis.
Before the visit, if possible, stop applying antifungal cream for at least 1 week so that the fungal test is more accurate, and bring the shoes you suspect you are allergic to.
Quick summary
Cracked heels (heel fissures) mostly come from dry skin, thick skin and pressure.
Urea cream 20–40% twice a day, together with petrolatum and socks at night, is the mainstay. You should see results within 2–4 weeks.
If there is no improvement, or there is scale across the whole sole, itching, or thick sharply bordered plaques, think of fungus, eczema, psoriasis or palmoplantar keratoderma.
People with diabetes or numb feet must not scrape or soak for long. A crack that has opened into a wound should be seen by a doctor within 24 hours.
Lime juice and blades add risk with no evidence that they help. Vitamin supplements are not needed unless you are deficient.
Pus, spreading redness, swelling and warmth, or fever mean you must see a doctor immediately.
Frequently asked questions about cracked heels
What causes cracked heels
Most cases come from heel skin that is dry and thickened until it can no longer stretch. When weight is put on it, the fat under the heel spreads outward and the skin splits into grooves. Contributing factors are dry air, long standing, open-heeled shoes, a high body weight, and older age. If there is no improvement after 2–4 weeks of care, or there is an itchy, peeling rash, there may be another cause, such as fungal infection of the sole, eczema or psoriasis. People with diabetes have dry foot skin from nerve damage, so they need special care.
What should I apply for cracked heels
If there is no open wound, use urea cream 20–25% twice a day. If the skin is very thick, the doctor may give urea 40%, salicylic acid 6–10% or ammonium lactate 12%, and then petrolatum over it before bed with socks. If grooves are open, use petrolatum first, because acids and urea sting. If fungus or psoriasis is found, medicine for that condition is needed, such as terbinafine or clobetasol, which the doctor chooses to suit each person.
How do I fix cracked heels urgently
To reduce the pain quickly, on the first night wash the feet, pat dry, apply petrolatum thickly and put on cotton socks. If there is bleeding, press to stop it for 5–10 minutes, then cover with gauze or a hydrocolloid dressing. Avoid walking barefoot and wear closed-heel shoes. The pain usually eases within a few days, but the skin needs 2–4 weeks to improve. People with diabetes or numb feet should see a doctor within 24 hours if there is an open wound.
What can cracked heels indicate
Most cracked heels do not signal a serious disease, but they may relate to diabetes when the feet are numb and very dry, to an underactive thyroid when there is dry skin all over with tiredness and feeling cold, to fungus when there is white scale across the whole sole, to psoriasis when there are thick sharply bordered plaques and pitted nails, and to palmoplantar keratoderma when there is thick yellow skin across the whole sole. If cracked heels are the only sign with no other symptoms, they usually come from dry skin together with pressure.
Can lime be used to treat cracked heels
Not recommended. Lime juice contains concentrated citric acid, so it stings and irritates when it gets into the cracks, and no research supports that it helps treat cracked heels. If the feet are in the sun after applying it, phytophotodermatitis can occur, with stinging redness or blisters within 24–48 hours and dark marks lasting for months. People with diabetes should not use it even more, because they may not feel the skin burning. If you really want an exfoliating acid, ammonium lactate 12%, which has a controlled concentration, is safer.
Which vitamin deficiency causes cracked heels
There is no good evidence that cracked heels come from a deficiency of any one vitamin. Most people with cracked heels are not vitamin deficient. A deficiency of vitamin B3, zinc or vitamin A can genuinely cause skin abnormalities, but with other accompanying symptoms, such as a rash in sun-exposed areas, a rash around the mouth, diarrhea, or night blindness. Blood tests should be done only for people with a very restricted diet, heavy alcohol use, or abnormal intestinal absorption, and high-dose vitamin A should not be taken by yourself.
Related reading: Dry skin (xerosis) · Moisturizers for dry skin: how to choose · What causes athlete's foot · What causes psoriasis · What causes corns on the feet · Skin conditions from diabetes · All skin conditions explained by a dermatologist
The information in this article is general knowledge, not a diagnosis or an individual treatment order. Results vary from person to person. Consult a doctor before using any medicine.
Written by Dr. Patara Voravutinon, Dermatologist · Last reviewed 4 November 2026
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