What Are Heel Fissures?

Heel fissure symptoms can range from mild to severe.

Examples of mild symptoms include:

• brown or yellow discoloration of the skin, which indicates the presence of callus
• thickening of the skin around the crack or cracks
• visible cracking or splitting of the skin on the heels

If left untreated, milder symptoms can become more severe ones, including:

• bleeding from the cracks in the heels
• open wound or wounds on the heels
• pain when putting pressure on the heels or walking

Heel fissures can also lead to deep ulcers (open sores) that can get infected and result in cellulitis (a painful skin infection). That’s why preventing and treating heel fissures whenever possible is so important.

Heel fissures commonly occur in those with diabetes.

This is because the one of the effects of diabetes on the body is damaged nerves, especially those in the feet. The damaged nerves may not sense that they need to sweat. This typically helps provide moisture to the feet.

Heel fissures can be also especially harmful if you have diabetes because they can lead to nonhealing foot ulcers.

Dry skin due to various reasons is the most common cause of heel fissures. But there are many possible reasons you may have dry skin that leads to heel fissures, including:

• eczema
• tinea pedis, a fungal infection commonly known as athlete’s foot
• living in cold, dry environments
• hypothyroidism
• psoriasis
• rheumatoid arthritis
• scleroderma

Any condition that causes tissue thickening or affects the body’s ability to sweat can increase your risk of heel fissures.

At-home treatments can help to soften your heels if you have mild symptoms.

You may benefit from a two-application approach — this involves applying thick moisturizers twice a day. Use preparations made with ceramides, petrolatum, or natural oils like almond, coconut, or sunflower oil.

You may also want to alternate these moisturizers with those that contain ingredients to remove dead skin cells, such as:

• alpha hydroxy acids (AHAs)
• salicylic acids
• urea

An article on heel fissures published in Dermatological Nursing recommends applying an emollient cream containing 10 to 25 percent urea.

Applications can cause a mild stinging sensation on the skin. Once the heel skin starts to soften, you can decrease the urea concentration.

Spend about 10 minutes each night softening your skin. Here’s a routine you can try:

1. Soak your feet in warm (not hot) water for 10 minutes in a small foot tub you can get at any drugstore. Add a creamy or milk-like hydrating cleanser to your foot bath if you’d like. (Be sure to wash the tub with soap and water and dry it thoroughly after each use.)
2. Gently pat your feet dry.
3. Use manual exfoliation to remove excess dead skin from your feet. Try a loofah, foot scrub brush, or pumice stone. Gentle friction is all that’s needed — don’t scrub too hard or you risk injuring your skin.
4. Apply a thick layer of ointment with petrolatum or petroleum jelly.
5. Put on thin, clean cotton socks over your moisturized feet. If you don’t like to sleep in socks, try hydrocolloid dressings that fit over the heel itself.

Applying creams and emollients to your feet can make them slippery. Try wearing nonskid socks to prevent any falls while you treat heel fissures.

Home treatments not working? Here are some possible medical treatment options.

See a podiatrist

If you have diabetes (or other conditions that affect your foot circulation), you may want to see a podiatrist if you have very thick, dry skin on the bottom of your feet.

A podiatrist uses special tools to remove dead skin with a technique called debridement to prevent heel cracking.

Try prescription medications for infections

Your doctor can also help treat infections with prescription antifungal and antibacterial medications if over-the-counter treatments don’t work.

Prescription medications can help treat the infectious organisms that increase your risk of heel fissures and ideally help you soften your heel skin.

See your doctor immediately for sores

If your heel fissures have developed into sores, see your doctor as quickly as possible.

Your doctor can begin prescribing wound care treatments that aim to treat the area and ideally restore healthy skin. These often take regular application and careful wound care measures at home to see results.

In addition to underlying medical causes for heel fissures, certain lifestyle changes can help prevent heel fissures. Here are some tips for doing just that:

• Don’t wear open-heeled shoes. Exposing your heels by wearing slingbacks or sandals can dry the heels’ skin out.
• Don’t walk barefoot on rough surfaces often. Walking outside on pavement or uneven stone flooring at your home can lead to heel damage and dryness. Try to wear shoes when you’re outside and nonskid socks or house slippers with a back when you’re indoors.
• Don’t be too hard on your feet. Using harsh soaps, soaking your feet in very hot water, or scrubbing excessively at your feet can contribute to further dryness and cracking.
• Moisturize your feet regularly. Moisturizing especially in the mornings and evenings will help keep your feet soft and smooth.
• Wear protective heel cups in your shoes. Heel cups can help reduce stress on your heels that can lead to heel fissures. You can purchase these at most drugstores or sports stores.
• Exfoliate regularly. Use a gentle foot scrub, loofah, or pumice stone to prevent the building of excess dead skin cells. This has a protective effect on your heels and prevents fissures.

Deep heel fissures can be very painful, and the pain can affect your quality of life. If you have diabetes, a heel fissure can also increase your stress and anxiety that the area will worsen.

According to an article in Dermatological Nursing, foot ulcers from heel fissures can also lead to amputations in people with diabetes. This is a critical reason why it’s so important to treat heel fissures as early as possible.

Heel fissures result from a lack of moisture. If not treated, this condition can snowball into more serious symptoms.

Keep your feet moisturized and examine them regularly for cracks and fissures to help address the symptoms in the earliest possible stages.

If you aren’t seeing results from your treatment and prevention, talk to your doctor.