Cracked Heels

Causes and Risk Factors

• Dry Skin: Common in Australian climates with low humidity

• Excessive Pressure: Prolonged standing, obesity, walking barefoot on hard surfaces

• Open Footwear: Exposes heels to friction and dryness

• Dermatological Conditions: Atopic dermatitis, psoriasis, keratoderma

• Medical Conditions: Diabetes (reduced sensation, decreased sweat), hypothyroidism, nutritional deficiencies (zinc, essential fatty acids)

Clinical Features

• Dry, thickened skin on heels with fissures or cracks

• Possible pain, bleeding, or infection if deep cracks

• May catch on socks or footwear

• Can appear asymptomatic or mildly itchy, occasionally painful with weight-bearing

Assessment

• Examine for dryness, thickness, possible infection (e.g. cellulitis)

• Check for underlying foot deformities, obesity, footwear habits

• Consider diabetic foot checks if patient has diabetes

Management

Non-Pharmacological

• Footwear: Use supportive, closed shoes with heel cushioning

• Heel Pads or cups to redistribute pressure

• Foot Soaks in warm water (5–10 minutes), followed by gentle pumice stone use

• Moisturising with emollients daily (e.g. urea-based creams)

Pharmacological

• Keratolytics: Urea cream (10–25%) or salicylic acid-based creams daily to reduce hyperkeratosis

• Antiseptics/Topical Antibiotics if fissures are infected or at high risk (e.g. diabetic foot)

• Steroid creams rarely used except for significant inflammation or dermatitis

When to Refer

• Suspected Infection: Deep fissures with signs of cellulitis

• Diabetes with peripheral neuropathy or severe cracks

• Refractory Cases: Persistent after 4–6 weeks of standard care

• Podiatry referral for offloading, orthotics if biomechanical issues

Prevention

• Regular Emollient Use: Urea-based heel balms daily

• Avoid Walking Barefoot on hard or abrasive surfaces

• Weight Management if overweight or obese

• Protective Footwear: Closed-back shoes, socks

• Adequate Hydration & Nutrition: Ensure balanced diet for skin integrity

Table: Quick Comparison of Keratolytic Options

Notes

• Check for diabetes or vascular disease if recurrent or non-healing cracks

• Encourage gentle filing/pumice stone after foot soak, avoid aggressive removal

• Some patients benefit from regular podiatry visits if unable to self-manage