Short answer: Most cracked heels develop when dry, thickened skin around the heel is repeatedly stretched by pressure. Open-backed shoes, prolonged standing, excess body weight and dry skin can all contribute. Sometimes persistent or severe heel fissures are associated with conditions such as eczema, psoriasis, diabetes, hypothyroidism or fungal infection.
The practical goal is to restore flexibility to the thick dry skin, reduce pressure on the heel and protect open fissures while they heal.
Why heels crack
The skin around the heel can become dry and thickened, forming a callus. When body weight presses down, the heel’s fat pad expands sideways. If the callused skin is too stiff to stretch with it, small fissures form at the edge of the heel.
As pressure continues, the fissures can deepen and become painful. Severe cracks may bleed and create an entry point for infection.
This mechanical explanation is why cracked heels are especially common with prolonged standing, open-backed footwear, dry skin and increased heel pressure.
The most common contributors
Dry skin: The less flexible the outer skin layer becomes, the more easily it splits under pressure.
Callus: Thick hard skin around the heel rim is often the stage before visible cracking.
Open-backed shoes: Sandals and similar shoes provide less support around the heel, allowing the heel pad to expand outward more easily.
Standing and mechanical load: Long periods on hard floors can increase repetitive pressure.
Body weight: Higher mechanical load can increase sideways expansion of the heel pad, although people of any body size can develop fissures.
Can cracked heels be a sign of diabetes?
They can occur in people with diabetes, but cracked heels by themselves do not diagnose diabetes.
Diabetes matters because dry skin, neuropathy, impaired circulation and slower wound healing can turn a small crack into a more serious foot problem. People with diabetes should inspect their feet regularly and take cracks, calluses, sores, redness and drainage seriously.
The American Academy of Dermatology recommends treating dry cracked heels promptly in people with diabetes because fissures can progress to infection or non-healing wounds.
AAD: Skin care for people with diabetes.
Other conditions that can cause or worsen heel fissures
Persistent cracking can sometimes be part of another skin or systemic condition.
Psoriasis can produce thick, sharply defined scale on the soles with painful fissuring.
Eczema and dermatitis can cause dry, inflamed skin that becomes more likely to crack.
Hypothyroidism can be associated with unusually dry and thickened skin, although heel cracks alone are not a useful thyroid test.
Tinea pedis (athlete’s foot) can cause scaling and fissuring, especially if there is itching, peeling or involvement between the toes.
Other keratinization disorders are possible but much less common. The key is not to diagnose a systemic disease from the heel alone, but to investigate when the presentation does not behave like ordinary dry callused skin.
How to treat dry cracked heels at home
For uncomplicated dry heel fissures, dermatologists recommend a combination of moisture, gentle keratolysis and protection.
Use a heel cream with 10–25% urea, an alpha-hydroxy acid or salicylic acid. These ingredients help hydrate and soften thickened skin.
Apply moisturizer soon after bathing. Skin retains moisture better when cream or ointment is applied while it is still slightly damp.
Use petroleum jelly at night. Applying a thick occlusive ointment and wearing cotton socks can reduce overnight water loss.
Protect painful cracks. Liquid bandage or an appropriate dressing can reduce movement at the fissure, lessen pain and help keep contaminants out.
Wear supportive closed-heel shoes. Avoiding worn-out or open-backed shoes can reduce expansion of the heel pad while the skin heals.
American Academy of Dermatology: How to care for dry, cracked heels.
Should you file or cut away the hard skin?
Very gentle reduction of callus after the skin has softened can sometimes help, but aggressive scraping creates another injury.
Do not cut thickened heel skin with scissors, knives or razor blades. Removing too much can cause bleeding and infection.
People with diabetes, neuropathy, impaired circulation or recurrent foot wounds should be particularly cautious about self-treatment and should get individualized foot-care advice.
Are cracked heels dangerous?
Most are not dangerous. They are usually a dry-skin and mechanical-pressure problem.
But deep fissures can bleed and become infected. Cracks in the feet are a recognized entry point for cellulitis, particularly when diabetes, edema, poor circulation or immune compromise is present.
The previous version of this article claimed that the World Health Organization attributed about 10% of skin infections to cracked heels. I could not verify a reliable WHO source for that number, so it has been removed.
When should you see a doctor or podiatrist?
Get medical assessment if a heel fissure is deep, repeatedly bleeds, becomes increasingly red, hot, swollen or painful, produces pus, or does not improve with basic skin care.
Also seek advice earlier if you have diabetes, reduced sensation in the feet, poor circulation, significant swelling, immune suppression, or a history of foot ulcers.
Persistent heel fissures accompanied by widespread rash, marked scaling, nail changes or symptoms elsewhere in the body may need evaluation for an underlying skin or systemic condition.
Bottom line
Most cracked heels are caused by a simple combination: dry thickened skin plus mechanical pressure.
The best-supported home approach is equally simple: soften and moisturize the skin, use a keratolytic heel cream when appropriate, protect open fissures and reduce heel pressure with suitable footwear.
Diabetes, psoriasis, eczema, hypothyroidism and fungal infection can contribute, but a cracked heel alone is not evidence that one of those diseases is present.
Sources
1. American Academy of Dermatology. How to care for dry, cracked heels.
2. DermNet. Cracked heel.
3. American Academy of Dermatology. Dermatologist-recommended skin care for people with diabetes.
Alright, so here’s what I do: I’ve got this foot file that I keep in the shower, right? I use it about 2 to 3 times a week, usually at the end of my shower when my feet are all soft from the water. Oh and twice a week, I rub some olive oil on my feet, then slip on some socks for maybe 20 minutes, just until they don’t feel all greasy anymore. Once youve got rid of all that dead skin, keeping it up is the real trick.