- Heel fissures are deep cracks in dry callused skin on the heel, especially the back rim.
- They start cosmetic but can become painful, bleed, and (in diabetic patients) get infected.
- Treatment is debridement, intensive moisturizing, and identifying any contributing systemic cause.
- Open-back shoes, prolonged standing, and dry climates make fissures worse.
- Diabetic patients should never let heel fissures go untreated — infection risk is real.
What are cracked heels?
Heel fissures are linear cracks that develop in callused, dry skin on the heel — most often at the back rim where the heel pad meets the skin of the foot. They start as cosmetic dryness and progress to deep, painful cracks that can bleed and, in compromised hosts (especially diabetic patients), become infected.
The mechanism is mechanical: the heel pad spreads out under body weight, the skin at the rim has to stretch, and dry callused skin can't stretch — it splits. Open-back shoes, hours of standing on hard floors, low humidity, hypothyroidism, and chronic skin conditions all contribute.
At NES we treat heel fissures with a combination of in-office debridement of the thick callused rim, prescription-strength moisturizing and keratolytic regimens, and footwear modification. Diabetic patients get extra attention — heel fissures are a not-uncommon entry point for serious soft-tissue infection.
See it in motion
Animations licensed from ViewMedica · Swarm Interactive
What it feels like
Heel fissures are visually obvious. Common presentation:
- Visible cracks in the skin around the back rim of the heel
- Hard, dry, yellowing callus on the heel
- Pain with weight-bearing, especially with open-back or hard-soled shoes
- Bleeding from the cracks in severe cases
- Redness, warmth, or drainage if infection has developed (urgent)
- Worsening symptoms in dry weather or after long days standing
Why it develops
Heel fissures develop from a combination of mechanical and systemic factors:
- Dry skin from low humidity, hot showers, or harsh soaps
- Prolonged standing on hard surfaces
- Open-back shoes (sandals, flip-flops, mules)
- Obesity, which increases heel pad spread under load
- Hypothyroidism and other systemic causes of dry skin
- Diabetes, which causes both dry skin and impaired healing
- Chronic skin conditions (psoriasis, eczema)
How we diagnose cracked heels
Heel fissures are diagnosed clinically. We evaluate for contributing systemic conditions (thyroid, diabetes, skin disorders) when fissures are recurrent or unusually severe.
Non-surgical care
Heel fissure care is medical, not surgical. Our standard protocol:
- In-office debridement of the thick callused rim — removes the rigid edge that's splitting
- Daily application of keratolytic creams (urea 20–40 percent, salicylic acid, or lactic acid)
- Heavy emollient at bedtime, sometimes occluded with cotton socks
- Switching to closed-back, cushioned shoes
- Avoiding hot showers and harsh soaps
- Heel cups or silicone pads for severe cases
- Diabetic foot care education for high-risk patients
When to see a specialist
- Heel fissures that bleed, drain, or look infected
- Painful fissures that limit walking
- Fissures in a diabetic patient — any fissure, any severity
- Recurrent fissures despite home moisturizing
Heel fissures are managed by every NES podiatrist, with diabetic patients seen most often by Dr. Cara Beach. Routine debridement and care can be done at any of our 8 clinics.