From the Guidelines
The best treatment for heel calluses and cracks involves a combination of moisturizing, exfoliation, and protection, with a focus on preventing further irritation and promoting healing. To achieve this, start by soaking your feet in warm water for 10-15 minutes, then gently file down callused areas with a pumice stone or foot file 1. Apply a thick, urea-based moisturizer like Eucerin Advanced Repair Foot Cream (10% urea) or AmLactin Foot Repair Cream (15% lactic acid) immediately after bathing and before bed, covering with cotton socks to enhance absorption. For deeper cracks, use a healing ointment containing petroleum jelly such as Aquaphor or Vaseline. Over-the-counter salicylic acid products (15-40%) can help dissolve thicker calluses when applied directly to affected areas 1. For severe cases, consider liquid bandage products to seal cracks and promote healing. Wear properly fitting, cushioned shoes with heel support to prevent further irritation, as recommended by the International Working Group on the Diabetic Foot (IWGDF) guidelines 1. This regimen works because moisturizers containing urea or lactic acid both hydrate the skin and break down excess keratin buildup, while regular gentle exfoliation removes dead skin before it can accumulate into thick calluses. Consistency is key—apply treatments daily for at least 2-3 weeks to see significant improvement. It's also essential to educate patients on proper foot care, including daily foot washing, drying, and moisturizing, as well as avoiding walking barefoot or in thin-soled slippers 1. By following these steps and prioritizing prevention, patients can effectively manage heel calluses and cracks, reducing the risk of further complications and promoting overall foot health.
From the FDA Drug Label
Indications and Usage For debridement and promotion of normal healing of hyperkeratotic surface lesions, particularly where healing is retarded by local infection, necrotic tissue, fibrinous or purulent debris or eschar. Urea is useful for the treatment of hyperkeratotic conditions such as dry, rough skin, dermatitis, psoriasis, xerosis, ichthyosis, eczema, keratosis pilaris, keratosis palmaris, keratoderma, corns and calluses, as well as damaged, ingrown and devitalized nails.
The best treatment for heel calluses and heel cracks is urea (TOP), as it is useful for the treatment of hyperkeratotic conditions such as calluses. Key points to consider:
- Urea promotes normal healing of hyperkeratotic surface lesions
- It is useful for treating dry, rough skin and other hyperkeratotic conditions 2
From the Research
Treatment Options for Heel Calluses and Heel Cracks
- Emollient cream may alleviate pain and dryness and improve the appearance of heel cracks 3.
- A moisturizer containing urea, glycerine, and petrolatum can be effective in healing deep open fissures on the feet of people with diabetes, with a higher percentage of participants achieving complete target fissure healing after 4 weeks compared to placebo 4.
- The use of a test cream resulted in greater xerosis improvement and overall fissure healing compared to placebo, and was well tolerated 4.
Factors Associated with Heel Cracks
- Presence of deep fissures is correlated with autonomic neuropathy and angiopathy, suggesting that control of blood supply should be effective for preventing deep fissures prone to ulceration 5.
- Superficial fissures are correlated with autonomic neuropathy, highlighting the importance of managing this condition to prevent fissure development 5.
Conservative Treatment Options
- Conservative, non-pharmacological treatments such as shock waves, laser therapy, orthoses, pulsed radiofrequency, dry-needling, and calcaneal taping may be effective in reducing pain in patients with plantar heel pain 6.
- Debridement, including nonmechanical and mechanical methods, is often used to remove nonviable tissue and facilitate wound healing in diabetic foot ulcers, and may be relevant for heel cracks 7.