Is petroleum jelly appropriate for treating heel fissures?

Petroleum Jelly for Heel Fissures

Petroleum jelly alone is not appropriate as primary treatment for heel fissures—use an emollient cream containing urea, glycerine, and petrolatum instead, which has demonstrated superior efficacy in healing deep fissures and improving xerosis.

Evidence-Based Recommendation

The most relevant high-quality evidence comes from a 2017 randomized, double-blind, placebo-controlled trial specifically evaluating heel fissure treatment 1. This study demonstrated that a moisturizer containing urea, glycerine, and petrolatum (not petroleum jelly alone) significantly improved healing outcomes:

• Significantly fewer participants had deep open fissures at 2 weeks (24.7% vs 42.7%, P=0.027) and 4 weeks (6.4% vs 24.1%, P=0.002) compared to placebo
• Overall fissure healing was significantly better (P<0.001)
• Xerosis improvement was significant at both time points

Why Not Petroleum Jelly Alone?

While petroleum jelly is an excellent occlusive moisturizer with proven safety 2, it lacks the active keratolytic and humectant properties needed to effectively treat established heel fissures. The combination product works through multiple mechanisms:

• Urea: Provides keratolytic action to soften thickened skin
• Glycerine: Acts as a humectant to draw moisture into the skin
• Petrolatum: Creates an occlusive barrier to prevent moisture loss

Clinical Algorithm

For heel fissures:

1. Use a urea-containing emollient cream (containing urea, glycerine, and petrolatum) applied twice daily for 4 weeks
2. Assess at 2 weeks—if deep open fissures persist, continue treatment and consider podiatry referral
3. Address underlying causes (diabetes screening, footwear assessment)

For simple dry skin prevention (not active fissures): Plain petroleum jelly or emollients are acceptable 3

Important Caveats

• In diabetic patients with heel fissures, this is particularly critical as untreated fissures serve as bacterial entry points that can progress to ulceration and serious complications 1
• The IWGDF guidelines emphasize using emollients to lubricate dry skin as part of preventive foot care 3, but do not specifically address petroleum jelly for established fissures
• Simple emollient use is recommended for prevention, but active fissures require more aggressive treatment 4

Bottom line: Reserve petroleum jelly for prevention of dry skin; treat established heel fissures with combination urea-based products that have demonstrated clinical efficacy in healing deep fissures.