Treatment for Heel Cracks (Fissured Heels)
For painful heel cracks, apply a humectant-rich emollient cream containing 15% urea twice daily to hydrate the skin, reduce hyperkeratosis, and promote healing. 1, 2
First-Line Topical Treatment
Urea-Based Formulations
- Apply Urea 40% cream to affected skin twice daily, rubbing in until completely absorbed 1
- A humectant-rich formulation containing 15% urea combined with 15% alpha-hydroxy acids effectively increases skin hydration, removes scales, reduces thickness of hyperkeratotic skin, and improves skin barrier function without weakening it 2
- Once-daily application is as effective as twice-daily use if twice-daily causes irritation, though twice-daily is the standard FDA-approved regimen 1, 2
Salicylic Acid for Severe Hyperkeratosis
- Apply Salicylic Acid 6% to affected areas at night after washing, covering the treated area overnight, then wash off in the morning 3
- Hydrate the skin for at least 5 minutes prior to application (via wet packs or foot soaks) to enhance penetration 3
- If excessive drying or irritation occurs, apply a bland emollient cream in the morning 3
- Once clearing is apparent, occasional use maintains remission 3
Simple Emollient Therapy
- Emollient creams alleviate pain and dryness while improving the appearance of heel cracks, though they are less effective than humectant-rich formulations 4
Footwear and Mechanical Considerations
Proper Footwear Selection
- Ensure shoes have proper fit, width, and cushioning to prevent ongoing mechanical trauma 5
- Use shoes with adequate arch support and heel cushioning 5
- Consider over-the-counter or custom arch supports to redistribute pressure away from cracked areas 5
Orthotic Devices
- Heel cushions or orthotic devices help redistribute weight and reduce pressure on affected areas 5
Treatment Algorithm
Initial 6-Week Period
- Apply urea 40% cream twice daily to affected heel cracks 1
- Ensure proper footwear with adequate cushioning and support 5
- For severe hyperkeratosis with deep fissures, consider alternating with salicylic acid 6% applied nightly 3
- Apply bland emollient cream if irritation develops 3
If No Improvement After 6-8 Weeks
- Consider customized orthotic devices for underlying biomechanical issues 5
- Evaluate for underlying conditions (diabetes, peripheral vascular disease, inflammatory skin conditions) that may impair healing 5
- Refer to podiatry if conservative measures fail 5
Important Caveats
Application Warnings
- Excessive repeated application of salicylic acid will not increase therapeutic benefit but could result in increased local intolerance and systemic salicylism 3
- Some smarting and stinging may occur with humectant-rich formulations, particularly initially 2
- Rinse hands thoroughly after application unless hands are being treated 3
Avoid Overdebridement
- Overdebridement of hyperkeratotic tissue can make underlying skin susceptible to increased tenderness and worsen symptoms 5
Weight Management
- Weight loss reduces pressure on the heel and should be recommended if indicated 5