Topical Treatment for Heel Cracks
For heel cracks, apply a urea-based cream (10-40% concentration) twice daily to debride hyperkeratotic tissue and restore skin hydration. 1
First-Line Treatment Approach
Use urea cream as your primary topical agent because it provides both keratolytic (removes dead skin/callus) and humectant (moisturizing) properties essential for healing cracked heels. 1
Urea Concentration Selection
- Start with 20-40% urea cream for moderate to severe heel cracks with significant hyperkeratosis, callus formation, or fissures. 1, 2
- Use 10-20% urea for mild to moderate dryness without deep fissuring. 3, 4
- Higher concentrations (40%) are FDA-approved specifically for debridement of hyperkeratotic lesions and damaged skin. 1
Application Protocol
- Apply twice daily (morning and evening) to affected heel areas. 1
- Rub in completely until absorbed. 1
- Continue daily application even after visible improvement to prevent recurrence. 2, 5
Evidence Supporting Urea-Based Treatment
The superiority of urea formulations is well-established:
- 20% urea cream significantly outperforms placebo in hydrating heel skin across all measurement sites. 3
- 10-15% urea formulations with alpha-hydroxy acids effectively remove scales, reduce hyperkeratotic skin thickness, and improve skin barrier function without weakening it. 2
- 10% urea lotion achieves 65% reduction in scaling, roughness, redness, and cracking compared to 40% reduction with standard glycerol-based emollients. 4
- Emollient creams generally alleviate pain, dryness, and improve appearance of heel cracks. 6
Special Considerations for Diabetic Patients
If the patient has diabetes, the treatment approach requires additional vigilance:
- Use urea cream as part of comprehensive foot care, but recognize this addresses prevention rather than active ulceration. 7
- Do NOT use urea or any topical cream on open diabetic foot ulcers—these require sharp debridement, offloading, and moisture-retentive dressings only. 8, 9
- Avoid topical antiseptic or antimicrobial dressings for wound healing purposes in diabetic ulcers. 8, 9
- Daily foot inspection is mandatory for diabetic patients to catch progression from dry/cracked skin to ulceration early. 7
Application Precautions
- For topical use only—avoid contact with eyes, lips, or mucous membranes. 1
- Some patients may experience temporary smarting or stinging, particularly with higher concentrations. 2
- If cracks progress to open wounds or show signs of infection (erythema, warmth, swelling, purulent discharge), discontinue urea cream and seek medical evaluation. 10
Common Pitfalls to Avoid
- Don't use urea cream on open wounds or ulcers—it's indicated only for intact hyperkeratotic skin. 1
- Don't expect immediate results—consistent twice-daily application for 2-4 weeks is typically needed for significant improvement. 2, 4
- Don't discontinue after initial healing—heel xerosis tends to recur without ongoing maintenance therapy. 5
- Don't confuse simple heel cracks with diabetic foot ulcers in diabetic patients, as management differs completely. 8, 7