Heel cracks (fissures) are started when the heel skin becomes thickened due to foot pressure and poor support of the heel. Eventually the dry, thick skin begins to crack at the surface, especially in colder weather when skin tends to be drier as sweat glands are less active. As the thickness worsens, so does the crack, gradually becoming deeper and deeper with the thick skin. Eventually, the sides of the crack become so deep that the base of the crack tears down to the tissue under the skin. It is during this time the fissure becomes especially painful, and can even start to bleed. Infections can occur when the base of the fissure harbors bacteria and spreads into the surrounding skin. Unfortunately, these types of fissures are not just limited to the heel, and can in fact occur wherever calluses occur on the bottom of the feet.
Treatment tries to accomplish two goals. The first is to reduce the callus and fissure down to the level of normal skin. Although mild fissures can be sanded down at home using an emery board or pumice stone, most require a physician to use a scalpel to reduce the callus and fissure effectively. Callus is dead tissue and does not hurt when removed (like hair does not hurt to be cut), however the wound at the base of the crack is tender and needs a steady hand to trim it properly. Once the crack is essentially flattened, the wound at its base needs to be healed. Usually this only needs a few days with antibiotic ointment and a band-aid covering the site to achieve healing. The second goal is aimed at reducing the likelihood of the crack reoccurring. Moisturization with a heavy moisturizer or exfoliant will keep the heel and foot skin soft, and regular use of an emery board or pumice stone may be needed to reduce any callus build-up. Moisturization may need to be repeated several times a day in order to be effective. Finally, proper padding in the heel region of the shoe with a silicone gel material may help reduce external pressure on the skin, which in turn may reduce the overall process from occurring.