Cracked heels treatment: urea creams, a daily routine and when to get help

In short

An NHS podiatry service says dry and cracked heels are generally caused by lack of moisture in the skin, and can be worse in open backed shoes such as sandals.
A 2026 review of 12 trials in 603 people with diabetes found urea creams improved dry feet more than plain creams after four weeks, with high certainty evidence, and side effects were rare and mild.
Urea at 2% to 10% mainly moisturises, while 10% to 30% also softens and loosens hard skin, according to a 2021 dermatology review; the Royal College of Podiatry recommends a urea based foot cream for hard skin.
The Royal College of Podiatry advises filing hard skin little and often and never cutting it with a blade, and says very deep cracks need urgent advice from a podiatrist, GP or NHS 111.
If you have diabetes, the NHS says to see a GP or diabetes nurse about cracked skin on your feet, and the Royal College of Podiatry says to get advice within 24 hours for any break in the skin.

The short answer

For most people, cracked heels are a dry skin problem with a pressure problem on top. When heel skin dries out and thickens into callus it loses its stretch, and it can split under the pressure of walking. Treatment is about putting moisture back every day, keeping the hard skin thin, and protecting the heel while it heals.

The cream with the most evidence is one containing urea, a moisturising ingredient that also softens hard skin. Most of the trials are in people with diabetes, where urea creams did better than plain creams. A daily routine of a urea cream and gentle filing, kept up after the skin improves, is what UK podiatry services advise.

Cracks that are deep, bleeding, red or sore can let infection in. Those, and any cracks at all in someone with diabetes or poor circulation, need professional advice rather than home care. This guide covers why heels crack, what the evidence says about urea creams and strengths, a simple routine, when to get help, and what a foot health appointment involves.

This is general information, not a diagnosis. If you are worried about your feet, speak to a GP, a pharmacist or an NHS podiatrist.

Why heels crack

The podiatry service at South Tees Hospitals NHS Foundation Trust says dry and cracked heels "are generally caused by lack of moisture in the skin", and that they can be worse in open backed shoes such as sandals, where nothing holds the heel pad in.

Other things make heel skin drier or harder:

Age. The Royal College of Podiatry says that as we get older the skin becomes thinner, less elastic and drier, and "soles and heels become dry".
Hard skin. Callus on the rim of the heel is thick and stiff, so it splits more easily than soft skin. Our guide to corns and calluses explains how callus builds up.
Diabetes. Dry skin on the feet is common in people with diabetes. A 2026 systematic review describes dry feet in diabetes as increasing the risk of the skin cracking, of ulcers and of serious complications.
Athlete's foot. Not every dry, flaky heel is just dry skin. The Royal College of Podiatry says athlete's foot can show up as dry, flaky skin around the heels, sometimes cracked or peeling, and that this kind needs an antifungal cream or spray from a pharmacist, not just moisturiser.

If one heel is cracked and itchy, or the dry skin spreads up the side of the foot or between the toes, ask a pharmacist whether it could be a fungal infection.

What the evidence says about urea creams

Urea is found naturally in the outer layer of the skin as part of its own moisturising system, and it absorbs water, according to the 2021 review of urea covered below. In creams it helps hold water in the skin and, at higher strengths, loosens hard, dead skin so it can be filed or shed.

The strongest evidence: dry feet in diabetes

A systematic review and meta-analysis published in September 2026 pooled 12 randomised trials in 603 adults with diabetes and dry feet. It found that creams with added active ingredients, mostly ones that hold water in the skin such as urea, reduced dryness more than plain base creams after two and four weeks. Creams containing urea did better than standard creams after four weeks, and the authors rated that finding as high certainty evidence. Side effects were rare and mild.

One of the trials shows what that looks like. In a 2002 double blind trial, 40 people with diabetes and moderate to severe dry feet put a cream with 10% urea and 4% lactic acid on one foot and the same cream without the active ingredients on the other, twice a day for four weeks. On a nine point dryness score, the treated feet improved from about 6.1 to 3.2 and the comparison feet from about 6.2 to 4.4, and the difference held two weeks after stopping. Note that the plain cream helped too: regular moisturising matters, whatever you use.

The limits

The trials were in people with diabetes. The same creams are widely used for everyone, but the trial evidence is from that group.
They measured dryness, not cracks. Only one included trial was about cracked heels specifically.
Products mixed several active ingredients, and urea strengths ranged from 5% to 25%, so the review could not say which strength works best.
Most trials were small and short, often four weeks, and some compared one foot with the other, which risks mixing the creams up.

We did not find good trials of heel balms in people without diabetes, or of other remedies for cracked heels.

Which urea strength: 10%, 25% or more?

A 2021 review of urea in dermatology groups strengths like this:

Urea strength	What it mainly does	Typical use
2% to 10%	Moisturises and supports the skin barrier	Everyday dry skin, keeping heels soft once they have improved
10% to 30%	Moisturises and softens hard skin	Rough, thickened or cracked heels
30% and above	Breaks down hard skin strongly	Very thick skin; 40% to 50% is used for nail problems

The same review cites a small pilot study in 30 people with diabetes and very dry feet, where both 10% and 25% urea creams improved skin hydration and the 25% cream did better. It says urea products are well tolerated, with mild skin irritation now and then, more often at higher strengths. Two of the review's authors work for a skincare company that makes urea products and others have been paid by it, which is worth knowing.

What that means in practice

For rough, cracked heels, a foot cream with 10% to 25% urea is a reasonable choice. Check the label for the urea percentage.
Once the heels are soft again, a lower strength or an ordinary thick moisturiser may be enough to keep them that way.
If a cream stings on cracked skin, stop and ask a pharmacist. Do not put urea cream into open, bleeding cracks.
Keep cream off the skin between your toes, as the Royal College of Podiatry advises.

The Royal College of Podiatry says simply: "For areas of hard skin, you can use a cream that has urea in it."

A simple routine for cracked heels

This routine brings together advice from the South Tees NHS podiatry service and the Royal College of Podiatry. Expect to see a difference over a few weeks, not overnight.

Moisturise every day. South Tees advises creaming your feet daily after a bath or shower with a thick moisturising hand or foot cream. A urea cream is a good choice for heels.
File a little, often. South Tees suggests filing the hard skin once or twice a week with a foot file when the skin is dry. The Royal College of Podiatry says to file "a little and often". Stop well before the skin feels tender.
Never cut hard skin. The Royal College of Podiatry says: "Do not attempt to cut or remove the skin with a sharp blade." That includes razor style hard skin removers.
Protect the heel. South Tees suggests socks, stockings or closed in shoes, even in hot weather, if the dry skin is worse or cracking, and notes that open backed shoes such as sandals can make it worse.
Keep going when it improves. South Tees advises continuing to apply the cream daily once the skin is better, to stop it coming back.

The South Tees advice is for the general public. If you have diabetes or poor circulation, check with your diabetes team or podiatrist before filing, and see the next section.

Cracked heels as you get older

Heel cracks become more common with age, and they can be harder to manage. The Royal College of Podiatry explains that older skin becomes thinner, loses its elasticity and becomes drier and more fragile, and that soles and heels in particular become dry. At the same time, reaching your feet to file and moisturise them gets harder.

The same page says moisturising feet, but not between the toes, helps keep them supple, that problems such as corns, cracked skin and ingrown toenails can be treated successfully, and that "an annual foot health check is as important as a sight or hearing test." If you cannot comfortably reach your heels, a long handled applicator, a family member or a regular foot health appointment is better than leaving the cracks to deepen. Our guide to foot care for older people has more.

When cracks need professional care

A shallow crack in heel callus is usually just uncomfortable. A crack deep enough to bleed has gone through to living skin, and breaks in the skin on the feet can become infected. Get help in these situations.

Deep or bleeding cracks

The Royal College of Podiatry's foot health advice for people with arthritis says that if you notice very deep cracks in your skin, or a wound or blister, "you should get urgent advice from a podiatrist, your GP or by calling 111", because you may have an infection. That advice is written for people with arthritis, but the reasoning applies to anyone with a crack that bleeds or will not close.

Signs of infection

The NHS says to ask for an urgent GP appointment or get help from NHS 111 if your skin is painful, hot and swollen. Call 999 or go to A&E if that comes with a very high temperature or feeling hot, cold or shivery, a fast heartbeat or breathing, feeling dizzy or faint, or confusion.

If you have diabetes

The NHS lists blisters or cracked skin on your feet as a reason to see a GP or diabetes nurse.
The Royal College of Podiatry's diabetes leaflet (February 2026) says that if your skin is dry and cracked, use a urea based moisturising cream once a day until it improves.
The same leaflet says to cover any break in the skin or blister with a sterile dressing and contact your foot care team, podiatry department or GP "as soon as possible (within 24 hours)".

Our guide to foot care with diabetes covers daily checks and what to watch for.

What a foot health appointment involves

If home care is not working, or the callus is too thick to file down yourself, a foot professional can take the hard skin down safely and give you a plan to keep it that way. The NHS says referral to an NHS podiatrist may not be available to everyone and waits can be long, so you may choose a private podiatrist or a Foot Health Practitioner instead.

At Fairy Feet, cracked heels are seen as part of a Foot Health Treatment / Medical Pedicure, which includes a foot and nail assessment, care of hard skin and nails, and advice on keeping your feet healthy. If you have diabetes, the Diabetic Foot Health Consultation adds checks of circulation and feeling in the feet. If your heels are simply rough and you want them to look and feel nicer, a pedicure may be all you need.

It helps to bring or know:

any medicines you take, and whether you have diabetes, circulation problems or a skin condition
which creams you have tried, and for how long
the shoes you wear most days

A foot health appointment does not replace medical care. A crack that is infected, or any wound in someone with diabetes, should be seen by a GP, NHS 111 or the diabetes foot team first.

How we checked

We read the South Tees NHS podiatry page on skin conditions (updated April 2022), the Royal College of Podiatry's pages on ageing feet, athlete's foot and foot health with arthritis, its February 2026 diabetes leaflets, and the NHS pages on cellulitis and type 2 diabetes complications, all checked on 10 November 2026. We read the 2026 systematic review on moisturisers for diabetic dry feet in full through Europe PMC, the abstract of the 2002 urea trial, and the full text of the 2021 review of urea, including its conflicts of interest.

We searched for trials of treatments for cracked heels specifically and found only case reports and very old papers, so we say that the evidence is for dry feet in diabetes. We left out causes listed only on clinic websites (such as flat feet or long hours standing), brand names, and home remedies without trial evidence. This is general information, not medical advice. If you spot a mistake, please tell us through the contact form.

Where Fairy Feet fits

Marianna Tapai FHP is a qualified Level 4 Foot Health Practitioner who has worked with feet and nails since 2006, blending Hungarian and English techniques, in her own studio in Doncaster. Cracked heels are routine work: a Foot Health Treatment / Medical Pedicure (£39.99) covers a foot and nail assessment, care of the hard skin, and advice on creams and footwear. For people with diabetes there is a Diabetic Foot Health Consultation (£14.99), and a call-out home visit is available if getting to the studio is hard. Fairy Feet is rated 5.0 from 25 Google reviews.

Marianna is a Foot Health Practitioner, not a podiatrist or chiropodist; she does not diagnose or prescribe. If a crack is bleeding, red, hot or swollen, or you have diabetes and any break in the skin, see a GP, call NHS 111 or contact your diabetes foot team before booking anything else. If dry skin may be athlete's foot or a skin condition such as eczema, ask a pharmacist or GP first. To ask a question or arrange an appointment, use the contact form; there is no online booking.

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Questions people ask

What is the best cream for cracked heels?

The ingredient with the most trial evidence is urea. A 2026 review of 12 trials in people with diabetes found urea creams improved dry feet more than plain creams after four weeks. For rough or cracked heels, a foot cream with about 10% to 25% urea, used every day, is a reasonable choice.

Is 25% urea too strong for heels?

Trials of urea foot creams in people with diabetes used strengths from 5% to 25%, and a review of urea describes 10% to 30% as moisturising and softening hard skin. Mild irritation is more likely at higher strengths. Do not put it into open or bleeding cracks, and keep it off the skin between your toes.

Should I cut or shave off hard skin on my heels?

No. The Royal College of Podiatry says not to cut or remove hard skin with a sharp blade. File it a little and often when the skin is dry, and moisturise daily instead.

How long do cracked heels take to heal?

Trials of urea creams measured improvement in dry skin over two to four weeks of daily use. Deep cracks can take longer and may need professional care. Keep using cream after they heal to stop them coming back.

When are cracked heels serious?

When cracks are deep or bleeding, when the skin around them is painful, hot and swollen, or when you have diabetes or poor circulation. The Royal College of Podiatry says very deep cracks need urgent advice from a podiatrist, GP or NHS 111, and people with diabetes should get advice within 24 hours for any break in the skin.

Sources

Skin conditions (podiatry). South Tees Hospitals NHS Foundation Trust, updated 29 April 2022, checked 10 November 2026.
Moisturizer formulations for diabetic foot xerosis: a systematic review and meta-analysis of randomized controlled trials (Borgström K, Björklund S, Gudmundsson P, Ericsson A, Acosta S). Frontiers in Clinical Diabetes and Healthcare, September 2026.
A prospective, randomized, controlled double-blind study of a moisturizer for xerosis of the feet in patients with diabetes (Pham HT, Exelbert L, Segal-Owens AC, Veves A). Ostomy/Wound Management, May 2002.
Urea in Dermatology: A Review of its Emollient, Moisturizing, Keratolytic, Skin Barrier Enhancing and Antimicrobial Properties (Piquero-Casals J and others). Dermatology and Therapy, 2021.
Ageing feet. Royal College of Podiatry, checked 10 November 2026.
Athlete's foot. Royal College of Podiatry, checked 10 November 2026.
General foot health advice for people with a rheumatic condition. Royal College of Podiatry, checked 10 November 2026.
Moderate risk of non-healing wounds and amputation (diabetes leaflet). Royal College of Podiatry, February 2026.
Complications of type 2 diabetes. NHS, reviewed 10 February 2025, checked 10 November 2026.
Corns and calluses. NHS, reviewed 28 July 2026, checked 10 November 2026.
Cellulitis. NHS, reviewed 18 April 2024, checked 10 November 2026.