It usually starts with something small. A parent spends a week in bed with the flu. You come home from surgery in a boot or a cast. When someone finally looks at the heel, the skin there has turned red, purple, or even black and hard — and the first thought is that it’s a bruise. The second is: what did I miss?

Heels break down faster than most people expect. There is very little padding between the skin and the heel bone, and a heel resting on a mattress, a footrest or the inside of a boot carries that load hour after hour. A heel pressure sore can look minor on the surface while the damage runs deeper, and it often hurts far more than it looks.

This guide covers how to recognize each stage on the heel, what to do and what not to do, and when to ask for a referral to a wound care clinic.

Why heels break down so quickly

A pressure sore — also called a pressure ulcer, pressure injury or bedsore — forms when steady pressure on one spot cuts off blood flow to the skin and the tissue beneath it. The heel is one of the most common places for it, because when you lie on your back, the whole weight of the lower leg rests on a small, bony point with almost no cushioning.

These things raise the risk:

• Lying or sitting with the heels loaded. Long hours in bed, in a recliner or in a wheelchair with the feet resting on a footplate keep pressure on the same spot.
• Casts, boots and splints. A hard heel cup or a tight cast can press into the skin, and no one sees what is happening underneath until it is removed.
• Poor circulation. Conditions that reduce blood flow to the feet, such as diabetes or peripheral artery disease, leave the heel with less to draw on.
• Reduced feeling. Nerve damage means you may not feel the ache that would normally make you shift position.
• Friction and shear. Heels dragged across sheets while someone slides down the bed or is moved can damage the skin surface.
• Moisture. Skin that stays wet from sweat or incontinence softens and breaks down more easily.

Stages of a pressure sore on the heel

Clinicians in the United States use the staging system from the National Pressure Injury Advisory Panel (NPIAP). Knowing the stages helps you describe what you see and act quickly.

• Stage 1: the skin is intact but red, and the redness does not fade when you press on it. The spot may feel warmer, cooler, firmer or softer than the skin around it. On darker skin, the redness may look different or be hard to see, so the change in feel matters more.
• Stage 2: the top layer of skin has broken, leaving a shallow, pink or red open area. It can also look like an intact or burst blister filled with clear fluid.
• Stage 3: the sore goes through the full thickness of the skin, and fat may be visible in the wound.
• Stage 4: the damage reaches tendon, muscle or bone.
• Deep tissue pressure injury: a deep red, maroon or purple patch that does not fade, or a dark, blood-filled blister. The skin may still be intact, but the damage sits underneath. It is common on the heel, and people often mistake it for a bruise.
• Unstageable: the base of the sore is covered by yellow, tan or black dead tissue, so no one can see how deep it goes.

One point matters especially on the heel. A heel that has turned black, dry and hard may carry stable eschar — a firm layer of dead tissue. The National Pressure Injury Advisory Panel’s guidance is that stable eschar on the heel should not be softened or removed. Do not soak it, pick at it or put softening creams on it. Take the pressure off and get it assessed.

Taking the pressure off the heel

Pressure relief is what prevents a heel pressure sore, and it is also what gives an existing one a chance to heal.

• Float the heels. Place a pillow lengthwise under the calves, not under the heels, so the heels hang free and touch nothing. A pillow under the heel itself still loads it.
• Use heel protectors or offloading boots for anyone who spends long periods in bed. Ask a nurse or wound care clinician which type suits the situation.
• Change position regularly, and move rather than drag, so the heels don’t slide across the sheets.
• Check under casts, boots and splints every day, or ask the care team to. Report any pain or rubbing under a device right away.
• Look at both heels every day. Use a mirror or ask for help. Press gently on any red area: if the redness does not fade, treat it as a stage 1 sore.
• Keep the skin clean and free of wetness, changing damp bedding or pads promptly.
• If you use a wheelchair, ask about footplate padding and pressure-relieving cushions.

No cream prevents a pressure sore; taking the pressure off does. Dry, cracked heel skin is a separate problem, common in older adults and in people with diabetes, and it needs its own daily care.

What Dry Heel Skin Is Short Of

The outer layer of your skin works like a brick wall. The cells are the bricks, each holding water. Between them sits a mortar your skin makes out of lipids. Lose either and the wall goes stiff, and stiff skin splits under pressure.

The heel has it harder than most skin. The sole has no oil glands — sweat is its only moisture supply — and with age that supply often falls. The heel also carries your weight when you stand and the weight of your leg when you lie down, so its outer layer thickens and dries. A wall that is thick, dry and under constant load is the one that cracks.

Water only stays if something holds it, and the mortar is what does that. On skin that is already dry and cracking, added water leaves about as fast as it arrives.

Moisturizers soften the surface for a while. Urea creams soften dry, thickened heel skin. Both help — but neither replenishes the lipids the barrier is short of, and the wall needs water and mortar together, so the skin dries out and the heel cracks again.

SkinIntegra® Rapid Crack Repair Cream was developed for exactly this gap. It is not a stronger exfoliant. It replenishes what is missing.

At its core is SkinIntegra B.I.O.™ (Bio-Identical Oils) — a patented blend of five plant-derived oils (Sacha Inchi, Sea Buckthorn, Rice Bran, Sesame Seed and Jojoba Seed) matched in balance and composition to the skin’s own lipids. We profiled what a healthy skin barrier is made of, then selected oils to match it. That is what SkinIntegra B.I.O.™ does.

It also contains 25% urea with lactic acid — a concentration that softens and loosens hardened skin and is widely used on dry, sensitive and diabetic skin, with the lactic acid adding hydration and gentle exfoliation. Unlike 40% urea, which works aggressively and can leave skin feeling dry, SkinIntegra absorbs quickly and leaves skin feeling immediately moisturized.

It is formulated without salicylic acid, and is fragrance-free, paraben-free, alcohol-free, petrolatum-free and dye-free.

What the clinical evidence shows

In a head-to-head trial published in the Journal of the American Podiatric Medical Association, 48 adults with deeply cracked feet used either Rapid Crack Repair or a 40% urea cream, twice a day for four weeks.

Rapid Crack Repair did as well as 40% urea — at a lower strength, and well tolerated throughout. Among the 22 adults who used it, 91% showed some improvement within two weeks. By four weeks, podiatrists were seeing less dryness in 82% and less cracking in 73%, and no one had new or worsening redness, burning, stinging or itching.

SkinIntegra Rapid Crack Repair Cream carries the Seal of Approval from the American Podiatric Medical Association (APMA). Medical professionals at major hospitals across the United States also recommend it.

For skin that stays dry and cracked, or that looks better for a few days and then looks the same again, the missing piece is usually not more exfoliation. It is replenishing what the barrier is short of.

Use it only on intact heel skin that is dry or cracked, working it into the rim and back of the heel. Never apply it to a pressure sore, a blister, an open crack, redness that does not fade when pressed, or any dark, purple, black or hard area of the heel. It is a skin care cream, not a wound treatment. If you have diabetes or poor circulation, check with your healthcare provider before using a new product on your feet.

For more on why daily skin care matters for feet at risk, see why skin barrier care is essential.

Cleaning and dressing a heel pressure sore

Once the skin has broken, the sore needs wound care, and a nurse, podiatrist or wound care clinician should guide it. The usual steps look like this:

1. Wash your hands thoroughly with soap and water, or use hand sanitizer, before touching the area.
2. Clean the sore gently with saline or the cleanser your clinician recommends. Don’t scrub, and don’t use harsh antiseptics unless you’ve been told to.
3. Pat the skin around it dry with a clean, soft cloth. Don’t rub.
4. Apply the dressing your clinician chose. Different stages need different dressings, so don’t swap in something else.
5. Secure the dressing so it stays in place without squeezing the foot.
6. Change it as instructed, and straight away if it becomes wet or soiled.

Keep the pressure off the heel the whole time. A dressing protects the sore, but it does not take the load off it.

Nutrition and hydration

Healing skin needs building material. Protein matters most — lean meat, fish, eggs, dairy, beans and nuts — and vitamin C and zinc both play a part in tissue repair. Drink enough water through the day. If appetite is poor, or you are caring for someone who eats very little, ask the care team about a dietitian or a nutritional supplement.

When to get medical help

Contact a doctor, nurse or podiatrist promptly if you notice:

• Redness on the heel that does not fade when pressed
• A purple, maroon or black patch, or a dark blood blister
• Any break in the skin, or a blister on the heel
• Increasing redness, warmth, swelling or discharge around a sore, or red streaks spreading from it
• Fever or chills
• Pain that seems out of proportion to how the sore looks
• A sore that has not improved after two weeks of care

Heel sores can be slow to close, and it is reasonable to ask for a referral to a wound care clinic, especially if a sore has stalled or you have diabetes or poor circulation. For more on why healing slows, see why diabetic skin heals slowly. If the skin on the heel is cracked and bleeding rather than sore from pressure, see how to treat cracked heels that bleed.

Frequently Asked Questions

What does a stage 1 pressure sore on the heel look like?

The skin is intact but red, and the redness stays when you press on it gently. The area may feel warmer, cooler, firmer or softer than the skin around it, and it may hurt or itch. On darker skin the color change can be hard to see, so feel matters more. Take all pressure off the heel straight away and tell the care team.

What are boggy heels?

“Boggy” describes heel tissue that feels soft or spongy when you press it, instead of firm. It can be a sign of damage under intact skin, including a deep tissue pressure injury. Float the heel so nothing touches it, and have it assessed promptly.

Why do older adults get heel sores so easily?

With age, skin gets thinner and the padding under the heel thins too. Many older adults also move less, spend long hours in bed or a chair, and have reduced circulation or feeling in their feet. Each of those puts more load on the heel for longer, with less warning.

Can I put lotion or cream on a heel pressure sore?

Not on the sore itself. An open sore needs the dressing your clinician chooses, and a dark, hard heel should not be softened at all. Moisturizing the intact skin around it is part of normal daily skin care, as long as you keep clear of the sore and any discolored area.

How long does a heel pressure sore take to heal?

It depends on the stage. A stage 1 area can settle within days once the pressure comes off completely. Deeper sores take weeks to months, and heel sores often heal more slowly than sores elsewhere. If a sore hasn’t improved after two weeks of good care, ask about a wound care clinic.

The heel needs daily attention

A heel pressure sore is easier to stop early than to heal late. Float the heels, check them every day — including under any cast or boot — and act on redness that doesn’t fade or skin that turns dark. Keep intact heel skin cared for, keep creams off anything that is broken or discolored, and ask for a wound care referral when a sore isn’t getting better.