Pressure ulcer prevention: heels

Given that 24% of all pressure ulcers occur on the heels, it is essential that practitioners undertake effective prevention and management strategies for this area. The heel bone (calcaneus) is covered by only a thin layer of skin and fat, making the skin highly susceptible to damage while sustaining high-intensity pressure, even when a pressure redistribution surface is in use (National Pressure Ulcer Advisory Panel (NPUAP) et al, 2014).

Because there is a wide range of approaches and devices available to prevent and manage heel pressure ulcers, health professionals can become confused and frustrated with the amount of conflicting advice (Morton, 2012). The plethora of products and information can lead to practitioners combining the use of these devices or positioning approaches designed to assist in pressure ulcer management and prevention, and perhaps not focusing on individual patient needs and goals.

Offloading

Ideally, heels should be free of all pressure; this

References

Clegg R, Palfreyman S. Elevation devices for the prevention of heel pressure ulcers: a review. Br J Nurs. 2014; 23(20 Suppl):S4–S11. https://doi.org/https://doi.org/10.12968/bjon.2014.23.sup20.s4 

Moore Z, Van Etten M. Preventing pressure damage when seated. Wounds UK. 2015; 11(3 Supp2):18–23 

Morton N. Preventing and managing heel pressure ulceration: an overview. Br J Community Nurs. 2012; 17(6 Suppl): S20–22 

National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and treatment of pressure ulcers: quick reference guide. Cambridge Media: Osborne Park, Australia; 2014.  

National Institute for Health and Care Excellence. Pressure ulcers: prevention and management CG179. 2014. https://www.nice.org.uk/guidance/cg179 (accessed 4 January 2023) 

National Institute for Health and Care Excellence. Pressure ulcers. Quality standard 89. 2015. https://www.nice.org.uk/guidance/qs89 (accessed 4 January 2023) 

Vuolo J. Should we be using water filled gloves under the heel to prevent pressure ulcers? Nurs Times. 2010; 106(14):14