Preventing Heel Pressure Ulcers

The heel and anklebone are the second and fifth most common sites for pressure ulcer development.¹ Incorporating a heel pressure ulcer prevention protocol—along with early, aggressive implementation of pressure-reducing and pressure-relieving devices—has been proven to reduce the rate of heel pressure ulcers.²

The National Pressure Ulcer Advisory Panel (NPUAP) and European Pressure Ulcer Advisory Panel (EPUAP) guidelines recommend ensuring “that the heels are free of the surface of the bed…”³ The guidelines also state that “Heel-protection devices should elevate the heel completely (offload them) in such a way as to distribute the weight of the leg along the calf without putting pressure on the Achilles tendon.”³

Implementing a protocol that keeps the heel offloaded in patients at risk for heel pressure ulcers is crucial. Heel pressure ulcers often take time to become visible—the NPUAP/EPUAP states that “the time between development of a pressure ulcer and the point when the ulcer becomes visible at the skin varies between several hours to three to five days.”³ This means that it is important to incorporate heel pressure-relieving devices before an ulcer is present, as it may have latent symptoms.

REFERENCES: 1. Amlung SR, Miller WL, Bosley LM, Adv Sking Wound Care. Nov/Dec 2001; 14(6):297-301. 2. Walsh J, et al., Keeping Heels Intact: Evaluation of a Protocol for Prevention of Facility-Acquired Heel Pressure Ulcers. Presented at the Symposium on Advanced Wound Care, San Antonio, TX. Apr. 2006. 3. National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel. Prevention and treatment of pressure ulcers: clinical practice guideline. Washington DC National Pressure Ulcer Advisory Panel; 2009.