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 “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.

Using heel protectors for the prevention of hospital-acquired pressure ulcers
Rajpaul K, Acton C
British Journal of Nursing 2016, Vol 25, No 6: TISSUE VIABILITY SUPPLEMENT
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Preventing Heel Pressure Ulcers and Plantar Flexion Contractures in High Risk Sedated Patients
Meyers T
J Wound Ostomy Continence Nurs. 2010 Jul-Aug;37(4):372-8.
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Evaluation of a protocol for prevention of facility-acquired heel pressure ulcers
Walsh JS, Plonczynski DJ
Journal of Wound, Ostomy & Continence Nursing. March/April 2007; 34(2):178-183.
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Heel Pressure Ulcers: How Do We Prevent Them and Evaluate Practice? An Example Within an Acute Care Hospital
Acton C, RN, Msc
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The Use of Heel Protectors in the Prevention, Treatment and Management of Pressure Ulcers
Kumal R, RN, Dip HE, BSc (Hons), MSc
Presented at EMWA 2015; London, UK; 13-15 May, 2015
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Use of a Heel Protection Device and Honey Dressing – An Evidence Based Regimen for SDTI on a Spinal Cord Injury Patient
Pukiova I
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Never Events: Can The Congressional Mandate Be Met?
Lyder C
Poster Presented at the Institute for Health Care Improvement (IHI), Orlando, FL December 6-8, 2010
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Human Cadaver Testing to Determine the Reliability of Heel Boot Positioning or Grip of Eight Commercially Available Pressure Relieving Heel Protector Boots
Bill B, Pedersen J, and Call E, MS RSM (NRM)
Poster presented at the Poster presented at the 25th Annual Symposium on Advanced Wound Care (SAWC); April 19-22, 2012
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Heel Pressure Ulcer Prevention: A Comparative Effective Evaluation
McGovern J, DiPerri J
Poster presented at the 25th Annual SAWC Conference April 19-22 2012
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Heel Pressure Ulcer Prevention – The Continued Journey within an Acute Care Facility
Hanna-Bull D, RN, BScN, MN
Poster presented at the WOCN conference, New Orleans, LA, June 2011
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