Nearly 30% of pressure ulcers occur on the heel and associated regions of the lower limb (Wounds UK, 2019), and although anyone can develop a pressure ulcer, those who are seriously ill, have impaired mobility, a neurological condition, impaired nutrition, poor posture or a deformity are at greatest risk (NICE, 2014). It has been theorised that when pressure ulcers develop, they start internally at the bone and progress outwards (Gefan, 2008), meaning that areas where there is little subcutaneous tissue over the bones to provide padding to offset pressure are the most common areas to develop pressure ulcers. The heel and the sacrum are regularly reported as being the most common sites. (Amlung, 2001; Whittington, 2000; Greenwood et al, 2017).

What are the stages of pressure ulcer?
  • Grade I: Non-blanchable erythema of intact skin. Discolouration of the skin, warmth, oedema, induration or hardness may also be used as indicators, particularly on individuals with darker skin.
  • Grade II: Partial thickness skin loss involving epidermis, dermis or both. The ulcer is superficial and presents clinically as an abrasion or blisters.
  • Grade III: Full thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend down to, but not through underlying fascia.
  • Grade IIII: Extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures with or without full thickness skin loss. (Direct quote NICE Guidelines, 2005)
EPUAP (2003) classification system. Cited in NICE guidelines (2005) Pressure Ulcers: the management of pressure ulcers in primary and secondary care. Draft for second Consultation. Direct Quote)

What can I do to protect my heel from pressure injury?
The European Pressure Ulcer Advisory Panel (EPUAP) guidelines recommend ensuring that the heels are free of the surface of the bed which can be accomplished through the use of heel-protection devices; designed to elevate the heel completely which distributes the weight of the leg along the calf without putting pressure on the Achilles tendon (2016). Having a heel relief device that offloads the pressure is detrimental as heel pressure ulcers can be underlying for some time before becoming visible (NICE Guidelines, 2005). There are an array of products offered to relieve pressure from the heel effectively, including products that have been designed to allow for better immersion of the heels.

How do I choose a product that does this for me?
Apex Medical Ltd have a choice of dynamic mattresses aimed at offloading pressure from the heel. The design allows for individual heel zones to be deflated meaning that carers can adjust areas of the mattress underneath the surface of the heel to create a ‘floating cell’ effect that will eliminate pressure on the vulnerable area.
 
For more information on which heel offloading mattress is right for you, contact our sales support team who will be happy to help you.
References
Amlung SR, Miller W;, Bosley LM. (2001). The 1999 national pressure ulcer prevalence survey: a benchmarking approach. Advances in Skin and Wound Care. Vol;14 (6): 297-301. [Google Scholar]
EPUAP (2003) classification system. Cited in NICE guidelines (2005) Pressure Ulcers: the management of pressure ulcers in primary and secondary care. Draft for second Consultation. Direct Quote) https://www.nice.org.uk/guidance/cg29/documents/pressure-ulcer-managagement-second-consultation-nice-guideline2
Gefan, A. (2008) The Compression Intensity Index: a practical anatomical estimate of the biomechanical risk for a deep tissue injury. Technology and Health Care. Vol; 16 (2): 141-9 [Google Scholar]
Greenwood, C.E; Nelson, E.A; Nixon, J. McGinnis, E. (2017) Pressure-relieving devices for preventing heel pressure ulcers. Cochrane Database Syst Rev. Vol. 2017 (5). [Journal] 
Meyers, T. (2010). Preventing Heel Pressure Ulcers and Plantar Flexion Contractures in High Risk Sedated Patients. J Wound Ostomy Continence Nurse. Vol:37 (4). [Journal]. http://www.ncbi.nlm.nih.gov/pubmed/20571472?dopt=Abstract
NICE Guidelines (2005). Pressure ulcers: the management of pressure ulcers in primary and secondary care. Draft for second Consultation. [Journal]. https://www.nice.org.uk/guidance/cg29/documents/pressure-ulcer-managagement-second-consultation-nice-guideline2
NICE. (2014) cited in Assessing, preventing and managing heel pressure ulcers. Practice Development. Vol 13, No.2. Page 67. [Google Scholar]. 
Rajpaul K, Acton C. (2016). Using hell protectors for the prevention of hospital-acquired pressure ulcers. British Journal of Nursing. Vol 25, No.6. Tissue Viability Supplement. [Journal] https://sage-products.co.uk/wp-content/uploads/BJN_2016-Kumal-and-Claire-Acton-Article.pdf 
Walsh, J.S. Plonczynski, D.J. (2007). Evaluation of a protocol for prevention of facility-acquired heel pressure ulcers. Journal of Wound, Ostomy & Continence Nursing. Vol, 34 (2). 178-183. [Journal]. https://journals.lww.com/jwocnonline/pages/articleviewer.aspx?year=2007&issue=03000&article=00015&type=abstract
Wounds UK. (2017). Assessing, preventing and managing heel pressure ulcers. Practice Development. Vol 13, No.2. Page 67. [Google Scholar].
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