Heel protection to prevent pressure sores

What is a pressure sore?

A pressure sore (also known as a pressure ulcer or bed sore) is an area of damage to the skin and the underlying soft tissue, usually over a bony area of the body.  The correct term, used by healthcare professionals is pressure ulcer.  We tend to associate the elderly with being prone to pressure ulcers, although they can affect anyone who is less active.  Those with mobility impairments or limitations are especially at risk.

A pressure ulcer occurs as a result of the skin being squashed between the weight of the skeleton and the bed or chair surface. Lack of blood to the skin in these areas can deprive it of essential oxygen and nutrients which means skin damage can occur. This is why the areas of our body over a bone are most vulnerable. The heel and elbow area needs special attention due to the fact there is no subcutaneous fat or padding.

Looking for the early signs - Prevention is better than cure

Spotting the early signs of pressure damage can often prevent further skin damage and the area of skin can recover very quickly. Red areas of skin over a bone such as the heel can often indicate the first sign of skin damage, which may also be sore or painful. Rubbing these areas should be avoided. Instead, pay special attention to these areas of skin and make sure they are not in contact with the surface of the bed or chair for extended periods. Allow the blood to flow back into these regions as this will assist in the repair of the damaged area. Changing position frequently and raising the affected area off the surface are helpful treatments and always avoid dragging the skin as this can also put the delicate skin area under further strain.

What else can I do to protect my skin?

Good skin care using neutral soap and drying gently can help to protect vulnerable areas.  You may wish to moisturise the heel to avoid the skin drying out. A healthy diet with plenty of fluids will also help to keep the skin healthy.

Those with underlying healthcare conditions can be more susceptible to skin breakdown in the heel area.  Conditions such as, but not limited to diabetes, peripheral arterial disease or a previous history of heel or foot ulcers can increase your risk.  Consult a healthcare professional if you are concerned about how your condition can increase your risk of pressure ulcers.

If lying or sitting in one position for long periods of time cannot be avoided, or if you have difficulty getting out of the bed or chair, a specialist support surface can be a useful preventative aid in protecting the skin from damage. A mattress or cushion which helps to reduce the high pressures exerted on the skin over bony areas and offers a degree of positioning and comfort can be really effective. Specialist devices which protect the vulnerable heel and elbow regions are also advised. These can help to protect the skin and can often be useful aids in treating an existing pressure ulcer. However, always seek medical advice if you notice any broken areas.

The vulnerable heel

Completely removing the pressure from the delicate heel area, a term referred to medically as ‘off-loading’ is an effective way to prevent the formation of pressure ulcers in this area.

                                        Air filled – Invacare Maxx Care Pro Heel boot

In the image above, you can see that the heel is completely free from pressure during lying.  Also the foot is supported and heel off loaded when the feet are flat on the floor.
There are wide variety of heel protection devices available, at a range of costs.  

There are wide variety of heel protection devices available, at a range of costs.  

These devices may be constructed of air, foam, gel or various fabrics which protect the heel in different ways.
Clinical experience suggests that boot‐type devices are more likely to stay on the leg and support the foot in a neutral alignment. (1)

References: (1) Wounds International, Technology and product reviews, Joyce Black 2012
Author: Annie Allsopp, Clinical Specialist, Invacare Ltd