Preventing Heel Pressure Injuries

The heel and anklebone are the second and fifth most common sites for pressure injury development.1 Incorporating a heel pressure injury prevention protocol—along with early, aggressive implementation of pressure-reducing and pressure-relieving devices—has been proven to reduce the rate of heel pressure injuries.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… 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 injuries is crucial. Heel pressure injuries 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 address heel pressure before an ulcer is present, as there may be latent symptoms.

REFERENCE: 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.

Preventing Heel Pressure Ulcers – Sustained Quality Improvement Initiative in a Canadian Acute Care Facility
Hanna-Bull D
J Wound Ostomy Continence Nurs. 2016;43(2):129-132.
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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.
View abstract – PubMed 

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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Four Years of Heel Pressure Ulcer Prevention
Hanna-Bull D, RN, BScN, MN; Stephen Martin MD FRCS(c); Maclean J, OT Reg(Ont)
Poster presented at the 19th Annual CAWC Conference; November 7-10, 2013, Vancouver, Canada
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A Successful Quality Improvement Initiative Results in Reduction of Hospital Acquired Heel and Sacral Pressure Ulcers
Bell K, MS, RN, CCRN, CCNS; Clinical Nurse Specialist, CCU/ICU
Poster presented at the 27th Annual Symposium on Advanced Wound Care Spring/Wound Healing Society, April 23-27, 2014 in Orlando, FL
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Evidence-Based Quality Improvement Initiative and Nursing/Physical Therapy Collaboration Results in Decreased Hospital-Acquired Heel Pressure Ulcers
Dyckman F, MSN, BSN, PHN, APRN-CNS, CWOCN; Love C, PT, DPT
Presented at The Symposium on Advanced Wound Care, October 16–18, 2014; Las Vegas, NV
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Limited Mobility and the Foot: Plantar Flexion Contractures, Heel and Malleoli Pressure Ulcers, Peroneal Nerve Damage  How Can We Prevent Them? What Happens If We Dont?
Loehne H, PT, DPT, CWS, FACCWS
Poster presented at the 26th Annual Symposium on Advanced Wound Care (SAWC); May 1-5, 2013
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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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Pressure Ulcer Prevention Protocols and Evidence-Based Interventions Reduce Pressure Ulcers at Sacrum and Heel
Heighton R, BScOT Reg NS; Interim Director of Rehabilitation Services, Guysborough Antigonish Strait Health Authority
Poster presented at the CAWC and CAET 20th Annual Conference, Toronto, Ontario, Canada; October 30, 2014-November 2, 2014
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Successful Quality Improvement Initiative Results in 95% Decrease of Facility-Acquired Heel Pressure Ulcers
Witkowski K, Reg.N., BScN, ET – Nurse Clinician Enterostomal Therapy – Skin/Wound & Ostomy
Poster presented at the 18th Annual Conference of the Canadian Association of Wound Care, November 8-11, 2012, London, Ontario
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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 Reduction through use of Assistive Boots
Leitkam S, Bush TR, Linden B, Friederichs K, Deland T
Poster presented at APMA the Conference, July 15-18 2010
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A healthcare provider must always rely on his or her own professional clinical judgement when deciding whether to use a particular product when treating a particular patient. Sage Products does not dispense medical advice and recommends that healthcare providers be trained in the use of any particular product before using it in surgery.
The information presented is intended to demonstrate the breadth of Sage Products’ product offerings. A healthcare provider must always refer to the package insert, product label, and/or instructions for use before using any of Sage Products’ product. Products may not be available in all markets because product availability is subject to the regulatory and/or medical practices in individual markets. Please contact your Sage Products representative if you have questions about the availability of Sage Products’ products in your area.

Pressure Ulcers in Adults: Prediction and prevention
AHRQ (formerly AHCPR) Clinical Practice Guideline Number 3, AHCPR Pub. No. 92-0047: May 1992.
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View Quick Reference Guide

Pressure Ulcer Prevention and Treatment
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.
Download Quick Reference Guide (PDF)

Pressure Ulcer Prevention
Association of Perioperative Registered Nurses (AORN) Standards Recommended Practices and Guidelines
“Use devices that eliminate or redistribute pressure” to prevent perioperative* heel ulcers.
*Perioperative defined as a pressure-related deep tissue injury under intact skin that presents within the first 5 days following surgical procedures.
View AORN website

IHI 5 Million Lives Campaign targets pressure ulcer prevention 
The 5 Million Lives Campaign is an initiative to protect patients from five million incidents of medical harm over the next two years (December 2006 – December 2008).
View campaign highlights
View campaign materials for pressure ulcer prevention

 

A healthcare provider must always rely on his or her own professional clinical judgement when deciding whether to use a particular product when treating a particular patient. Sage Products does not dispense medical advice and recommends that healthcare providers be trained in the use of any particular product before using it in surgery.
The information presented is intended to demonstrate the breadth of Sage Products’ product offerings. A healthcare provider must always refer to the package insert, product label, and/or instructions for use before using any of Sage Products’ product. Products may not be available in all markets because product availability is subject to the regulatory and/or medical practices in individual markets. Please contact your Sage Products representative if you have questions about the availability of Sage Products’ products in your area.

Successful Heel Pressure Ulcer Prevention Program in a Long-term Care Setting
Lyman V
Journal of Wound, Ostomy and Continence Nursing: November/December 2009 – Volume 36 – Issue 6 – p 616-621
View abstract

 

A healthcare provider must always rely on his or her own professional clinical judgement when deciding whether to use a particular product when treating a particular patient. Sage Products does not dispense medical advice and recommends that healthcare providers be trained in the use of any particular product before using it in surgery.
The information presented is intended to demonstrate the breadth of Sage Products’ product offerings. A healthcare provider must always refer to the package insert, product label, and/or instructions for use before using any of Sage Products’ product. Products may not be available in all markets because product availability is subject to the regulatory and/or medical practices in individual markets. Please contact your Sage Products representative if you have questions about the availability of Sage Products’ products in your area.

Intervention with a new heel protection device and silver alginate dressing to prevent amputation of the leg due to stage IV ulcer of the heel and malleolus
Garrett D
Salem Village Nursing and Rehabilitation Center, Joliet, IL
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Pressure mapping Comparison of unprotected heels on a hospital bed vs. heels positioned in the Prevalon® Pressure Relieving Heel Protector.
Bush T, Ph.D.
Michigan State University Biomechanical Design and Research Laboratory, September 2009
Download case study (PDF)

 

A healthcare provider must always rely on his or her own professional clinical judgement when deciding whether to use a particular product when treating a particular patient. Sage Products does not dispense medical advice and recommends that healthcare providers be trained in the use of any particular product before using it in surgery.
The information presented is intended to demonstrate the breadth of Sage Products’ product offerings. A healthcare provider must always refer to the package insert, product label, and/or instructions for use before using any of Sage Products’ product. Products may not be available in all markets because product availability is subject to the regulatory and/or medical practices in individual markets. Please contact your Sage Products representative if you have questions about the availability of Sage Products’ products in your area.