The Impact of Heel Health on Patient Care

Welcome to the EHOB Post. This monthly newsletter features educational information, industry news, company updates, and tools and resources focused on our specialties, pressure injury prevention and safe patient handling.

This month, we discuss susceptibility to pressure injuries on heels and the impact this has on patient care.

Preventing pressure injuries on the heels is critical for good patient care

It’s widely documented that the heel is the second most common site for pressure injuries (1). And 41% of all deep tissue injuries also manifest on the heel (2). These pressure injuries are often associated with extreme pain, expensive treatments, and increased length of stay (3).

What makes the heel so susceptible?

The wedge-like design of the heel handles a lot of pressure, particularly when patients are in bed. It’s a big load on a small area. The skin covering the calcaneus (heel) bone is only 3.8 mm thick. That’s about the thickness of a cracker, and only 0.46 mm of this skin is the epidermis. But the subcutaneous tissue isn’t much better. It’s thick, firm, and fibrous, with little padding. All in all, it’s a recipe for disaster among those at risk (4). Download the Heel Susceptibility Infographic for quick reference.

Proper Heel Offloading

Proper heel offloading is paramount in the prevention of heel ulcers, and more often than not, pillows just won’t cut it.

The National Pressure Injury Advisory Panel recommends using a heel protector that will “Offload the heel completely in such a way as to distribute the weight of the leg along the calf without placing pressure on the Achilles tendon and the popliteal vein.” (5)

Heel devices that address protection and prevention from shear forces and lateral leg rotation warrant a closer look. Boots that are easy to use and open-ended for quick assessments will surely reduce some of the stress and strain of a long shift.

Learn more about?heel protection solutions?that have gone above and far beyond the pillow.

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References

1. Amlung, S.R., Miller, W.L., Bosley, L.M. (2001, November/December). The 1999 National Pressure Ulcer Prevalence Survey: a benchmarking approach. Adv Skin Wound Care, 14(6), 297-301.

2. Van Gilder C, Macfarlane GD, Meyer S. Results of nine international pressure ulcer prevalence surveys: 1989 to 2005. Ostomy Wound Manage 2008; 54(2): 40–54.

3. By the Numbers: CHPSO Pressure Injury Data.”CHPSO: A Division of the Hospital Quality Institute, 4 Aug. 2017, www.chpso.org/post/numbers-chips-pressure-injury-data.

4. van Zwam, W. G. H., van Turnhout, M. C., & Oomens, C. W. J. (2020). Risk factors for developing heel ulcers for bedridden patients: A finite element study. Clinical Biomechanics, 78, 105094. https://doi.org/10.1016/j.clinbiomech.2020.105094?

5. European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance. (2019). Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline.