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Five Scientific-Proven Methods for Heel Pressure Ulcers Prevention | Penang Home Wound Care Service

How to Prevent Heel Pressure Ulcers for Bedridden Patients | Remeds' Penang Home Wound Care Service
I WISH caregivers can spend a minute or two reading on this as pressure sores are so commonly seen in ankles and heels of bed-bound patients, yet not many knows it is actually PREVENTABLE. With prevention, it helps to reduce patients’ suffering.

In most of the wound care cases that we encountered, the most common area where pressure sores develop in bedridden patients is not just the tailbone (coccyx), but also the ankles and heels, which are often overlooked by most of the caregivers.

In one of our case, the bedbound patient’s ankles and heels are presented with multiple blisters and open sores. Her history of diabetes made the wound healing even more challenging.

There is a risk of developing pressure sores when patient lies in the same position for a long period of time, and the protruded bony areas, i.e. ankles and heels are under prolonged pressure.

So, what could be done to prevent pressure sores from developing in ankles or heels of patient?

The best way is to ensure the heel is not in contact with the bed – the so-called “Floating heel.”

How do you achieve a "floating heel"?

Here are some key points which I concluded in short from the latest wound care guideline by National Pressure Injury Advisory Panel (NPIAP) and European Pressure Ulcer Advisory Panel (EPUAP):

1. First and foremost, there are several ways to "lift" the heel off the bed.

The most common being to use a soft pillow or foam cushion along the full length of the lower leg, leaving the heel suspended.

elevated heel using foam cushion
Weight of the leg is distributed along the calf, heel lifted and pressure is avoided over the Achilles tendon. ⚠️: A slight bend of the knee at 5°-10° is the best position to prevent Deep Vein Thrombosis (DVT).

However, this is only suitable for patients who have not develop any pressure sores or with mild pressure sores (Stage I & II only).

(For more information on the four stages of pressure sores, click here )


2. Another approach is to use commercially available heel support devices, namely Heel Off-Loading Devices (HOLDs). The devices help to completely relieve pressure in Stage III, IV or even more severe pressure sores.

There are three common types of heel off-loading devices:

  • Medical grade latex-free foam-based

  • Pillow-based (Cotton)

  • Air-based

Latex-free foam Heel Off-Loading Devices, leaving the heel suspended
Latex-free foam Heel Off-Loading Devices, leaving the heel suspended

Anti-sagging cotton medical heel pillow pad. The heel pad is designed to protect the heel and ankle from pressure and also for foot drop prevention or correction.
Anti-sagging cotton medical heel pillow pad. The heel pad is designed to protect the heel and ankle from pressure and also for foot drop prevention or correction.


3. The use of anti-decubitus foot rings is NOT recommended because the high pressure areas created by the edges of these rings can damage skin tissue.

Anti-decubitus foot rings
Anti-decubitus foot rings are not recommended in the latest wound care guidelines.


4. Use of prophylactic dressings - Medical soft silicone foam dressings as a prophylactic measure to prevent friction is recommended in the guideline.

Medical soft silicone foam dressings
Soft silicone foam dressings help to reduce friction as a prophylactic measure.

Studies have shown that the use of prophylactic dressings can reduce heel pressure injuries compared to no dressing. Along with the use of prophylactic dressings, it is also recommended that other important prophylactic measures, such as heel off-loading devices should be continued.

The caregiver should also assess the skin for signs of pressure sore formation at the time of daily dressing changes.


5. Intermittent decompression - Assist the bedridden patient to turn every 2 hours and change the patient's position at a 30° angle of inclination.

This will prevent prolonged pressure on either ankle or heel.

Repositioning of bedridden patients
Repositioning of bedridden patient - preferably at 30-degree angle of inclination on left or right alternatively every 2 hourly
Pressure Ulcers are Preventable and Curable.

These are the 5⃣ proven-effective ways as shown above.

Besides, check the skin condition of the bedridden patient's feet at least once a day can also help to detect and treat pressure sores early.

(For more information on how to check for signs of pressure sores, read here )

Article by: Pharmacist Khang Phing Goh


At Remeds, we have an unwavering belief that bedsore is definitely CURABLE and PREVENTABLE with proper nursing care and caregiver education. The same goes for diabetic ulcers and other wounds.

WhatsApp us today or give us a call for a FREE consultation about our wound care service today to start receiving your personalized Wound Care treatment by our skillful and experienced nurses.

Remeds Wound Care Nurses are specialised in providing efficacious individualised wound care service at your doorstep!

Our Contact No: 010-882 3994


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