The heel is a high-risk area for the development of pressure ulcers (National Institute for Health and Care Excellence (NICE) 2019). Pressure ulcers on the heel can develop when there is prolonged pressure to the heel, or when exposed to shear or friction like a poor fitting slipper or shoe. Even a footplate on a wheelchair could cause pressure damage to the heel if the patient’s heel is placed under direct pressure for even a short period of time. There is very little padding on our heels and the posterior area of the heel where the heel is extremely vulnerable has only a small surface area, has little subcutaneous tissue and no muscle covering the bone, which ultimately reduces pressure redistribution and padding (Greenwood et al; 2017).
The European Pressure Ulcer Advisory Panel (EPUAP) (2019) advises patients who are either at risk, or who have an existing pressure ulcer, have their heels completely offloaded. However, it is essential there is even distribution of weight along the calf thus preventing any pressure being placed on the Achilles tendon (Figure 1) and the popliteal vein (Figure 2). The knee should be in flexion at 5-10 degrees, preventing popliteal compression and increased risk of DVT.
The Heel OFFLOADER™ features on both the OSKA Series2 and OSKA Series4 mattresses and can be used to suspend the heels to create ‘zero pressure’. Implementing this feature in practice is quick and easy to do. Simply unzip the mattress cover at the foot end to reveal the highly responsive AEROLITE™ foam sitting on top of the base foam layer. With good microclimate management being so important in preventing pressure ulcers from forming, the AEROLITE™ foam also boasts outstanding microclimate properties to allow air to flow through the foam to keep the body cool and dry.
The AEROLITE™ foam can be tucked back on itself to create a zero-pressure zone. The mattress cover can then be replaced by zipping it back up to hold the Heel OFFLOADER™ in the prescribed position according to the height of the resident. This simple but highly effective way of creating zero pressure for heels has the additional benefit of staying firmly in place, as opposed to a pillow which can easily move around or slip out.
Not only is it extremely comfortable and supportive for patients and residents, this quick and easy to implement Heel OFFLOADER™ can be an integral part of the patient’s pressure ulcer prevention care plan. Please see below for a video in how to implement the Heel OFFLOADER™ as an aid in the prevention and treatment of heel ulcers up to and including category 4.
References
European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: Quick Reference Guide. Emily Haesler (Ed.). EPUAP/NPIAP/PPPIA: 2019
Greenwood CE, Nelson EA, Nixon J, McGinnis E. Pressure-relieving devices for preventing heel pressure ulcers. Cochrane Database of Systematic Reviews 2017, Issue 5. Art. No.: CD011013. DOI: 10.1002/14651858.CD011013.pub2.
National institute for Health and Care Excellence (NICE) (2019) Mepilex Boarder Heel and sacrum dressings for preventing pressure ulcers. Available at; 1 Recommendations | Mepilex Border Heel and Sacrum dressings for preventing pressure ulcers | Guidance | NICE (Accessed: 13 August 2021).
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