Pressure sores, also known as pressure ulcers or bedsores, are localized damage to the skin and underlying tissues. These injuries typically develop over bony prominences due to prolonged pressure, or pressure combined with friction or shear forces. The heels are among the areas most frequently affected, alongside the sacrum, coccyx, and hips. Preventing these sores is important for maintaining comfort and overall health, as they can be painful, challenging to treat, and lead to serious complications.
Understanding Heel Pressure Sore Risk
Heels are particularly vulnerable to pressure sore development because they are bony prominences with only a thin layer of skin and fat for protection. When an individual lies on their back, the entire weight of the lower legs and feet rests on the heels, which can reduce blood flow to the area. This sustained pressure can obstruct blood capillaries, depriving tissues of oxygen and nutrients, leading to tissue damage and ulcer formation.
Several factors increase susceptibility to heel pressure sores. Immobility, whether from chronic bedrest, wheelchair confinement, or conditions like paralysis, is a major risk factor as it leads to prolonged pressure on the same areas. Reduced sensation, often seen in conditions such as diabetes with neuropathy, means individuals may not perceive the discomfort or pain signaling impeded blood flow, increasing risk. Poor circulation, due to conditions like peripheral arterial disease or even the use of vasopressors in critical care, can also compromise blood flow to the heels, making them more prone to damage.
Relieving Pressure on Heels
Reducing or redistributing pressure on the heels is a key strategy for preventing pressure sores. For individuals with limited mobility, regular repositioning is important to alleviate sustained pressure on any single area. Healthcare providers often recommend turning schedules to ensure pressure points are frequently shifted.
Proper positioning plays an important role in offloading the heels. For example, placing pillows between the knees when lying on the side can prevent the heels from pressing against each other or the bed surface. Specialized heel suspension devices, such as foam wedges or heel protector boots, are designed to elevate the heels off the bed, ensuring no direct contact or pressure. These devices aim to distribute weight across the calf, protecting delicate heel tissue.
Pressure-relieving mattresses or overlays contribute to overall pressure distribution, indirectly benefiting the heels. These support surfaces are designed to conform to body contours, spreading pressure over a larger area and reducing pressure intensity on bony prominences. While not directly applied to the heel, they create a more supportive environment that minimizes forces contributing to sore formation.
Maintaining Skin Health
Maintaining skin integrity and resilience is important for pressure sore prevention. Daily skin inspection allows for early detection of changes like redness, discoloration, warmth, or tenderness, which signal tissue damage. Regular checks of the heels, potentially using a mirror, help identify problems early.
Moisture management is also important, as excessive moisture can weaken the skin and make it more vulnerable to breakdown. Address incontinence or sweating by keeping skin clean and dry. Gently washing the heels with mild soap and warm water, then patting them dry, maintains hygiene without irritation.
Preventing dry, cracked skin through regular moisturization is beneficial. Using gentle moisturizers keeps the skin supple and intact, enhancing its protective barrier. Avoiding friction and shear forces is important; these occur when skin rubs against surfaces or when layers of skin slide over deeper tissues. Techniques such as lifting rather than dragging an individual during repositioning, and using draw sheets, minimize these forces on the heels.
Supporting Overall Well-being
Beyond direct skin and pressure management, supporting overall well-being contributes to preventing pressure sores. Adequate nutrition provides the building blocks for healthy skin and tissue repair. A diet rich in protein, along with essential vitamins like C and minerals such as zinc, maintains skin integrity and supports healing.
Proper hydration plays a role in skin health by keeping it supple and elastic. Ensuring sufficient fluid intake maintains skin turgor and resilience, making it less susceptible to damage. Encouraging mobility and activity, to the extent possible, improves circulation and reduces prolonged pressure on any single area. For those with limited mobility, passive range of motion exercises stimulate blood flow and maintain tissue health.
Management of underlying health conditions is important for reducing pressure sore risk. Conditions like diabetes (which impairs sensation and circulation) or other circulatory issues require careful management. Addressing these systemic factors creates a healthier physiological environment, enhancing the body’s ability to resist skin breakdown.