Heel ulcers are particularly challenging to treat as a wide range of factors can affect potential healing. The prevalence of heel ulcers is high and continues to increase in conjunction with our increasing diabetic and aging population.
There are many potential obstacles to healing which may include infection, compromised nutritional status and less than optimal hydration, anaemia of chronic disease, neuropathy and the mental status of the patient. Proper offloading is critical whether the patient is bedridden, wheelchair bound or ambulatory. For bedridden patients or those in wheelchairs, foam egg crate heel protectors work well at reducing pressure along the posterior aspect of the heel. The air loss mattress is another effective modality that helps to disperse focal pressure under bony prominences in bedridden patients.
Heel ulcers in patients have the potential to deteriorate rapidly so frequent re-evaluation is critical. A team approach is highly recommended in the management of heel ulcers as this population of patients typically can have co-morbidities that make treatment a lengthy and complicated process.