Preventing heel breakdown.

The prevalence of heel pressure ulcers is a major health care problem. Heel ulcers develop as a result of pressure, shear, or friction concentrated on a small area over a bony prominence that lacks subcutaneous tissue. Significant risk factors for development of heel breakdown include immobility, age, mental status, nutrition, chronic illness, and orthopaedic surgical procedures, especially hip pinning and hip replacement surgeries. It is important for nurses to identify patients at risk for heel pressure ulcers and to initiate appropriate preventive interventions. This article discusses the etiology of heel pressure ulcers, risk factors, heel assessment, and choice of heel protection devices.