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Heel Ulcers: Indications and Classifications





Heel ulcers can occur from a number of underlying conditions, including:

• Diabetes
• Poor circulation
• Inflammatory diseases
• Renal failure
• Habitual smoking
• Venous insufficiency
• Genetics
• Immobility

The likelihood of heel ulcers also increases with a patient’s age. Other risk factors that can contribute to the development of heel ulcers include:

• Moisture from perspiration
• Loss of feeling in the lower limbs
• Inadequate nutrition
• Shearing force
• Friction
• Poor hygiene
• Unhealthy skin

Before beginning treatment, it’s important for wound care specialists to perform a thorough medical history and examination to assess each patient’s skin integrity based on the Braden scale or other acceptable assessment tools.


Another important factor in creating an appropriate treatment regimen for each patient is to stage the heel ulcers using the International NPUAP-EPUAP Pressure Ulcer Classification Guidelines:

Stage I: Nonblanchable Erythema - Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching.
Stage II: Partial Thickness Skin Loss - Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled blister.
Stage III: Full Thickness Skin Loss - Full thickness tissue loss. Subcutaneous fat may be visible but does not obscure the depth of tissue loss. May include undermining and tunneling.
Stage IV: Full Thickness Tissue Loss - Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. Undermining and tunneling are often included.
UNSTAGEABLE: Full Thickness Tissue Loss in which the base of the ulcer is covered by slough and/or eschar in the wound bed.
DEEP TISSUE INJURY (DTI): In which discolored intact skin or a blood-filled blister is caused by pressure-related damage of the underlying soft tissue.

Once assessment and classification are complete, a treatment regimen can be mapped out to include a variety of strategies. The number one factor in a successful treatment plan is the creation of a pressure-free environment in which the heel can be floated.


A professional heel offloading device like Heelift® can be useful to create this zero-pressure environment. Heelift is often an appropriate choice because it floats the heel in a soft foam device that features ventilation and cushioning for the patient’s comfort.


Contact us now for more information on heel ulcers and the role Heelift can play in their treatment.


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