Pressure ulceration of the heel: prevalence, complexities and management

Heel pressure ulceration remains a significant and largely preventable cause of morbidity, yet it continues to pose complex clinical challenges. The heel's unique anatomical structure, limited soft-tissue padding and relatively poor vascular supply increase vulnerability to pressure, shear and friction, particularly among older adults and individuals with diabetes or peripheral arterial disease. This article synthesises the evidence surrounding the prevalence, risk factors and pathophysiology of heel pressure ulcers, highlighting their propensity for delayed healing, infection and limb-threatening complications. Despite their frequency and severity, current national guidelines provide limited heel-specific recommendations, resulting in variation in practice. The article discusses the importance of comprehensive risk assessment, early vascular evaluation, and implementation of evidence-based prevention strategies such as effective offloading. Key principles of local wound management, including debridement, infection control and appropriate dressing selection are outlined. By improving recognition of heel-specific risk and promoting consistent, multidisciplinary approaches, clinicians can reduce avoidable harm, enhance healing outcomes and support improved quality of life for patients with heel pressure ulceration.