The Hidden Danger Beneath the Heels: Why Pressure Ulcers Start Where You Least Expect

When caring for someone who spends most of their time in bed or a wheelchair, we tend to naturally focus on the essentials such as helping them eat, stay clean, take their medicines, and rest comfortably. In all that, small details can slip through the cracks. One of those details is the heel.

Under the blanket, the heel quietly carries the body’s weight hour after hour. Over time, constant pressure can damage the skin and slow down circulation. A heel pressure ulcer can begin as a small patch of redness, but once the skin breaks, healing can take weeks or even months. Understanding how and why this happens helps caregivers prevent pain and protect the people they care for.

Understanding Heel Pressure Ulcers

A pressure ulcer, often called a bedsore, happens when continuous pressure or friction limits blood flow to the skin. Without enough oxygen and nutrients, the skin begins to weaken and may eventually break down.

The heel is one of the most common places for this to happen. The skin there is thin with very little fat to cushion the bone. People who are older, immobile, diabetic, or recovering from surgery face a higher risk.

According to the World Health Organization (2023), pressure injuries most often occur on the sacrum and heels among patients who have limited mobility. Early warning signs include redness that does not fade after pressure is relieved, shiny or firm skin, or a cool temperature compared with surrounding areas.

Why Heels Are Often Overlooked

Heel ulcers tend to develop quietly. The area is often covered by socks or blankets, and caregivers may not think to check it every day. At home, most patients do not have ripple mattresses or strict repositioning routines like those used in hospitals.

By the time swelling or pain is noticed, the ulcer may already have become serious. A 2022 NHS report found that nearly one in three pressure injuries occurs on the heel, yet many are discovered only after the damage has advanced.

Small habits make a big difference. Checking the heels once or twice daily, especially during bathing or dressing changes, can help spot early warning signs before the skin breaks.

How Proper Care and Prevention Help

Preventing a heel ulcer is far easier than treating one. The first step is to relieve pressure by keeping the heel slightly lifted or cushioned so it does not rest directly on the bed. Soft pillows, heel protectors, or silicone foam dressings can help reduce friction and improve comfort.

Silicone foam dressings are designed to protect the skin by spreading pressure evenly and preventing rubbing. They absorb fluid while keeping the wound bed moist, creating the best conditions for healing. The silicone layer also allows the dressing to be removed gently without pulling or irritating fragile skin.

The European Pressure Ulcer Advisory Panel (2023) highlights soft silicone foam as a reliable option for both prevention and early-stage ulcers. It helps protect vulnerable skin, reduces pain during dressing changes, and supports faster recovery.

What Caregivers Can Do at Home

• Check the heels daily, especially for patients who have limited movement or diabetes.
• Reposition the person every two hours to reduce pressure buildup.
• Keep sheets smooth, clean, and dry to prevent friction.
• Place a pillow under the calves to lift the heels slightly off the mattress.
• Use a silicone foam dressing on high-risk areas to prevent skin breakdown.
• Seek medical advice if redness or discoloration does not fade within 30 minutes after relieving pressure.

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Every Small Act Matters

Caring for someone who depends on you takes strength and patience. Every small action, such as turning them gently, smoothing a sheet, or checking their heels, can make a difference. Protecting the heels helps prevent pain, infection, and unnecessary hospital visits. Most of all, it preserves dignity and comfort.

Empower healing at home with solutions made for gentle care.

References

• World Health Organization. (2023). Pressure injury prevention and management guidelines.
• National Health Service. (2022). Pressure ulcer statistics and prevention strategies.
• European Pressure Ulcer Advisory Panel. (2023). Best Practice Recommendations.