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J Wound Ostomy Continence Nurs. 2010 Jul-Aug;37(4):372-8. doi: 10.1097/WON.0b013e3181e3990b.

Preventing heel pressure ulcers and plantar flexion contractures in high-risk sedated patients.

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Harris County Hospital District, 10077 Northridge Dr., Conore, TX 77303, USA.



An intervention using heel pressure ulcer and plantar flexion contracture prevention protocols for high-risk patients was established to promote earlier recognition of heel skin issues and provide effective prevention of both conditions.


Fifty-three patients who were sedated, managed in an intensive care unit for 5 days or more, and had a Braden Scale score of 16 or less were treated with heel protector devices that maintained the foot in a neutral position and floated the heel off the bed.


On admission to the intensive care unit, heel skin assessment and the Braden Scale were administered to all patients. Initial ankle range of motion was measured with a goniometer on admission and before the application of the heel protector. Goniometric measurements were documented every other day. Heel assessments and the Braden Scale for Predicting Pressure Sore Prevention and Ramsay Sedation Scale scores were recorded in every shift and recorded as part of the study every other day. Measurements continued until the patient was transferred, the heel protector boot was discontinued by the physician, or the patient's Braden Scale score rose above 16.


Application of the heel protectors led to a 50% reduction in prevalence of abnormal heel position. No patients developed plantar flexion contractures or new heel ulcers. Patients with normal heels had significantly higher Braden Scale scores compared to those with abnormal heels (P 5 .0136).


Despite their high risk, no patients using the heel protector device developed a heel pressure ulcer or plantar flexion contracture.

[Indexed for MEDLINE]

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