Journal of Orthopaedic Nursing
Volume 13, Issue 2 , Pages 97-104 , May 2009

Heel ulceration – An exploration of the issues

  • Karen Ousey, PhD, RGN, ONC (Principal Lecturer)

      Affiliations

    • Corresponding Author InformationTel.: +44 1484 473462; fax: +44 1484 473212.

References 

  1. Barczak C, Barnett R, Childs E, Bosley L. Fourth national pressure ulcer prevalence survey. Adv. Wound Care. 1997;10(4):18–26
  2. Baumgarten M, Margolis D, Berlin JA, Storm BL, Garino J, Kagan SH, et al. Risk factors for pressure ulcers among elderly hip fracture patients. Wound Repair Regan. 2003;11:96–103
  3. Bennett G, Dealey C, Posnett J. The cost of pressure ulcers in the UK. Age Ageing. 2004;33(3):230–235
  4. British Orthopaedic Association . The Care of Patients With Fragility Fractures. London: BOA; 2007;
  5. Bonjour JP, Schurch MA, Rizzoli R. Nutritional aspects of hip fractures. Bone. 1996;18:139S–144S
  6. Braden B, Bergstrom N. A conceptual schema for the study of the aetiology of pressure sores. Rehabil. Nurs. 1987;12(1):8–12
  7. Bridel J. Assessing the risk of pressure sores. Nurs. Stand. 1993;7:32–35
  8. Bryant RA, Rolstad BS. Examining threats to skin integrity. Ostomy/Wound Management. 2001;47(6):18–22
  9. Clark M, Farrar S. Comparison of pressure sore risk calculators. In:  Harding KG,  Leaper DL editor. Proceedings of the first European conference on advances in wound management, Cardiff, United Kingdom. London: Macmillan; 1991;p. 158–162
  10. Clark M, Bours G, Defloor T. The prevalence of pressure ulcers in Europe. In:  Clark M editors. Advances in Tissue Viability. Quay Books; 2004;
  11. Courtenay, M., 2002. Movement and mobility. In: Hogston, R., Simpson, P.M. (Eds.), Foundations of Nursing Practice: Making the Difference. Palgrave London, pp. 262–285.
  12. Edwards JL, Pandit H, Popat MT. Perioperative analgesia: a factor in the development of heel pressure ulcers?. British Journal of Nursing, (Tissue Viability supplement). 2006;15(6):
  13. European Ulcer Advisory Panel (EPUAP), 1999. Guidelines on treatment of pressure ulcers. Epuap Review 1, 7–8.
  14. European Ulcer Advisory Panel (EPUAP) . Guidelines on treatment of pressure ulcers. EPUAP; 2005;
  15. Finucane TE. Malnutrition, tube feeding and pressure sores: data are incomplete. Journal of American Geriatric Society. 1995;43:447–451
  16. Foster MR, Heppenstall RB, Friedenberg ZB, Hozack WJ. A prospective assessment of nutritional status and complications in patients with fractures of the hip. J. Orthop. Trauma. 1990;4:49–57
  17. Grey JE, Harding KG, Enoch S. Pressure ulcers. Brit. Med. J. 2006;332:472–475
  18. Gunninberg L, Lindholm C, Carlsson M, Sjoden PO. The development of pressure ulcers in patients with hip fractures: Inadequate nursing documentation is still a problem. J. Adv. Nurs. 2000;31:1155–1164
  19. Haalboom JR, den Boer J, Buskens E. Risk assessment tools in the prevention of pressure ulcers. Ostomy Wound Manage. 1999;45:20–24
  20. Hamilton F. An analysis of the literature pertaining to pressure sore risk-assessment scales. J. Clin. Nurs. 1992;1:185–193
  21. Herbert R. The biology of skin ageing. In:  Redfern S editors. Nursing Elderly People. Churchill, Livingstone: Edinburgh; 1991;
  22. Hew E, Op Reimer WJS, Van Achterberg T. Pressure ulcers: diagnostics and interventions aimed at wound-related complaints: a review of the literature. J. Clin. Nurs. 2005;14:464–472
  23. Hoshowsky V, Schramm C. Intra operative pressure sore prevention: an analysis of bedding materials. Res. Nurs. Health. 1994;17:333–339
  24. Houwing R, Rozendaal M, Wouters-Wesseling W, Buskens E, Keller P, Haalboom J. A randomised, double-blind assessment of the effect of nutritional supplementation on the prevention of pressure ulcers in hip-fracture patients. Clin. Nutr. 2003;22(4):401–405
  25. Houwing R, Rozendaal M, Wouters-Wesseling W, Buskens E, Keller P, Haalboom J. Pressure ulcer risk in hip fracture patients. Acta Orthop. 2004;75:390–393
  26. Kemp MG, Keithley JK, Smith DW, Morreale B. Factors that contribute to pressure ulcers in surgical patients. Res. Nurs. Health. 1990;13:293–301
  27. Land L. A review of pressure damage preventative strategies. J. Adv. Nurs. 1995;22:329–337
  28. Lindgren M, Unosson M, Krantz AM, Ek AC. Pressure ulcer risk factors in patients undergoing surgery. J. Adv. Nurs. 2005;50:605–612
  29. Lindholm C, Sterner E, Romanelli M, Pina E, Torra y Bou J, Hietanen H, et al. Hip fracture and pressure ulcers – the Pan European Pressure Ulcer Study – intrinsic and extrinsic risk factors. 2008;5(2):315–328
  30. Lovheim H, et al. Poor staff awareness of analgesic treatment jeopardises adequate pain control in the care of older people. Age Ageing. 2006;35(3):257–261
  31. MacDonald, K., 1995. The reliability of pressure-assessment tools Professional Nurse 11, 169–170, 172.
  32. Marshall C. The ankle: brachial pressure index. Brit. J. Podiatry. 2004;7(4):93–95
  33. Mayrovitz HN, Macdonald J, Smith JR. Blood perfusion hyperaemia in response to graded loading of human heels assessed by laser-Doppler imaging. Clin. Physiol. 1999;19(5):351–359
  34. Mayrovitz NM, Sims N, Dribin L. Heel skin hyperaemia: direct compression versus vascular occlusion. Clin. Physiol. Funct. Imag. 2003;23(6):354–359
  35. Murphy MC, Brooks CN, New SA, Lumbers ML, Murphy MC, Brooks CN, et al. The use of the Mini-Nutritional Assessment (MNA) tool in elderly orthopaedic patients. Eur. J. Clin. Nutr. 2000;54:555–562
  36. National Pressure Ulcer Advisory Panel, 1998. Pressure Ulcer Scale for Healing, <http://www.npuap.org/> (accessed 24.01.09.).
  37. National Institute for Clinical Excellence (NICE), 2005. Pressure Ulcers: The Management of Pressure Ulcers in Primary and Secondary Care: A Clinical Guideline. CG029 National Institute for Clinical Excellence London.
  38. Nicosia G, Gliatta AE, Woodbury G, Houghton PE. The effect of pressure-relieving surfaces on the prevention of heel ulcers in a variety of settings: a meta-analysis. Int. Wound J. 2007;4(3):197–207
  39. Nixon J, McGough A. Principles of patient assessment: screening for pressure ulcers and potential risk. In:  Morison M editors. The Prevention and Treatment of Pressure Ulcers. first ed.. London: Mosby; 2001;p. 55–74
  40. Ouchterlony J, Arvidsson S, Sjostedt L, Svardsudd K. Preoperative and immediate postoperative adverse events in patients undergoing elective general and orthopaedic surgery. Acta Anaesthesiol. Scand. 1995;39:643–652
  41. Ousey K. Pressure ulcers. In:  Ousey K,  McIntosh C editor. Lower Extremity Wounds: a Problem Based Approach. Wiley; 2007;p. 161–190
  42. Schoonhoven L, Haalboom JRE, Bousema MT, Algra A, Grobbee DE, Grypdonck MH, et al. Prospective cohort study of routine use of risk assessment scales for prediction of pressure ulcers. Brit. Med. J. 2002;325:1–5
  43. Stuart L, Proudman M, Wiles PG. A new response to heel protection is reducing cost and improving lives. Wounds UK. 2008;4(4):12
  44. Szor JK, Bourguignon C. Description of pressure ulcer pain at rest and at dressing change. J. Wound Ostomy Continence Nurs. 1999;26:115–120
  45. Thomas DR. Improving outcome of pressure ulcers with nutritional interventions: a review of the evidence. Nutrition. 2001;17:121–125
  46. Tourtual D, et al. Predictor of hospital acquired pressure ulcers. Ostomy/Wound Management. 1997;43:24
  47. Versluysen M. How elderly patients with femoral fracture develop pressure sores in hospital. Brit. Med. J. 1986;292:1311–1313
  48. Vowden P. Doppler ultrasound in the management of the diabetic foot. The Diabetic Foot. 1999;2(1):16–17
  49. Warden V, Hurley AC, Volicer L. Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale. J. Am. Med. Dir. Assoc. 2003;4:9–15
  50. Wong VK, Hopf HW, Froelicher ES, Dowling , Stotts NA, Dowling GA. How heel oxygenation changes under pressure. Wound Repair Regen. 2007;15(6):786–794
  51. World Health Organisation . WHO guidelines: cancer pain relief. second ed.. Geneva: WHO; 1996;

PII: S1361-3111(09)00115-0

doi: 10.1016/j.joon.2009.06.001

Journal of Orthopaedic Nursing
Volume 13, Issue 2 , Pages 97-104 , May 2009