What is the recommended approach to heel protection to prevent heel ulcers?

• A. Keep heels flat on the bed with no protection
• B. Use heel protectors and pressure-relieving surfaces
• C. Massage the heels hourly
• D. Elevate heels above heart level at all times

Answer: (C)

Preventing heel ulcers comes down to unloading pressure and preventing friction on the heel. The heel is a vulnerable area because the bony heel bone sits close to the skin with little soft tissue cushioning, so prolonged contact with the bed or wheelchair surface quickly reduces blood flow and leads to tissue damage. The most effective approach is to protect the heel with cushioning devices and use surfaces that relieve pressure.

Heel protectors cradle or cushion the heel and keep it from bearing direct weight on the bed, while pressure-relieving surfaces—such as specialized mattresses, overlays, or bed surfaces designed to distribute load—minimize sustained pressure and shear across the posterior heel. When combined, these strategies keep the heel off heavy pressure points and reduce the risk of ulcers.

Other options aren’t protective: massaging the heels hourly can create friction and shear and may worsen tissue injury, and elevating the heels above heart level continuously can impair perfusion and isn’t a primary method for ulcer prevention. Keeping the heels flat on a protected, pressure-relieving surface is the safer, more effective approach.