Pressure ulcers

Overview – pressure ulcers can be founds on legs, ankles or heels

Pressure ulcers (also known as pressure sores or bedsores) are injuries to the skin and underlying tissue, primarily caused by prolonged pressure on the skin.

They can happen to anyone, but usually affect people confined to bed or who sit in a chair or wheelchair for long periods of time.

Symptoms – what are the early signs and symptoms of pressure ulcers?

Pressure ulcers can affect any part of the body that’s put under pressure. They are most common on bony parts of the body, such as the heels and ankles. They often develop gradually, but can sometimes form in a few hours.

Early symptoms of a pressure ulcer

Symptoms can include:

• Part of the skin becoming discoloured – people with pale skin tend to get red patches, while people with dark skin tend to get purple or blue patches
• Discoloured patches not turning white when pressed (non- blanching)
• A patch of skin that feels warm, spongy or hard
• Pain or itchiness in the affected area

A podiatrist or nurse may call a pressure ulcer at this stage a category 1 pressure ulcer.

Later symptoms

The skin may not be broken at first, but if the pressure ulcer gets worse, it can form:

• An open wound or blister – a category 2 pressure ulcer
• A deep wound that reaches the deeper layers of the skin – a category 3 pressure ulcer
• A very deep wound that may reach the muscle and bone – a category 4 pressure ulcer

Causes – what can cause pressure ulcers?

Anyone can get a pressure ulcer, but the following things can make them more likely to form:

• Marked foot deformity with arthritis/ bony prominences
• Being over 70 – older people are more likely to have mobility problems and skin that’s more easily damaged through dehydration and other factors
• Being confined to bed with illness or after surgery
• Inability to move some or all of the body (paralysis)
• Obesity
• Urinary incontinence and bowel incontinence
• A poor diet
• Medical conditions that affect blood supply, make skin more fragile or cause movement problems – such as diabetes, peripheral arterial disease, kidney failure, heart failure, multiple sclerosis (MS) and Parkinson’s disease

Treatment – how to treat pressure ulcers

Treatments for pressure ulcers depend on how severe they are.

For some people, they need basic podiatry/ nursing care. For others, they can be serious and lead to life-threatening complications, infection

Ways to stop pressure ulcers getting worse and help them heal include:

• Applying dressings that speed up the healing process and may help to relieve pressure
• Moving and regularly changing your position
• Using specially designed static foam mattresses or cushions, or dynamic mattresses and cushions that have a pump to provide a constant flow of air
• Relieve/ remove causative pressure such as footwear
• Eating a healthy, balanced diet
• A procedure to clean the wound and remove damaged tissue (debridement)

Surgery to remove damaged tissue and close the wound is sometimes used in the most serious cases.

Prevention – how to precent pressure ulcer occuring

It can be difficult to completely prevent pressure ulcers, but there are some things you or your care team can do to reduce the risk.

These include:

• Referral to podiatry to assess pressure relief and offloading specific to the foot
• Regularly changing your position – if you’re unable to change position yourself, a relative or carer will need to help you
• Checking your skin every day for early signs and symptoms of pressure ulcers – this will be done by your care team if you’re in a hospital or care home
• Having a healthy, balanced diet that contains enough protein and a good variety of vitamins and minerals – if you’re concerned about your diet or caring for someone whose diet may be poor, ask your GP or healthcare team for a referral to a dietitian
• Stopping smoking – smoking makes you more likely to get pressure ulcers because of the damage caused to blood circulation

If you’re in a hospital or care home, your healthcare team should be aware of the risk of developing heel pressure ulcers. They should carry out a risk assessment, monitor your skin and use preventative measures, such as regular repositioning.

If you’re recovering from illness or surgery at home, or you’re caring for someone confined to bed or a wheelchair, ask your DN / podiatrist for an assessment of the risk of developing heel pressure ulcers.