Never Event: The Iatrogenic Heel Ulcer

Each surgeon has their own method for applying post-operative splints, but even the most careful ones with high volumes can encounter heel pressure sores. Finally, a new resource offers guidance on proper splint applications.

Research overview

A biomechanical study explored how splint characteristics on posterior heel contact pressures – a key risk factor for pressure injuries in foot and ankle care. Researchers examined 20 legs from 10 healthy volunteers using short leg splints with padding thicknesses from 0-10 layers, tested two padding brands, and compared heel positioning directly on the splint surface versus floating on a pillow.

Key findings

When the heel rested directly on the splint surface, average pressure consistently exceeded the 32 mm Hg threshold for capillary collapse, regardless of padding thickness or brand. In contrast, floating the heel on a pillow significantly reduced pressure below the threshold, particularly with 6-10 layers of thicker padding or 8-10 layers of thinner padding. Notably, improperly bunched padding resulted in heel pressures three times higher than those with evenly applied layers.

The optimal splint involves using 8-10 evenly applied layers, opting for thicker padding, ensuring the heal is floating, and maintaining a heel-free position during application.