Case Study: The Importance of Correct Product Selection to Offload a Heel Pressure Ulcer

The purpose of this poster is to discuss the use of a static air boot versus an ankle foot orthosis to offload a stage III heel pressure ulcer in a fifty-three year old female who is wheelchair dependent and has multiple sclerosis, contractures, and neuropathy in her lower legs.   Nine percent of all wheelchair dependent individuals develop heel pressure ulcers. 

This patient presented to our wound center with a stage III pressure ulcer to her right heel. The ulcer had been open for two months and was treated appropriately with wound gel but was not offloaded.  We immediately implemented offloading using a static air boot. 

From week one to 16, the ulcer made consistent progress.  However from week 16 to 32, wound healing plateaued with evidence of increased pressure.   We were perplexed as to the cause until we witnessed her right leg spasm, causing her heel to rub against the frame of her wheelchair.  The static air boot was not sturdy enough to protect the heel.

The wound center was hesitant to transition to any type of ankle foot orthosis offloading boot due to our experience with Achilles tendon injuries in neuropathic patients.   However, more durable offloading was need and an ankle foot orthosis offloading boot with hydro cushion padding in the Achilles area was trialed.   The pressure ulcer closed within three months without any Achilles complications.  She continues to wear this boot to prevent re-ulceration of her heel.

This case study emphasizes the importance of not just offloading pressure ulcers, but offloading with the correct product.   While the static air boot is usually effective in non-ambulatory patients, the combination of contracture with leg spasms necessitated the sturdier ankle foot orthosis offloading boot.  This treatment could be generalized and used on other wheelchair patients dealing with spasticity and similar wounds.