Registered Nurses' Association of Ontario

Heel Off-Loading from Bed or Wheelchair

Heels are susceptible to skin breakdown due to the thin layer of subcutaneous tissue covering the calcaneus, the shape of the calcaneus bone, and the risk for ischemia with minimal pressure and shearing forces.


In addition to local wound care, the treatment of heel pressure injuries should focus on:

  • Eliminating pressure and shear by suspending the heels off of the support surface using a pillow or heel suspension devices. Some of the heel suspension devices also help to prevent foot drop (i.e., difficulty lifting the front part of the foot).
  • Selecting a heel suspension/protection device, that considers the person’s activity level, goals of care and comfort.
  • Ensuring regular inspection of the skin under the device in order to prevent further skin breakdown.
  • Minimizing plantar pressure by assessing the person’s footwear. If the person is ambulatory, a referral to a chiropodist may be warranted.


Clinical Management
Assessment and Management of Pressure Injuries for the Interprofessional Team, Third Edition
Point of Care Resources