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Managing complexities with heel ulcers

On our most recent BioMonde LIVE Expert Guest webinar, we were delighted to be joined by Advanced Podiatrist, Gill Sykes of Harrogate & District NHS Trust, who presented an educational piece on managing heel ulcers and the complexities that arise with them. In this article, we will be sharing the key insights and learnings we took away from her presentation.

Heels are important, and we all rely on them for our quality of life. The heel is the biggest part in the structure of a foot, comprising of 26 bones in total. Heels are a complex part of the body to manage and if a compromised heel is left untreated, or if treatment were to go wrong for any reason, then this could result in amputation.

Care and consideration when assessing feet is crucial – and using the NICE guidelines as a framework, particularly for patients with diabetes, can be very valuable. In cases with complex heels, it is useful to have a compact mirror to aid visibility and be sure to remove existing wound dressings before examination, this will make identifying any potential risk factors much easier.


Risks to a diabetic foot can include tissue loss and callus which can lead to ulceration, as well as more serious conditions such as gangrene and Charcot arthropathy which may eventually cause loss of limb. Being able to properly grade and assess pressure ulcer formation is also fundamental. Although pressure ulcers are different to DFUs, forming only on bony prominences rather than anywhere on the foot. Both should be treated as a matter of urgency to prevent further tissue damage.

Heel ulcers are the most common ailment that Gill is presented with in practice currently – these include wounds just starting to blanche and fissure, to deep tissues injuries and gangrenous necrotic heels. Podiatrists can recognize three main aims to work toward during wound debridement: These are to prevent re-sloughing, ensuring that a wound is correctly offloaded, and to promote healing where possible.

Role of Larval Therapy

According to Gill, Larval Therapy can be an option to consider when aiming to debride and could be seen as a first-line method of treatment for complex heels. Useful tips for avoiding further damage to patients’ heels whilst they are undergoing treatment include the importance of being aware of seemingly harmless factors, such as bed-ends and cushions. If not monitored, these items can occlude the larvae, and can also cause permanent pressure damage to a patient over a prolonged period. It is always worth being aware of offloading options available, such as specialist beds or mattresses, soft cast, and the use of special boots and footwear if a patient is more mobile. Always remember, Heel S.O.S – Strictly Off Surface.

When selecting the most appropriate offloading technique(s), do check what is available on the formulary and different departments within a clinical setting. A multi-disciplinary approach can be most effective when teams such as orthotists and podiatrists work together. Providing patients with an active say in their own treatment is also recommended, allowing them freedom to be on-board with decision making; especially when it comes to selecting what is most suitable for their lifestyle.

BioMonde extend our warmest gratitude to Gill for her time and effort in delivering an exceptional presentation: ‘Managing complexities with heel ulcers’. A huge thank you to everyone that attended the webinar, and we look forward to seeing you again when BioMonde LIVE returns in September.

To replay the full webinar, click here.

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