QUICK ANSWER
Heel pressure injuries are difficult to heal because the heel has very little natural cushioning, limited blood flow, and is exposed to constant pressure during sitting, lying down, or reduced movement. Healing can be especially slow in older adults and people with diabetes, poor circulation, or limited mobility.
Effective treatment usually involves pressure offloading with heel protection devices or positioning supports, appropriate wound dressings, infection prevention, and medical review where circulation issues may be involved.
Early intervention is important because heel wounds can deteriorate quickly, even when they initially appear small or superficial. Seek medical advice promptly if there is increasing pain, redness, swelling, discharge, blackened tissue, or signs of infection.
Support pressure relief and wound protection with products designed for fragile heels and sensitive skin:
Helpful products commonly used in heel wound care:
Best for reducing friction and pressure on vulnerable heels Wrap Around Heel Boots
Best for cushioning and protecting heels during bed rest ICare Coccyx Wedge Cushion
Best for redistributing pressure during sitting and recovery 3M Cavilon Barrier Film
Best for protecting fragile skin from moisture and irritation Acticoat Antimicrobial Dressing
Best for infection control in high-risk or slow-healing wounds
Heel pressure injuries are one of the most difficult wounds to manage in aged care and home care settings.
What often makes them so distressing for families is that they can appear small on the surface while becoming serious underneath very quickly.
This guide explains why heel wounds heal so slowly, why diabetes and circulation problems increase risk, what warning signs families should watch for, and what good wound management actually looks like.
Why are heel pressure injuries so hard to heal?
When most people think about a wound healing slowly, they assume something has gone wrong with the treatment. But with heel pressure injuries, the difficulty is often structural. The heel is simply one of the worst places on the human body to sustain a wound.
The heel has almost no cushioning between the skin and the bone underneath. When someone spends long periods in bed or a chair, the bony prominence of the heel presses constantly against whatever surface it's resting on. There's very little tissue to absorb that pressure, which means the skin and tissue beneath it take the full force of it, hour after hour.
The more detailed explanation adds another layer. The heel sits directly over the calcaneum, the large bone at the back of the foot. In people who are lying down or partially reclined, there's minimal connective tissue to protect what's underneath. This means a wound can progress through the skin and into deeper structures, including tendon and bone, faster than it would in areas with more natural padding. That's not a sign that care has failed. It's a feature of the anatomy itself.
How does poor circulation affect heel wound healing?
Even in a healthy person, the heel doesn't receive a generous blood supply. The majority of circulation to the heel comes from the posterior tibial artery, with a small contribution from the peroneal artery. These happen to be among the first arteries affected when someone develops peripheral arterial disease, a condition that narrows and hardens blood vessels over time.
In practical terms, this means that for older people, particularly those who are less mobile, blood flow to the heel is already reduced. Add extended periods of immobility and that circulation drops further. Healing requires a good blood supply to deliver oxygen and nutrients to damaged tissue, so when that supply is compromised, even a small wound can struggle to repair itself. It isn't a question of the body not trying. It's a question of the body not having the resources it needs to do the job.
If Your Loved One Has Diabetes, the Risk Is Significantly Higher
Diabetes deserves its own section here because it changes the picture considerably. There are a few reasons for this, and it's worth understanding all of them.
Diabetic Peripheral Neuropathy
First, diabetic peripheral neuropathy, the nerve damage that often develops with long-term diabetes, can significantly reduce or completely remove sensation in the feet. This matters because a person who can't feel pressure on their heel has no natural signal telling them to shift their position. They're not choosing to stay still. They genuinely don't feel the discomfort that would normally prompt movement.
Tissue Changes
Second, diabetes causes changes to the soft tissue in the heel itself. The collagen fibres in the tissue become thicker and stiffer over time, which means the heel loses some of its natural ability to absorb and redistribute pressure. The result is a foot that's less able to cope with the forces being applied to it, even when those forces are relatively minor.
Put these two things together, reduced sensation and reduced tissue tolerance, and it becomes clearer why diabetic patients are so much more vulnerable to heel pressure injuries, and why those injuries can become serious before anyone even notices they've started.
What are the stages of heel pressure injuries?
Pressure injury stages describe how deeply tissue damage has progressed beneath the skin.
Stage I presents as a reddened area of skin that doesn't turn white when you press on it. The skin is still intact, but something is happening underneath.
Stage II involves a visible break in the skin, either a shallow open sore or a fluid-filled blister. This is the stage where infection becomes a real concern.
Stage III shows a deeper wound, often described as a crater, where body fat may be visible. The skin and tissue above it have broken down.
Stage IV involves damage to muscle, tendon, or bone. This is a serious medical situation requiring specialist wound care.
There's also a category that doesn't fit neatly into the numbered stages: deep tissue pressure injury. This can appear as a dark purple or maroon patch on intact skin, almost like a deep bruise, and it's actually the most common type of heel pressure injury seen in hospital patients. What makes it particularly difficult is that it can progress rapidly despite appearing minor on the surface. If you see this kind of discolouration on your loved one's heel, it needs to be assessed promptly.
What warning signs should families watch for with heel wounds?
Early identification of circulation problems or infection can significantly improve healing outcomes. You don't need to be a clinician to notice the warning signs that a heel wound is worsening or becoming infected. Here's what to look for and take seriously.
Signs the wound may be worsening:
- Redness that doesn't fade when you gently press on it
- Purple or maroon discolouration
- The foot feeling warmer or cooler than usual (temperature changes can indicate circulation problems or early infection)
- No pulse check has been done on the foot — a weak or absent pulse can indicate vascular involvement that needs specialist attention
Signs of infection:
- A smell from the wound
- Pus or cloudy discharge
- Increasing redness or swelling around the edges
- Warmth in the surrounding skin
- Fever
Any of these warrant a conversation with the nursing or medical team the same day. They're not over-reactions. They're the right call.
How are heel pressure injuries treated?
Good heel pressure injury care has a few non-negotiable components, and understanding them can help you advocate for your loved one if you feel something is being missed.
1. Keep the Heel Completely Offloaded
Offloading means ensuring the heel is floating and not in contact with any surface. This sounds straightforward, but it requires consistent, ongoing attention from everyone involved in care.
Common approaches include:
- Pillows placed lengthways under the lower leg to lift the heel clear of the mattress
- Foam heel protectors or specialised heel-suspension booties
- Offloading wedges or positioning aids designed specifically for pressure relief
The key point from clinical guidelines is clear: the heel should not be resting on anything. This is a core care requirement, not an occasional measure. If you're visiting a loved one in a care facility and their heel is resting on the mattress, that's worth raising directly with the nursing team. Heel elevation needs to be written into their care plan.
2. Change Position Every Two Hours
Pressure injuries worsen when the same area bears weight for extended periods. For bed-bound patients, position changes should occur roughly every two hours to redistribute pressure and restore circulation to affected tissue.
In a care facility, this should be documented and consistent. At home, it can be harder to manage alone. If you're providing care without adequate support, it's worth raising with a GP or support coordinator, as this is exactly the kind of need that can be addressed through a formal care plan or additional in-home support services.
3. Avoid Hydrogen Peroxide and Iodine Cleansers
When it comes to cleaning the wound, the products you'd typically reach for in a first aid situation are often the wrong choice here. Hydrogen peroxide and iodine-based cleansers are generally not recommended for open wounds because they can damage the new tissue that's trying to form, slowing the healing process rather than supporting it.
The wound should be cleaned gently with saline or a wound-appropriate cleanser, as directed by the treating clinician or wound care nurse.
4. Keep the Wound Covered, Clean, and Moist
A common misconception is that wounds heal better when left open to air. For pressure injuries, the opposite is true. Keeping the wound covered with an appropriate dressing creates the moist environment that healing tissue needs, while also protecting the area from bacteria and physical irritation.
The right dressing will depend on the stage of the wound and whether infection is present. A wound care nurse or GP can advise on what's appropriate, and it's worth reviewing the dressing type regularly as the wound changes.
When should antimicrobial or silver dressings be used for heel wounds?
For wounds that are healing well, a standard non-adherent dressing that keeps the area moist and protected may be all that's needed. But for wounds that show signs of infection, or in people with diabetes or compromised circulation, standard dressings often don't provide adequate protection against bacterial load.
This is where antimicrobial wound dressings come into the picture. Antimicrobial dressings, including silver-based options, are designed to actively manage bacteria in and around the wound, which reduces the risk of infection taking hold and supports the conditions needed for healing. They're particularly relevant when a wound is at high risk due to the patient's underlying health, or when there are early signs that the wound isn't responding to standard care.
Silver wound dressings work by releasing silver ions into the wound environment, which disrupts bacterial activity without harming the surrounding tissue in the way that some older antiseptics do. They're widely used in aged care wound management and are appropriate for a range of wound types and severities.
Here are three options from the Platinum Health Supply range worth knowing about.
1. Mölnlycke Mepilex Heel Dressing
The Mepilex Heel Ag is designed specifically for heel wounds, which makes it worth highlighting here. Its anatomical shape is contoured to fit the heel rather than requiring a flat dressing to be folded or adapted to an awkward surface. The Ag in the name refers to silver, which is integrated into the foam to provide continuous antimicrobial protection.
It's a good option when the wound is at Stage II or early Stage III and there's a concern about bacterial load, particularly in patients with diabetes or reduced circulation. The soft silicone contact layer also means removal is gentle on fragile skin, which matters a great deal in older patients where surrounding skin can be paper-thin.
2. Mölnlycke Mepilex Ag Silver Foam Dressing
The Mepilex Ag is the flat foam version from the same Mölnlycke range, available in a range of sizes. It combines the absorbency of a foam dressing with continuous silver-based antimicrobial activity, making it suitable for wounds with moderate to high exudate as well as those showing early signs of infection.
Where the Heel Ag is shaped for the heel specifically, the Mepilex Ag offers more flexibility across wound sizes and locations. It can be used on heel wounds when the contoured version isn't available, or when a wound extends beyond the heel itself. The same gentle silicone adhesive applies, reducing the risk of skin stripping on removal.
3. Acticoat Three Day Antimicrobial Barrier Dressing
The Acticoat by Smith and Nephew takes a different approach. Rather than a foam construction, it uses nanocrystalline silver technology across a low-adherent barrier layer. That nanocrystalline format releases silver ions rapidly and sustains that release over up to three days, which means fewer dressing changes while maintaining consistent antimicrobial coverage.
It's particularly well suited to wounds with a higher infection risk or where bioburden management is the primary concern. The dressing needs to be moistened with sterile water prior to application, and it works effectively across a range of wound types including pressure injuries, diabetic foot wounds, and surgical wounds. It's available in both 5cm x 5cm and 10cm x 10cm sizes, giving flexibility for different wound areas.
If you're unsure which of these is the right fit for your situation, the team at Platinum Health Supply is happy to help you work through it.
When should you seek medical help for a heel pressure injury?
This is the section that's easy to skip past, but please don't. Some heel wounds, particularly in people with diabetes or arterial disease, won't heal without clinical intervention. That's not a failure of home care or nursing care. It's a function of what's happening medically underneath the wound.
Research shows that in cases where blood supply to the heel is significantly compromised, restoring that circulation through a procedure called revascularisation can be what makes the difference between a wound that heals and one that doesn't. This is well beyond the scope of wound dressings alone, and it's a conversation that needs to happen with a vascular specialist or GP.
If the wound is deepening, if it's not responding after several weeks of appropriate care, if the foot seems to have reduced circulation, or if your loved one has diabetes and the wound is at Stage II or beyond, please push for a medical review. You won't be over-reacting.
Getting the Right Products and Support
Heel pressure injuries are genuinely difficult wounds to manage, and they're especially common in older people, people with diabetes, and those who are less mobile. If your loved one has developed one, it doesn't mean anyone has done something wrong. It means you're dealing with a wound in one of the most challenging locations on the body, in a person whose physiology makes healing harder.
What makes a real difference is understanding what you're dealing with, knowing the warning signs, and having access to the right products and clinical support. You're already doing the first part by reading this. The rest is about staying informed, asking questions, and not hesitating to push for escalation when something doesn't look right.
If you'd like help finding the right wound care products for your situation, the team at Platinum Health Supply is here to help.
Frequently Asked Questions About Heel Pressure Injuries
Why are heel wounds so difficult to heal?
The heel has very little natural cushioning between the skin and bone, which means pressure damages tissue more easily. Blood circulation to the heel is also relatively limited, making healing slower, especially in older adults or people with diabetes.
What does a heel pressure injury look like in the early stages?
Early signs can include redness that does not fade when pressed, dark purple or maroon discolouration, warmth, swelling, or skin that looks bruised. These changes should be assessed promptly, even if the skin is still intact.
Why are people with diabetes at higher risk of heel wounds?
Diabetes can reduce sensation in the feet and affect blood flow, making it harder to notice pressure damage early and more difficult for wounds to heal once they develop.
What helps heel pressure injuries heal more effectively?
Consistent pressure relief, proper wound dressings, regular repositioning, infection management, and maintaining good circulation all play an important role in supporting healing.
When should a heel wound be reviewed by a doctor?
Medical review is important if the wound is worsening, showing signs of infection, becoming deeper, not improving after several weeks, or occurring in someone with diabetes or circulation problems.
Heel pressure injuries can look smaller on the surface than they really are underneath. Early attention, consistent pressure relief, and the right wound care support can make a significant difference.
