What is heel offloading?

Heel offloading is a clinical technique used to completely remove pressure from the heel in order to prevent or treat a pressure injury heel. Unlike general pressure redistribution methods, true heel offloading means that the heel is fully suspended and not in contact with any surface.

This distinction is critical. Simply reducing pressure is not enough. The heel must be entirely free from pressure to protect the underlying tissue and maintain adequate blood flow.

The heel is particularly vulnerable to pressure injuries due to its anatomy. The calcaneus (heel bone) sits close to the skin with only a thin layer of soft tissue covering it. When a patient is immobile or bedridden, prolonged pressure over this small surface area can quickly lead to tissue breakdown.

In addition, the heel is exposed to shear and friction forces during repositioning, which further increases the risk of injury. These combined factors make heel offloading an essential part of any effective heel pressure injury prevention strategy.

Heel offloading

Clinical guidelines for heel offloading

International pressure injury guidelines, including those from the NPIAP, EPUAP, and PPPIA, provide clear recommendations for heel pressure injury prevention.

Key best practices include:

Heel suspension (floating the heel)
The heel should be elevated so that it does not touch the bed or any surface.
Complete pressure relief
The goal is not redistribution, but total removal of pressure from the heel.
Prevention of shear and friction
Devices should minimize movement-related forces that damage the skin.

These guidelines emphasize that while temporary solutions such as pillows may be used, heel suspension devices are preferred for long-term offloading or for patients who are restless or at high risk.

A properly designed heel suspension device ensures consistent positioning, maintains offloading over time, and reduces the risk of incorrect application.

Clinical evidence and research

Clinical evidence plays a crucial role in validating the effectiveness of any offloading device. One key study evaluating heel offloading in practice is the Wounds UK clinical evaluation of the Maxxcare Heel Pro Evolution. To read the full document, please contact Maxxcare.

This evaluation was conducted in a rehabilitation setting across multiple wards, involving patients who were either at risk of developing heel pressure injuries or already had existing wounds.

The study followed patients over a 14-day period, with regular skin assessments and monitoring of outcomes.

Key results

The results of the evaluation demonstrate the clinical value of effective heel offloading:

No new pressure injuries in patients with intact skin
Improvement in existing wounds, including healing progression
High patient comfort and acceptance, with 76% of patients reporting the device as comfortable

In addition, clinicians reported that the device effectively offloaded the heel in all observed cases, supporting its reliability in daily clinical use.

Clinical example

One particularly illustrative case in the clinical evaluation document involved a patient with an existing heel pressure injury:

Initial wound size: 4 cm²
After 14 days: reduced to less than 0.5 cm²

From a clinical perspective, this represents a significant acceleration in wound healing. By eliminating pressure on the heel, tissue perfusion improves, inflammation is reduced, and the natural healing process is supported.

This example highlights how effective heel offloading is not only preventive, but also a key component in treatment protocols.

To read the full document ‘Wounds UK clinical evaluation of the Maxxcare Heel Pro Evolution’ please contact us.

What makes a good heel suspension device?

Not all offloading devices provide the same level of protection. A high-quality heel suspension device should meet the following criteria:

Complete heel offloading
The device must fully suspend the heel, ensuring zero contact with surfaces.
Ankle protection
It should support and protect the ankle to prevent additional pressure points or instability.
Reduction of shear and friction
Materials and design should minimize harmful forces during movement.
Comfort for long-term use
Soft, breathable materials are essential to ensure patient compliance, especially during prolonged use.
Ease of application
The device should be simple and intuitive for caregivers to apply correctly every time.

Each of these factors contributes to both clinical effectiveness and real-world usability in healthcare settings.

The Maxxcare as a solution

The Maxxcare Heel Pro Evolution is an advanced heel suspension device specifically designed to support both heel pressure injury prevention and treatment.

It is engineered to:

Fully offload the heel and ankle
Reduce pressure, shear, and friction
Provide targeted protection for the Achilles tendon
Deliver maximum comfort during long-term use

The device contains four removable air-filled tubes, which play a key role in its functionality.

These air-filled components gently lift the heel away from the surface, ensuring complete suspension while redistributing pressure along the lower leg. This design not only protects the heel but also stabilizes the foot and ankle.

The smooth outer material reduces shear and friction, helping to protect fragile skin during repositioning.

In addition, the lightweight and soft construction enhances patient comfort, which is critical for compliance. When patients are comfortable, they are more likely to keep the device in place, allowing consistent offloading and better outcomes.

The Maxxcare Heel Pro Evolution is designed for both prevention and treatment, making it a versatile solution across different care settings.

Why heel offloading matters

Heel pressure injuries are a significant clinical challenge. They are the second most common site for pressure injuries, following the sacrum.

For patients, these injuries can cause:

Severe pain and discomfort
Reduced mobility and independence
Increased risk of infection and complications

For healthcare systems, the impact is also substantial:

Longer hospital stays
Increased treatment costs
Higher workload for care teams

Importantly, many heel pressure injuries are preventable. Early intervention with an appropriate offloading device can significantly reduce the risk of tissue damage.

This makes heel offloading not just a treatment strategy, but a critical preventive measure.

Conclusion

Heel offloading is a fundamental component of effective pressure injury care.

It ensures complete pressure relief from the heel
It aligns with international pressure injury guidelines
It is supported by clinical evidence demonstrating improved outcomes

Choosing the right heel suspension device is essential. A well-designed offloading device improves patient comfort, supports healing, and helps healthcare professionals deliver consistent, high-quality care.