Prevent and Treat Heel Pressure Ulcers

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ANATOMICAL CONCEPTS (UK) LTD

PREVENTION OF HEEL PRESSURE ULCERS Derek Jones PhD, MBA


SUMMARY OF CONTENTS OUR MAIN TOPICS TODAY

Defining Pressure Ulcers Medical Status + Mechanical Factors Where on the Body Do Pressure Ulcers Occur? What are the Cost Implications? Medical Risk Factors? Pressure and Shear - Mechanical Environment Diabetic Foot Disease Pressure Sore Development How Should We Protect the Heel? The PRAFO Range Features

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DEFINING PRESSURE ULCERS

Pressure Ulcers - also sometimes known as pressure sores, bedsores, decubitus ulcers - are commonly seen in situations where persons are "at risk" due to their medical status. Here is a Definition from Clinical Practice Guidelines "Any skin lesion, usually over a bony prominence, caused by unrelieved pressure resulting in damage of the underlying tissue"

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PRESSURE ULCER RISK IS SHAPED BY..

MEDICAL STATUS

Medical status of the patient is such that risk of pressure sores is elevated due to the presence of one or more risk factors

+

MECHANICAL ENVIRONMENT The body is in contact with support surfaces which apply loads to the body tissues. The nature of these loads can elevate the risk of ulceration

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WHERE DO PRESSURE ULCERS OCCUR?

Most pressure ulcer locations are at bony prominences

AREAS AT RISK we will fo cus on the Heels and Malleoli

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COST IMPLICATIONS 412,000 INDIVIDUALS WILL DEVELOP A NEW PRESSURE ULCER ANNUALLY IN THE UK

Total Cost Estimated at £1.4 to £2.1 Billion "The cost of pressure ulcers in the UK" Bennett, G et al Age and Ageing 2004, Vol 33: No.3, 230-235

Focus should be on prevention AS POPULATION AGES THE INCIDENCE OF ULCERATION IS EXPECTED TO INCREASE Anatomical Concepts (UK) Ltd


PRESSURE ULCERS THERE ARE MANY MEDICAL RISK FACTORS

Diabetic Foot Disease - with Neuropathy & Arterial Narowing Any Chronic Condition Requiring Bed Rest Lower Limb Fractures and Mulitsystem Trauma Combinations of Immobility, Dehydration, Immunosupression, Malnutrition Spinal Cord Injury Critical Care Situations - Immobility Significant Obesity or Thinness Degenerative Neurological Disease such as Dementia Cardiovascular compromise History of Previous Ulceration Compromised Nutritional Status Anatomical Concepts (UK) Ltd


GLOBAL BURDEN OF DIABETIC FOOT DISEASE AN AMPUTATION EVERY 30 SECONDS DUE TO DIABETIC FOOT DISEASE MANY OF THESE ARE PREVENTABLE

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HIGH "PRESSURE" IS BAD

"FRICTION & SHEAR" ARE VERY BAD Anatomical Concepts (UK) Ltd


WHAT DOES THAT MEAN? HOW DO PRESSURE AND SHEAR EFFECTS ARISE?

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Let's Imagine AREA

At Risk

Mechanical Shear Inappropriate Equipment, Poor Patient Transfer and Positioning will Elevate the Risk

Pressure Anatomical Concepts (UK) Ltd


PRESSURE ULCER DEVELOPMENT A CHAIN OF EVENTS

EXTERNAL PRESSURE

PRESSURE PERSISTS

Pressure occludes capillary flow. If this persists blood supply to cells is cut off

Cell has not oxygen supply (Ischemia) and as this persists cells die (Necrosis)

NECROSIS

ULCERATION

Necrosis spreads due to poor waste removal from damaged tissue area

Ulceration occurs due to combination of applied pressure and time. Process is accelerated if Shear is present and or elevated tissue temperatures

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High Pressure for a short time or Low Pressure for a longer time can lead to ulceration AREA

Shear Effects even more destructive than pressure

At Risk Pressure related to size of force applied and inverse of the contact area

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Heel exhibits a small contact area over a bony prominence


It's not just a Tissue Surface effect Anatomical Concepts (UK) Ltd


Severe Ulceration - Diabetic Neuropathy

Resolved at 56 Weeks

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Severe Ulceration - Diabetic Neuropathy Refused Amputation Anatomical Concepts (UK) Ltd


Almost healed 156

WEEKS

LATER

Severe Ulceration - Diabetic Neuropathy Refused Amputation Anatomical Concepts (UK) Ltd


THESE EXAMPLES WERE SUCCESSFULLY MANAGED WITH A PRAFO PRESSURE RELIEF ANKLE FOOT ORTHOSIS An Orthosis to provide total relief from pressure at the heels whether the patient is immobile and in bed or ambulent

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ALWAYS REMEMBER

To Deal With the Mechanical Environment (Pressure and Shear) as well as the Medical Risk Factors We can't say ANY amount of pressure will always be safe Anatomical Concepts (UK) Ltd


HOW SHOULD WE PROTECT THE HEEL? WHAT ELSE SHOULD WE THINK OF?

ZERO! PRESSURE

AND

SHEAR

Is the patient at risk of developing a plantarflexion deformity which will delay early mobilisation (ie: Acute Stroke)? Will protected mobility be required? Special needs? ie: Bariatric How are the toes being protected? Are there deformities to be managed? Avoid Friction During Transfers A n aP t oi xmeilcaaslt C| oDnecsei gp nt sa(nUdK T ) eLct d h


PRAFO FAMILY Pressure Relief Ankle Foot Orthosis

650SKG

652SKG

653SKG

The "original" design with Kodel liner

Adjustable Dorsiflexion/Plantarflexion

Valgus/Varus and Dorsiflexion/Plantar Flexion Anatomical Concepts (UK) Ltd


"STANDARD" PRAFO 650SKG Adjustments Dorsiflexion/Plantarflexion Calf Height Foot length Toe Protection Rotation Bar Prevents Internal/External Rotation

650SKG The "original" design with Kodel liner Anatomical Concepts (UK) Ltd


"STANDARD" PRAFO 650SKG

Metal Upright Structure

Maintains foot and ankle positioning whether recumbent or ambulant

Intrinsic Walking Base

Ensures that ambulation can take place whilst maintaining heel protection

Liner Systems

650SKG The "original" design with Kodel liner

Supplied with Kodel liner or Pad and Strap kit giving space for wound dressings Anatomical Concepts (UK) Ltd


PRAFO FAMILY The 652SKG features all the benefits of the PRAFO family with easy adjustment of the dorsiflexion/plantarflexion angle of the posterior upright The 653SKG extends adjustment possibilities even further by including valgus/varus

652SKG

653SKG

Adjustable Dorsiflexion/Plantarflexion

Valgus/Varus and Dorsiflexion/Plantar Flexion Anatomical Concepts (UK) Ltd


PAD & STRAP CONFIGURATION When greater control of the foot and ankle is required during ambulation the Pad & Strap liner can be used

Anatomical Concepts (UK) Ltd


ZERO PRESSURE OR SHEAR Correct fitting ensures no contact between the vulnerable heel and the support surface

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ROTATION BAR The rotation bar prevents any tendancy to internal or external rotation of the limb

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HOW TO FIT A PRAFO Anatomical Concepts (UK) Ltd


BARIATRIC VERSION 752SKT 140 KG WEIGHT LIMIT

See our website for other variations ANATOMICALCONCEPTS.COM

Anatomical Concepts (UK) Ltd


ISSUES TO CONSIDER

MEDICAL Be Aware of the Medical Factors that Influence Risk of Ulceration and Eliminate or Manage These.

MECHANICAL Ideally Eliminate Pressure and Shear at Areas of Risk such as the Heels. This is True for Protection/Prevention as well as for Wound Healing

SCOPE OF REHABILITATION If Early Mobilisation is Intended Then Choose a Device that Maintains Protection During Ambulation Anatomical Concepts (UK) Ltd


ANATOMICAL CONCEPTS

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UNITED STATES Anatomical Concepts Inc. 1399 E. Western Reserve Rd. Poland, OH 44514-3250 anatomicalconceptsinc.com


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