PRAFO, Pressure Ulcers, Guidelines Derek Jones PRAFO, Pressure Ulcers, Guidelines Derek Jones

The NHS is updating its pressure ulcer pathways — here's what's changed

The new international guideline on pressure injuries has some uncomfortable truths about heel protection. For years, clinicians have used whatever was to hand—pillows, fluid-filled gloves, sheepskin, egg-crate foam. The thinking was simple: something soft under the heel is better than nothing. It seemed reasonable. It felt proactive. The evidence says otherwise.

The 2025 International Pressure Injury Guideline—the fourth edition produced jointly by NPIAP, EPUAP, and PPPIA—includes a dedicated chapter on heels for the first time. It replaces the 2019 third edition and is explicit about what doesn't work: methods that many clinical settings still rely on daily.

New guidelines recognise the importance of mechanical factors

Importantly for those of us working in UK healthcare, the National Wound Care Strategy Programme and local NHS policies are already updating their pressure ulcer pathways against these recommendations.

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