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.

All medical devices have indications and contraindications, and the manufacturer always states these clearly. However, not all electrical stimulation devices on the market are classified as medical devices, so the manufacturer may not clearly describe when they might be unsafe to use.

A very common situation we face when dealing with clients is the presence of metal implants such as joint replacements, fracture fixation plates and spinal instrumentation near where we wish to apply electrodes. The concern has been that the energy generated by electrical stimulation over metal implants would cause local, damaging heating within the tissues. We consider this below.

We must follow the manufacturer's recommendations. However, you might wonder about the real risks. Do the benefits of using electrical stimulation outweigh the risks? This article explores this topic.

Recently, I found myself reflecting on the notion of "snake oil salesmen" as I observed a new client navigating their recovery from a spinal cord injury. In their quest for healing, this individual encountered a maze of contradictory advice regarding what recovery was achievable, leading to confusion about their journey. What to trust? Who to believe? What action makes sense?
Some individuals naturally know how to focus on what they can control while releasing the rest. While the future is unpredictable, carefully examining controllable factors, likely outcomes, and strategies to address these variables offers the best chance for success. This approach considers the chain reaction: "If I do X now, then Y will follow, leading to Z." The wise person sets out to carefully define the unknowns in that chain reaction. Carefully filtering the advice offered is a sound step.

Discover the significance and historical importance of World Occupational Therapy (OT) Day along with breakthrough innovations like the Tek RMD and the Carbonhand. Explore the crucial role of OT professionals in empowering patients to enhance independence and the overall quality of life.

Looking for a solution to equinus contractures? Our Dynamic Dorsi-Assist (DDA™) Ankle Foot Orthosis (654SKG) offers innovative orthotic care that is adjustable and personalized to your needs. Our orthotic devices provide immediate relief and support long-term rehabilitation. We also offer a pediatric version of the DDA™, the 554SKG, to extend our impact to patients of all ages.

Discover how to prevent pressure sores on heels in this insightful blog post. Learn about the risk factors, influencing factors and effective prevention tips. Explore the range of heel protectors that offer more than just protection, supporting safe mobilisation and aiding the patient's recovery journey. Available in various sizes and liner interfaces.