In 1994, I was visiting the Cleveland Clinic and saw a product design I came to know as the PRAFO (pressure relief ankle-foot orthosis). I recognised this as a practical orthosis being used to reduce the risk of heel pressure ulcers developing in at-risk patients following orthopaedic procedures. It's true that I liked the concept so much that we created a company, Anatomical Concepts (UK), to bring the products to the UK. Thirty years have now gone by, and we still deal with the PRAFO range. We still see the challenge that heel pressure ulcers present to affected individuals and our healthcare systems. For decades, we've emphasised prevention, yet acquired ulcers remain a widespread problem. We have some understanding of the mechanical and medical factors that heighten risk and lead to pressure ulcers, but something is missing.

Recent NHS pathway updates include important changes to pressure ulcer prevention guidance, particularly around heel protection and offloading. This article explains the key updates, how they align with current evidence, and the practical implications for services reviewing prevention strategies. It also clarifies the difference between products that reduce pressure and those that fully offload the heel.