Heel necrosis is an area of ulceration and dead tissue caused by unrelieved pressure on the heel. Fat pads are located beneath the heel bone of each foot and serve as shock absorbers when running, exercising or walking. When these tissues break down, you can develop necrosis of the heel fat pad, also known as heel pressure ulcers. Heel necrosis is a serious condition and should be evaluated by a physician immediately.
Causes
Heel pressure ulcers occur when sustained pressure cuts off circulation to the heel area. Without adequate blood flow and oxygen, the fatty tissue that makes up the heel fat pad becomes necrotic and dies. According to Medline Plus, risk factors for pressure ulcers include being bedridden or in a wheel chair, diabetes, vascular disease, immobility and malnourishment. Those who are immobile and diabetic are at the greatest risk for heel necrosis due to reduced blood flow to the feet. Thinning of the heel fat pad also increases your risk of developing heel necrosis.
Symptoms
Pressure sores fall into different categories based on their severity, according to the Mayo Clinic. Heel pressure ulcers often start as reddened areas, but can quickly progress to advanced-stage, necrotic tissue. Necrotic ulcers affect all layers of the skin and also involve underlying tissues, such as the fat pad of the heel, tendons, joints, muscles and even bone. At this stage, the upper layers of skin often appear bright red with blackened areas due to tissue death. Necrotic heel ulcers often have a crater-like appearance, or may appear small on the surface with a broader area of tissue damage below. Because of this reason, surface size is often misleading. Signs of wound infection include redness, warmth and a yellow or green discharge. Report symptoms of infection immediately.
Treatment
The Merck Manuals Online Medical Library states that pressure reduction is an important part of treatment and is accomplished through frequent repositioning of the patient, adding protective padding to the heels, and using special support devices to reduce heel pressure. Necrotic pressure ulcers involving fatty tissue often take many weeks or even months to heal. Ulcer care includes the cleaning, debridement and dressing of necrotic heel ulcers. Debridement is the removal of dead tissue in the wound to allow for new tissue to grow. Use heel protectors made of soft foam or gel to cradle the fatty tissue of the heel and reduce pressure on the necrotic ulcer, allowing it to heal faster.
Prevention
Avoid prolonged pressure on any part of your heels and keep your feet clean and dry. If you must spend time in bed or in a wheel chair, reposition your legs often to avoid pressure on your heels. Inspect your heels daily for areas of redness, tenderness or changes in color. Maintain a nutritious diet and use a pressure-reducing pillow under your heels when sleeping. Work with your doctor to develop a plan to prevent necrosis of the heel fat pad and other foot pressure ulcers.
