Heel Pressure Research Articles

Evaluate the Incidence of Sacral and Heel Pressure Ulcers During Acute Care After SCI

Evaluate the Incidence of Sacral and Heel Pressure Ulcers During Acute Care After SCI

Refining Heel Pressure Injury Risk Factors in the Hospitalized Patient.

To replicate previous research that found four independent and significant predictors of heel pressure injuries (HPIs) in hospitalized patients using a larger and more diverse patient population. Researchers conducted a retrospective, case-control study with a main and a validation analysis (N = 1,937). The main analysis had 1,697 patients: 323 patients who had HPIs and 1,374 who did not. The validation analysis had 240 patients: 80 patients who developed HPIs and 160 who did not. Researchers used a series of diagnosis codes to define variables associated with an HPI. Data were extracted from the New York Statewide Planning and Research Cooperative System for January 2014 to June 2015. Study authors conducted a series of forward stepwise logistic regression analyses for both samples to select the variables that were significantly and independently associated with the development of an HPI in a multivariable setting. Researchers generated a receiver operating characteristic curve using the final model to assess the regression model's ability to predict HPI development. Seven variables were significant and independent predictors associated with HPIs: diabetes mellitus, vascular disease, perfusion issues, impaired nutrition, age, mechanical ventilation, and surgery. The receiver operating characteristic curve demonstrated predictive accuracy of the model. Beyond a risk assessment scale, providers should consider other factors, such as comorbidities, which can predispose patients to HPI development.

Effects of walking speed and slope on pedobarographic findings in young healthy adults.

BackgroundThis study aimed to investigate the effects of walking speed and slope on foot pressure changes in young healthy adults.MethodsTwenty young healthy adults (mean age 22.4 years, SD 1.2 years; 10 male and 10 female) participated in the study. Dynamic pedobarographic data during treadmill walking were obtained for combinations of three different walking speeds (3.2 km/hr, 4.3 km/hr, and 5.4 km/hr) and 5 different slopes (downhill 8 degrees, downhill 4 degrees, ground walking (0 degree), uphill 4 degrees, and uphill 8 degrees). Pedobarographic data such as the peak pressure and pressure–time integral were measured on five plantar segments: medial forefoot (MFF), lateral forefoot (LFF), medial midfoot (MMF), lateral midfoot (LMF), and heel. Maximum ankle dorsiflexion was also recorded using the Plug in Gait marker set.ResultsAll participants maintained heel-toe gait in all walking conditions. The peak pressure on the MFF during downhill slope walking was lower than that during ground and uphill walking, whereas the peak pressure on the MFF during uphill slope walking was similar to that during ground walking at each walking speed. The peak pressures on the heel were similar for different walking slopes at each walking speed. The peak pressures on the MFF and heel increased with an increase in walking speed. The pressure-time integral of the MFF did not show significant changes at different walking speeds and slopes. The pressure-time integral of the heel increased with an increase in walking slope and decrease in walking speed.ConclusionsDifferent walking speeds and slopes affected the pedobarographic characteristics of young healthy adults. Downhill walking with slower speed appeared to be beneficial to reduce or optimize MFF pressures, while downhill walking at a comfortable speed would be helpful to reduce or optimize heel pressures. The findings of this study have clinical implications in recommending activities to patients with foot pressure-related symptoms and disorders.

Prevention of Pressure Ulcers in a Pediatric Cardiac Intensive Care Unit.

Background:Pressure ulcer (PU) is an injury to skin or underlying tissue as a result of pressure or pressure with shear stress. We classify PUs by the level of tissue injury: stage I–IV, unstageable, suspected deep tissue injury. This quality project was aimed to reduce the incidence of PUs > stage II in the cardiothoracic intensive care unit.Methods:We reviewed PUs > stage II from March 2010 to December 2017. Interventions included: PU bundle (April 2010, revised January 2013); multidisciplinary huddles for PUs > stage II (October 2011); multidisciplinary weekly skin rounds (March 2010, revised August 2012); unit specific workgroup (October 2012); caregiver input form (December 2012). The PU bundle included diaper barrier cream, pulse oximeter probe rotation, turning schedule, pressure reduction surfaces, heel pressure release, head of the bed elevation.Results:Between 2010 and 2014, PUs decreased from 15.7 events per 1,000 patient days to a new baseline of 2.9 events per 1,000 patient days. We have sustained this rate for 3 years. PUs related to immobility decreased from 35 in 2010–2011 to 4 in 2016–2017. PU related to medical devices decreased from 34 in 2010–2011 to 15 in 2016–2017.Conclusions:Institution of PU bundle, multidisciplinary weekly skin rounds, and huddles for PUs > stage II reduced PUs related to immobility, allowed for earlier identification of stage II PUs and reduced stage III PUs. Challenges remain in reducing PUs related to medical devices. Importantly, we sustained this improvement over the past 3 years.

Revisiting the dermatomal recruitment of, and pressure-dependent influences on, human eccrine sweating.

Herein we describe two experiments in which the recruitment and pressure-induced modifications of human eccrine sweating were investigated. In one experiment, the longstanding belief that glandular recruitment follows a gradual, caudal-to-rostral (dermatomal) recruitment pattern was re-evaluated. The onset of sweating was simultaneously determined (ventilated capsules) from four spinal (dermatomal) segments (forehead, dorsal hand, lower chest and dorsal foot) during the passive heating of supine participants (N = 8). No evidence was found to support either dermatomal or simultaneous glandular recruitment patterns. Instead, the results were more consistent with individualised (random) patterns of regional activation (P > 0.05), with significant time delays among sites. Such delays in the appearance of discharged sweat may reflect differences in neurotransmitter sensitivity, precursor sweat production or ductal reabsorption. In the second experiment, the pressure-induced hemihidrotic reflex (contralateral sudomotor enhancement) was revisited, using pressures applied over 10 cm2 areas of the chest (left side: 6 N cm-2) and left heel (3 N cm-2) during both supine and seated postures (N = 12). Participants were passively heated and thermally clamped before pressure application. Hemihidrosis was not observed from the contralateral surfaces within the same (chest) or lower spinal segments (abdomen; both P > 0.05) during chest pressure, but a generalised enhancement followed heel pressure when supine. We suggest that previous observations of hemihidrosis possibly resulted from elevated heat storage, rather than a neural reflex. Chest pressure significantly inhibited ipsilateral sweating (forehead, hand, chest; all P < 0.05), and that influence is hypothesised to result from interactions between ascending mechanoreceptor afferents and the descending sudomotor pathways.

Risk Factors Associated With Musculoskeletal Injury: A Prospective Study of British Infantry Recruits.

Musculoskeletal Injury (MSKI), a common problem in both military and physically active civilian populations, has been suggested to result from both extrinsic and intrinsic factors. To investigate prospectively whether gait biomechanics, aerobic fitness levels and smoking status as well as entry military selection test variables can be used to predict MSKI development during recruit training. British infantry male recruits (n = 562) were selected for the study. Plantar pressure variables, smoking habit, aerobic fitness as measured by a 1.5 mile run time and initial military selection test (combination of fitness, Trainability score) were collected prior to commencement of infantry recruit training. Injury data were collected during the 26 week training period. Incidence rate of MSKI over a 26 week training period was 41.28% (95 % CI: 37.28 - 45.40%). The injured group had a higher medial plantar pressure (p < 0.03), shorter time to peak heel rotation (p < 0.02), current smoking status (p < 0.001) and a slower 1.5 mile run time (p < 0.03). In contrast, there were no significant differences (p > 0.23) in lateral heel pressure, age, weight, height, BMI and military selection test. A logistic regression model predicted MSKI significantly (p= 0.03) with an accuracy of 34.50% of all MSK injury and 76.70% of the non-injured group with an overall accuracy of 69.50%. The logistic regression model combining the three risk factors was capable of predicting 34.5% of all MSKI. A specific biomechanical profile, slow 1.5 mile run time and current smoking status were identified as predictors of subsequent MSKI development. The proposed model could include evaluation of other potential risk factors and if validated then further enhance the specificity, sensitivity and applicability.

The role of using a special support surface in heel pressure ulcers appearance in intensive care unit patients

Introduction: Intensive Care Unit (ICU) patients suffer complications such as the development of pressure ulcers. Aim: The purpose of this study was to investigate the relationship between the use of special designed heel protector and the frequency and severity of heel pressure ulcers occurrence in ICU patients. Material and Method: The studied sample consisted of 40 patients hospitalized in ICU of a general hospital in Attica. Hospital Acquired Skin Injury (HASI) and Cubin Jackson (Score Cubin-Jackson) were used and data analysis was performed by the statistical package SPSS 19. Results: 62,5% of the studied sample were men, with mean age 59±17.7 years and length of hospital stay 21.4±18 days. The preventive intervention applied in the present study was effective, as no patient develop pressure ulcers. However, the incidence of tissue lesions at the unstressed edge did not appear to be influenced by factors such as patient age (p = 0.586), gender (p = 0.674 F = 0.180), total blood protein levels (p = 0.732 ), albumin levels (0.185) and hematocrit (p = 0.669). Conclusions: In those patients that the pressure ulcers heel protectors were applied no one develops pressure ulcers during their stay in ICU. On the contrary, in those patients

Impact of rocker sole footwear on plantar pressure distribution during standing and walking in adult obese women

Purpose: Obesity increases the stresses applied to the foot. Ergonomic rocker sole shoes increase energy expenditure of standing and walking in obese individuals but could potentially alter plantar pressure distribution. The aim of this study was to compare plantar pressure distribution during standing and walking between rocker sole and flat-bottomed shoes in obese subjects.Methods: Twenty adult obese women were asked to stand quietly and to walk at their preferred walking speed whilst wearing flat-bottomed or rocker sole shoes. Plantar pressure distribution was assessed using instrumented insoles.Results: During standing, toe pressure and as well as midfoot force were higher with rocker sole than with flat-bottomed shoes (p < 0.05). During walking with rocker sole shoes, mean pressure and maximal force were lower under the toes and the forefoot, but higher under the midfoot and rearfoot regions with respect to flat-bottomed shoes (p < 0.05).Conclusions: While standing with rocker sole shoes, obese subjects showed augmented pressure under the toes whereas forefoot and heel pressure had no significant difference compared to the flat-bottomed shoes. As walking with rocker sole shoes resulted in decreased forces and pressures under the forefoot but increased overload at heel and midfoot regions, obese individuals may not benefit from wearing rocker sole shoes during walking, at least from a plantar pressure distribution perspective.Implications for rehabilitationThe use of ergonomic rocker sole shoes causes a redistribution of in-shoe plantar pressures leading to potentially detrimental adjustments that fail to attenuate the obesity-related increase in midfoot pressure during standing, while accentuating this region-specific impairment in dynamic conditions.Rocker sole shoes may best be avoided for walking in obese patients with heel pain or with any midfoot/rearfoot alteration such as medial arch flattening.

Slow velocity of the center of pressure and high heel pressures may increase the risk of Sever\u2019s disease: a case-control study

BackgroundThis study determined if the body mass index, dynamic plantar-pressures, plantar surface contact-area, velocity of the centre of pressure (COP), gastrocnemius equinus, and gastrocnemius soleus equines are related to calcaneal apophysitis (Sever’s disease) in athletic children.MethodsThis case-control study examined 106 boys enrolled in a soccer academy, including 53 with Sever’s disease and 53 age-matched healthy controls. The dynamic average and maximum peak plantar-pressures, plantar surface contact-area, and velocity of the COP were evaluated with a digital pressure sensor platform. Goniometry was used to measure the ankle dorsiflexion range of motion and thereby identify gastrocnemius equinus and gastrocnemius soleus equinus.ResultsParticipants with Sever’s condition had significantly higher BMI and peak plantar-pressures (maximum and average) at the heel (Cohen’s d > 3 for pressures) than the controls. Those with Sever’s disease also had significantly slower velocity of the COP (Cohen’s d > 3). Boys with Sever’s disease were also 8 times more likely to have bilateral gastrocnemius equinus than disease controls.ConclusionsHigh heel plantar pressure and low velocity of COP are related to Sever’s condition in boys, although it is not clear whether these factors predispose individuals to the disease or are consequences of the disease. Gastrocnemius ankle equinus could be a predisposing factor for Sever’s condition.

Free flap and kickstand external fixator in foot and ankle soft tissue reconstruction. The versatility of a microsurgical-friendly application of an orthopedic device

IntroductionFoot and ankle are prone to injuries and often require free flap for complex soft tissue reconstruction due to the insufficiency of local soft tissue. Lower limb reconstruction can be commonly compromised by venous insufficiency, and the elevation of the limb represents a critical component of the postoperative care. This study aims to explore the versatility of combining free soft tissue flap reconstruction for complex foot and ankle defect with a temporary Kickstands External Fixator (KEF) placement. Materials and methodsA retrospective analysis was performed on 14 patients with unilateral foot or ankle complex soft tissue defects (post-traumatic, soft tissue infection and osteomyelitis, chronic skin ulcer, sarcoma), treated with free flap and KEF placement. Patients’ demographics, etiology of injury, type of reconstruction, duration of KEF, complications related to the flap and the KEF placement were recorded. ResultsThe mean age of patients was 52.57-year-old (range 35–68). The average follow up was 15.5 months (range: 3–25). An anterolateral thigh (ALT) flap was performed in 12 patients; 2 patients received composite forearm free flap plus flexor carpalis radial for Achilles tendon reconstruction. The average time for KEF removal was 378 weeks. All flaps survived, though partial necrosis was observed in 1 case. No complication at the flap donor site or related to the KEF placement was observed. No equinus deformity was reported. ConclusionThe KEF placement when performing a complex soft tissue free flap reconstruction of foot and ankle could be an effective method to guarantee limb elevation, avoid pressure on the flap especially in posterior reconstructions, avoid heel pressure ulcer formation and equinus deformity.

CHARACTERISTICS OF FOOT ARCHES AND FOOT PRESSURE DISTRIBUTION IN 10-11-YEAR-OLD MALE SOCCER PLAYERS

Aim. The aim of the study was to compare the longitudinal arch of the foot and foot pressure distribution (FPD) parameters in young male soccer players and controls. Methods. A group of 50 soccer players and 50 non-training controls participated in the project. Their height and weight were measured, and body fat percentage (BFP) and BMI calculated. The height of foot arches and FPD were examined. Results. Participants did not differ with age, height or BMI. However, soccer players were significantly lighter and had smaller BFP. The mean Arch Index (AI) was similar in both groups but more soccer players had very high foot arches whereas more controls a low longitudinal arch of the foot. Normal arches prevailed in controls. The AI became greater with the increase of BMI, both in soccer players and in controls. FPD was greater in controls on the head of the first metatarsal bone, whereas in soccer players on the head of the fifth metatarsal bone. A significantly greater FPD on the medial heel was found in both groups as compared to the lateral heel pressure, which was greater in controls. Conclusions. Regular soccer training changed FPD but affected the longitudinal arch of the foot less distinctly. Soccer training cannot be treated as an element supporting the process of proper foot formation in children.

Preventing the development of heel pressure ulcers.

The heel is a common site for pressure ulcer development, particularly in people who are supine or semi-recumbent because of immobility. There is little protective subcutaneous tissue and no muscle or fascia within the heel, which means that it is vulnerable to pressure, friction and shear forces. Heel pressure ulceration remains a clinical challenge for nurses and the wider healthcare team, as well as a cause of pain and physical debilitation for the patient. This article examines the risk factors for heel pressure ulceration, and details patient assessment and specific measures that can be undertaken to prevent the development of heel pressure ulcers.

Pedobarographic and stabilometric analysis and exercises for children with recurrent ankle haemarthrosis

Background/Aims: To investigate the dynamic plantar loading characteristics, postural stability and the effectiveness of an exercise programme in children with recurrent ankle haemarthrosis. Methods: In an exploratory study, 56 children with haemophilia (Group A) and 23 typically developing children (Group B) were initially assessed. Group A received a progressive exercise programme twice a week for 6 weeks in succession. Midstance plantar loading and the dynamic limit of stability were measured using Tekscan HR MatTM pressure measurement system and Biodex Balance System respectively. Findings: Heel pressure in Group A was significantly lower than Group B (P&lt;0.05), whereas mid-foot, forefoot, and hallux pressure were significantly higher (P&lt;0.05). Also, Group A showed poorer postural stability (P&lt;0.05). Furthermore, a significant correlation between postural stability and plantar loading measures was indicated in Group A. Following the completion of 6 weeks of exercises, the plantar pressure (except the medial mid-foot) and postural stability (except the mediolateral stability) for Group A were not significantly different in comparison to Group B (P&gt;0.05). Conclusion: Dynamic plantar loading provides a potentially valuable directory for the clinicians to understand variations of postural stability in children with ankle haemarthrosis. Further, adherence to a 6-week exercise rehabilitation programme might be helpful.

Prevention of heel pressure ulcers among adult patients in orthopaedic wards: an evidence-based implementation project

BackgroundImmobility and prolonged bed rest often lead to heel pressure ulcers in patients. A point prevalence audit undertaken in the orthopaedic wards of a Singapore tertiary hospital reported that 6 out of 30 patients who were audited had mild to blanching redness on their heels. AimsThe evidence-based project sought to achieve 80% compliance from nurses to perform heel off-loading practice and a 50% reduction in the occurrence of heel pressure ulcers. MethodsThe project, lasting two years, was undertaken in two orthopaedic wards and utilized a pre- and post-implementation audit strategy using the Joanna Briggs Institute on-line 'Practical Application of Clinical Evidence System' and 'Getting Research into Practice' programs. Implementation occurred in four phases and involved a sample consisting of 30 adult patients. ResultsNurses’ compliance with performing heel off-loading techniques increased. The post-implementation audit showed 93.3% compliance of nurses undertaking heel off-loading techniques in the subsequent four follow-up audits. Meanwhile, the compliance with documentation increased from 63.3% to 86.7%. The project resulted in more than 50% reduction in stage one heel pressure ulcers. ConclusionThe implementation of heel off-loading techniques significantly reduced the incidences of heel pressure ulcers in orthopaedic wards.

Priority issues for pressure injury research: An Australian consensus study.

Pressure injuries are a significant health concern in all clinical settings. The current body of research on pressure injuries reported in the literature presents primarily low level evidence. The purpose of the current study was to identify and prioritize pressure injury research issues. The approach entailed evidence scoping and implementing a formal consensus process using a modified nominal group technique based on the Research and Development/University of California at Los Angeles appropriateness method. Sixteen Australian pressure injury experts participated in five consensus voting rounds in May to June 2015. From 60 initial research issues, the experts reached agreement that 26 issues are a priority for future pressure injury research. The highest priorities were strategies to assess skin and tissues, appropriate outcome measures for indicators of pressure injury healing and recurrence, heel pressure off-loading and shear reduction strategies, economic cost of pressure injuries and their management and effectiveness of skin moisturizers and barrier products. Developing a prioritized research agenda, informed by clinical and academic pressure injury experts, can assist in reducing the burden of pressure injuries by identifying topics of the highest need for further research. A web-based nominal group voting process was successful in engaging expert decision-making and has wide-reaching international appeal in facilitating cost-effective consensus methodologies. The priority list generated from this research is currently used in Australia to inform government investment in pressure injury research.

Can an off-the-rack orthotic stiletto alter pressure and comfort scores in the forefoot, arch and heel?

The study sought to investigate whether an orthotic stiletto could modulate the pressure and comfort under the forefoot, arch and heel that stiletto wearers experience. Twenty-two women participated. We measured the peak pressure and pressure-time integral for orthotic stilettos with built-in metatarsal pad, heel cup and arch support; standard stilettos without inlays; and trainers. Comfort was recorded during 3 × 3 working days. The orthotic stiletto exhibited lower metatarsal head1 (MTH) and MTH2+3 and heel pressures than the standard stiletto (p < .01), and a long second metatarsal increased MTH2+3 pressure (p < .01). The comfort in the forefoot and heel was higher in the orthotic stiletto than in the standard one (p < .01), and comfort in the forefoot was correlated to the pressure-time integral of MTH2+3 (p = .03) and not peak pressure. Off-the-rack orthotic stilettos can notably reduce plantar pressures and improve forefoot and heel comfort during everyday use.Practitioner Summary: Off-the-rack orthotic stilettos with built-in metatarsal pad, arch support and heel caps can lower the pressure under the heel and forefoot in comparison with a standard stiletto and can improve comfort during everyday use. Having a long second metatarsal is a risk factor for increased forefoot pressure.

Do Prophylactic Foam Dressings Reduce Heel Pressure Injuries?

The purpose of this evidence-based report card is to examine the evidence and provide recommendations related to the effectiveness of prophylactic foam dressings in reducing heel pressure injuries. Do prophylactic foam dressings applied to the heel reduce heel pressure injuries for patients in the acute care setting? A search of the literature was performed by a trained university librarian that resulted in 56 articles that examined pressure injury, prevention, and prophylactic dressings. A systematic approach was used to review titles, abstracts, and text, yielding 13 studies that met inclusion criteria. Strength of the evidence was rated based on the methodology from Essential Evidence Plus: Levels of Evidence and Oxford Center for Evidence-Based Medicine. Thirteen studies were identified that met inclusion criteria; 1 was a randomized controlled trial, 2 were systematic reviews, 3 quasi-experimental cohort studies, 1 quality improvement study, 1 case series, 1 scoping review, 1 consensus panel, and 3 bench studies. All of the studies identified suggest that the use of prophylactic foam dressings reduces the development of pressure injuries on the heel when used in conjunction with a pressure injury prevention program. The strength of the evidence for the identified studies was level 1 (4 level A, 4 level B, and 5 level C). The use of prophylactic multilayer foam dressings applied to the heels, in conjunction with an evidence-based pressure injury prevention program, is recommended for prevention of pressure injuries on the heel (SORT level 1).

Subepidermal moisture detection of heel pressure injury: The pressure ulcer detection study outcomes.

We examined subepidermal moisture (SEM) and visual skin assessment of heel pressure injury (PrI) among 417 nursing home residents in 19 facilities over 16 weeks. Participants were older (mean age 77 years), 58% were female, over half were ethnic minorities (29% African American, 12% Asian American, 21% Hispanic), and at risk for PrI (mean Braden Scale Risk score = 15.6). Blinded concurrent visual assessments and SEM measurements were obtained at heels weekly. Visual skin damage was categorised as normal, erythema, stage 1 PrI, deep tissue injury (DTI) or stage 2 or greater PrI. PrI incidence was 76%. Off-loading occurred with pillows (76% of residents) rather than heel boots (21%) and often for those with DTI (91%). Subepidermal moisture was measured with a device where higher readings indicate greater moisture (range: 0-70 tissue dielectric constant), with normal skin values significantly different from values in the presence of skin damage. Subepidermal moisture was associated with concurrent damage and damage 1 week later in generalised multinomial logistic models adjusting for age, diabetes and function. Subepidermal moisture detected DTI and differentiated those that resolved, remained and deteriorated over 16 weeks. Subepidermal moisture may be an objective method for detecting PrI.

The effect of eliminating leg length difference on plantar foot pressure distribution in patients wearing forefoot offloading shoe

Background and purposeElevated heel construction offloads the forefoot after surgery. However, side-to-side height difference alters limb kinetics, whereas leg-length equalizing-sole at non-operated side may have beneficial effects on foot loading. The purpose of this study was to characterize leg-length equalizing sole effect on bilateral plantar pressures when using heel-lift forefoot-offloading shoe. Materials and methodsTwenty men were tested walking. Plantar peak pressures (PP) and pressure-time integrals (PTI) in the forefoot-offloading shoe and in contralateral running shoe were compared between two conditions: one with- and the other without leg-length equalizing sole elevation at the running shoe. ResultsAdding leg-length equalizing sole to the running shoe resulted in the following changes in the forefoot-offloading shoe: increased lateral midfoot PP (8.7%, p=0.03), increased lateral midfoot (11.3%, p=0.05) and lateral metatarsals PTI (10.3%, p=0.04), and decreased medial and lateral heel PTI (>5%, p=0.02). These changes were non-significant when applying a Bonferroni correction. Changes in the running shoe were: increased medial midfoot (20.5%, p=0.03) and decreased 2nd and lateral metatarsals PP (23%, p<0.01). PTI increased in medial and lateral heel (>25%, p<0.01), medial midfoot (63.2%, p<0.01) and lateral midfoot (9.2%, p=0.04) and decreased in 2nd and lateral metatarsals (>24.5%, p<0.01). ConclusionLeg-length equalizing sole at contralateral running shoe in subjects wearing forefoot-offloading shoe results in lateral load shift alongside heel pressure attenuation within the forefoot-offloading shoe, which is beneficial during first month after medial forefoot surgery. Reciprocal medial load-shift in the elevated running shoe itself should yet be considered when bilateral medial forefoot pathology is present.

A Novel Casting Technique for Tongue-Type Calcaneus Fractures With Soft Tissue Compromise

Displaced calcaneal fractures encompass a spectrum of fracture patterns, many of which are associated with soft tissue complications. Displaced tongue-type calcaneal fractures often cause pressure on the posterior heel skin, particularly when treatment is delayed. Resultant partial- or full-thickness skin necrosis presents significant challenges to the treating surgeon. In this article, the authors report on a case of full-thickness skin necrosis associated with a displaced tongue-type calcaneus fracture. The authors describe the use of a specialized heel window casting technique, which eliminates posterior heel pressure and greatly facilitates soft tissue surveillance and local wound care. The article also reviews the literature on soft tissue complications associated with displaced calcaneus fractures.