Heel ulcers – Pressure ulcers or symptoms of peripheral arterial disease? An exploratory matched case control study. Issue 2 (May 2016) - Twilley, Heidi
Abstract: Aims: To investigate the relationship between pressure ulcers of the heel and peripheral arterial disease (PAD) and determine the feasibility of conducting a statistically powered matched case control study. Background: Evidence indicates a relationship between chronic leg ulcers and vascular disease. The relationship between pressure ulcers of the heel and vascular disease is less well established. Design: A matched case control study. Methods: Data were collected between March 2014 and January 2015. 15 patients identified as having a grade 2, 3 or 4 pressure ulcer of the heel were compared with 15 matched controls without pressure ulcers of the heel. The primary clinical outcome measure was the ankle brachial pressure index (ABPI), where an ABPI <0.9 or >1.3 was considered clinically indicative of PAD. The primary feasibility outcome measure was the rate of recruitment. Results: Eighty seven patients were reported as having foot and heel ulcers; 36 of whom were identified as having pressure ulcers of the heel, 15 (42%) of whom were recruited to the study. Patients presenting with pressure ulcers of the heel were significantly more likely to simultaneously have previously undiagnosed PAD compared with age, gender and ethnicity matched controls without pressure ulcers of the heel (odds ratio: 11, 95% confidence interval 1.99–60.57). Conclusion: The formation of pressure ulcers of the heel could, in some patients, be related to the presence of PAD rather than a consequence of poor quality care. Healthcare professionals should assess the patient to exclude or confirm PAD. Highlights: Patients with heel ulcers are more likely to have underlying PAD than those without. A statistically powered study using a matched case control study could be feasible. PAD should be considered in the assessment of heel ulcers.