Casting Technique for Off-Loading of Posterior Heel Pressure Ulcerations

Introduction: Posterior heel pressure ulcerations are a common problem seen both in the clinic and in the hospital setting. This type of ulceration can cause necrosis of soft tissue and bone to the posterior heel, which can have devastating consequences. We believe that this technique provides an effective adjunctive treatment for posterior heel pressure ulcerations. Methods: In this paper, we present a casting technique to provide intrinsic off-loading to the heel while maintaining optimal soft tissue and bone positioning. Discussion: The primary author and senior author have had success employing this technique in patients that suffer from posterior heel pressure ulcerations. Applying maximal plantarflexion allows for relaxation of the soft tissues to the posterior heel and reduces tension on wound edges. This technique also allows for the correction of combined soft tissue and bony pathology, increasing stability and reducing the progression of deformity. This technique may in turn offer an approach to reduce the risk of osteomyelitis of the calcaneus, reducing the risk of higher-level amputation and ultimately reducing morbidity and mortality rates in our wound care patients.