What types of boots are used for managing pressure ulcers?

Types of Boots for Pressure Ulcer Management

For pressure ulcer prevention, heel suspension boots that completely elevate the heel off the bed surface are the most effective option, with the Heelift Suspension Boot demonstrating superior pressure relief compared to standard interventions. 1, 2

Evidence-Based Boot Selection

Primary Recommendation: Heel Suspension Devices

• Heel suspension boots that completely eliminate heel contact with the bed surface provide the most effective pressure relief and should be the first-line choice for pressure ulcer prevention 3
• The Heelift Suspension Boot (DM Systems) specifically demonstrated no increased adverse events compared to standard care in clinical trials 1
• A comparative study showed the Heelift suspension boot was significantly more effective than intravenous bags for heel pressure relief in orthopedic patients 2

Alternative Boot Options

• Foam heel suspenders that completely eliminate contact between the heel and bed are highly effective at decreasing pressure concentration 3
• Space boots and foam heel protectors provide moderate protection, performing better than sheepskin or polyester heel protectors 3
• Low-friction fabric bootees (such as Parafricta) reduced heel ulcers by 78% over two years by addressing friction and shear forces, particularly for grade 2 heel ulcers 4
• High-cushion Kodel heel protectors ("bunny boots") showed 3.9% ulcer incidence and were the most cost-effective option when combined with pillows 5

Specialized Boots for Diabetic Foot Ulcers

While the question addresses pressure ulcers generally, diabetic foot ulcers require different offloading approaches:

• Removable cast boots/walkers: Prefabricated knee-high boots with rocker or roller outsole, padded interior, and adjustable insoles 1
• Non-removable cast walkers: Same as removable boots but wrapped with fiberglass to ensure compliance 1
• Ransart boots: Removable fiberglass boots with total contact plantar surface and windows cut over ulcer areas 1
• Scotch-cast boots: Removable padded casts with windows over ulcers; for large heel ulcers, a removable heel cap is added 1

Critical Implementation Points

Proper Use Requirements

• Visual and tactile pressure checks must be performed at least once daily, even when using specialized boots 6, 7
• Repositioning every 2-4 hours remains necessary despite boot use, as boots alone do not eliminate the need for position changes 6
• Boots must elevate the heel completely off the underlying surface while preventing foot-drop and leg rotation 8

Common Pitfalls to Avoid

• Do not rely solely on standard foam pillows - dedicated heel protection devices provide superior pressure relief 3, 8
• Avoid devices that only reduce pressure without eliminating heel contact - complete elevation is more effective 3
• Do not use below-ankle offloading devices as primary treatment for pressure ulcers, as they provide inadequate immobilization 9
• Standard wheelchair cushions should never substitute for specialized pressure-relief cushions in patients with existing stage 4 ulcers 7

Evidence Quality Considerations

The American College of Physicians guidelines note that evidence for heel supports and boots shows mixed results with low-quality evidence overall 1. However, individual studies demonstrate clear superiority of suspension-type devices over standard interventions 3, 2. The most recent evidence (2024) from the International Working Group on the Diabetic Foot emphasizes therapeutic footwear for diabetic ulcers but does not specifically address general pressure ulcer boots 1.

Multicomponent Approach

• Combine boot use with early mobilization as soon as medically stable 6
• Use additional pressure discharge tools such as pillows or foam to avoid interosseous contact in other areas 6
• Consider multicomponent interventions including standardized prevention protocols alongside boot use 6