When pressure is applied to a small area, damage can occur more quickly. This is similar to the way a stiletto heel creates more pressure on a floor than a wider heel because the weight is concentrated in a smaller area.

Why does pressure damage happen?

Skin stretched over a small bony area is more likely to become damaged because pressure is concentrated in one place.

Areas most at risk

Pressure damage commonly develops over bony areas, including:

• heels, feet and toes
• bottom and sitting bones
• spine and lower back
• back of the head
• ears
• hips
• shoulders
• elbows.

Pressure sores

Pressure sores were previously known as bed sores because they were commonly seen in people who spent long periods in bed and were unable to move.

We now use the term pressure sore because pressure damage can affect anyone who remains in the same position for a prolonged period, whether they are in bed or sitting in a chair.

When skin is stretched over a bony area for a long time, pressure can build up and damage the skin and underlying tissue.

Stages of pressure damage

Healthcare professionals assess pressure damage using a grading system.

Stage one

Pressure damages small blood vessels in the skin.

The skin appears red and does not turn pale when pressure is applied.

Stage two

There may be a wound affecting the surface layers of the skin or a clear blister.

Stage three

There may be a deeper wound that extends below the skin surface and may include tunnels beneath the wound.

Stage four

There may be a very deep wound that extends to bone or exposes tendons.

Deep damage

A dark area over a bony prominence may look bruised or feel soft.

This requires urgent assessment by a healthcare professional.

How can pressure damage be prevented?

The most important way to prevent pressure damage is to reduce pressure on bony areas. If we move just a little bit, this stretches a different bit of skin over the bone and gives the first bit a well earned rest.

Changing position allows pressure to be relieved and helps maintain healthy blood flow to the skin.

Aim to change your position at least every 30 minutes where possible.

This can include:

• moving slightly in your chair or bed
• tilting to one side using a thin pillow
• standing up
• lifting your heels off the floor
• positioning your heels so they are free from pressure.

Looking after your heels

If your heels become red:

• raise your legs on a stool when sitting and allow your heels to rest free from pressure
• when in bed, place a pillow lengthways under your calves so your heels do not touch the mattress
• regularly lift your heels off the floor when sitting.

Looking after your skin when sitting or lying down

If your bottom becomes red:

• change your position regularly
• reduce the amount of pressure on the affected area
• use a pillow under one buttock to help redistribute pressure
• change sides at least every 30 minutes if possible.

If redness is caused by moisture, keep the skin clean and dry and speak to your nurse about using a barrier cream.

Pressure-relieving equipment

Specialist foam cushions and mattresses can help spread weight more evenly and reduce the risk of pressure damage. How

ever, they do not replace the need to move regularly.

Moving remains the most important way to prevent pressure damage.

When to seek advice

Please contact a healthcare professional if:

• your skin becomes red or sore
• you notice any open wounds.