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Research Comparing Three Heel Ulcer-Prevention Devices

Gilcreast, Darlene M.; Warren, Joseph B.; Yoder, Linda H.; Clark, Janis J.; Wilson, Joyce A.; Mays, Mary Z.

Section Editor(s): Doughty, Dorothy MN, RN, FNP, CWOCN, FAAN

Journal of Wound, Ostomy and Continence Nursing: March-April 2005 - Volume 32 - Issue 2 - p 112–120

OBJECTIVE To compare 3 pressure-reduction devices for effectiveness in prevention of heel ulcers in moderate-risk to high-risk patients.

DESIGN A prospective quasi-experimental 3-group design was used.

SETTING AND SUBJECTS A sample of 338 “moderate-risk to high-risk” adult inpatients, ages 18 to 97, at 2 medical centers in South Texas were studied.

INSTRUMENTS The Braden Scale for Pressure Ulcer Risk and investigator-developed history and skin assessment tools were used.

METHODS Subjects were randomly assigned to the High-Cushion Kodel Heel Protector (bunny boot), Egg Crate Heel Lift Positioner (egg crate), or EHOB Foot Waffle Air Cushion (foot waffle). Data are demographics, Braden scores, comorbidities, skin assessments, lengths of stay, and costs of devices. Analyses were Chi-square, analysis of variance, and regression.

RESULTS Of 240 subjects with complete data, 77 (32%) were assigned to the bunny boot group, 87 (36.3%) to the egg crate, and 76 (31.7%) to the foot waffle. Twelve ulcers developed in 240 subjects (5% incidence). Six subjects had only 1 foot. Eleven ulcers were Stage I (nonblanchable erythema), and 1 was Stage II (partial thickness). Overall incidence was 3.9% for the bunny boot, 4.6% for the egg crate, and 6.6% for the foot waffle (not significantly different among groups). The bunny boot with pillows was most cost effective (F[3], N = 240) = 1.342, p ≤ .001).

CONCLUSIONS In this study, the bunny boot was as effective as higher-tech devices. The results, however, were confounded by nurses adding pillows to the bunny boot group.

Darlene M. Gilcreast, PhD, RN, CDE, LTC(Ret), AN, Assistant Professor, University of Texas Health Science Center at San Antonio.

Joseph B. Warren, CWOCN, LTC, AN, USAR, Chief, Wound and Ostomy Service, Brooke Army Medical Center, Fort Sam Houston, Tex.

Linda H. Yoder, PhD, RN, AOCN, COL(Ret), AN, FAAN, Associate Professor, Uniformed Services University of the Health Sciences, Bethesda, Md.

Janis J. Clark, CWOCN, Wilford Hall Medical Center, Lackland AFB, Tex.

Joyce A. Wilson, CWOCN, Chief, Wound, Ostomy & Continence Service, Wilford Hall Medical Center, Lackland AFB, Tex.

Mary Z. Mays, PhD, Statistician, University of Arizona, Medical School, Tucson.

Corresponding author: Darlene M. Gilcreast, PhD, RN, CDE, LTC(Ret), AN, 5647 Wood Climb St, San Antonio, TX 78233-5036 (e-mail: or

Copyright © 2005 by the Wound, Ostomy and Continence Nurses Society