“Heel ulcers: pressure ulcers or symptoms of underlying PAD?“
Research type
Research Study
Full title
What is the incidence of Peripheral Arterial Disease (PAD)in hospital/in-patient unit patients and what is the incidence of PAD in hospital/in-patient unit population presenting with heel ulcers?
IRAS ID
121907
Contact name
Michael Clark
Contact email
Research summary
Pressure ulcers (PRUs) are common, painful, debilitating complications that reduce the quality of life for patients. They are also costly to the NHS.\n\nThe National Patient Safety Agency (NPSA) states that pressure ulcers are preventable, which implies that most pressure ulcers are failure of good nursing care.The Declaration of Rio de Janairo on Pressure Ulcer Prevention (2011) states there is scientific evidence that the lesions can be 95 % prevented. \n\nNational leg ulcer guidelines recognise that peripheral arterial disease (PAD) is an underlying cause for approximately 20 % of all leg ulcers and recommend the use of Doppler Ultrasound to establish the Ankle Brachial Pressure Index (ABPI), a reliable diagnostic as well as prognostic tool and gold standard for the assessment of leg ulcers. \n\nPAD is a progressive, degenerative disease that leads to the occlusion of small arteries through the development of fatty plaques. Over time the plaques harden (atherosclerosis). PAD is life style related (smoking, obesity, hypertension and diabetes) and associated with increased risk of heart attacks and strokes. However, PAD is asymptomatic in 80% of patients and increases with age. \n\nPAD is recognised as a risk factor in pressure ulcer development, however, national guidelines do not stipulate the active exclusion of PAD in patients with heel ulcers. Although heel ulcers are also part of the leg, historically they have been perceived and assumed to be “pressure ulcers” rather than “leg ulcers”, as the heel is particularly susceptible to pressure.\n\nThe case matched control study will recruit participants in community hospitals, presenting with heel pressure ulcers (experimental group) and without heel ulcers (matched control group: age, sex) and measure the ABPI to confirm the presence or absence (correlation) of PAD and heel ulcers. The data collection will last one year. \n
REC name
West Midlands - South Birmingham Research Ethics Committee
REC reference
14/WM/0047
Date of REC Opinion
11 Mar 2014
REC opinion
Further Information Favourable Opinion