Risk factors for developing heel ulcers for bedridden patients: A finite element study

W.G.H. van Zwam, Mark C. van Turnhout (Corresponding author), Cees W.J. Oomens

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Scopus)
59 Downloads (Pure)


Background: The heel is one of the most common sites of pressure ulcers and the anatomical location with the
highest prevalence of deep tissue injury. Several finite element modeling studies investigate heel ulcers for
bedridden patients. In the current study we have added the implementation of the calf structure to the current
heel models. We tested the effect of foot posture, mattress stiffness, and a lateral calcaneus displacement to the
contact pressure and internal maximum shear strain occurring at the heel.
Methods: A new 3D finite element model is created which includes the heel and calf structure. Sensitivity
analyses are performed for the foot orientation relative to the mattress, the Young's modulus of the mattress, and
a lateral displacement of the calcaneus relative to the other soft tissues in the heel.
Findings: The models predict that a stiffer mattress results in higher contact pressures and internal maximum
shear strains at the heel as well as the calf. An abducted foot posture reduces the internal strains in the heel and a
lateral calcaneus displacement increases the internal maximum shear strains. A parameter study with different
mattress-skin friction coefficients showed that a coefficient below 0.4 decreases the maximum internal shear
strains in all of the used loading conditions.
Interpretation: In clinical practice, it is advised to avoid internal shearing of the calcaneus of patients, and it
could be taken into consideration by medical experts and nurses that a more abducted foot position may reduce
the strains in the heel.
Original languageEnglish
Article number105094
Number of pages8
JournalClinical Biomechanics
Publication statusPublished - 1 Aug 2020


  • Heel ulcers, Pressure ulcers, Heel pressures, Shear forces on heel, Deep tissue injury


Dive into the research topics of 'Risk factors for developing heel ulcers for bedridden patients: A finite element study'. Together they form a unique fingerprint.

Cite this