# Pressure ulcers > A pressure ulcer (also called a pressure injury, pressure sore or bedsore) is damage to the skin and the tissue under it, caused by sustained pressure, usually over bony areas such as the heels, hips and tailbone. Pressure-relieving surfaces, daily skin checks and staying active help lower the risk, and infected or deep ulcers need more care. Guide in [Wounds and ulcers](https://footanklelowerlimb.com.au/learn/topics/wounds-and-ulcers), from Foot Ankle Lower Limb: https://footanklelowerlimb.com.au/learn/pressure-ulcer Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod (Podiatrist) on 11 November 2026. Next review by 11 November 2027. - **It's damage from pressure.** Sustained pressure, shear or friction harms the skin and the tissue under it, usually over bony areas such as the heels, hips and tailbone. - **Early skin changes matter.** Skin over a bony area that stays red or darker when pressed can be early damage. - **Prevention and early care overlap.** A pressure-relieving surface, daily skin checks, staying active and good nutrition all help. - **Infection is the main complication.** It can spread to deeper tissue, including bone. - **Feet and heels need particular attention,** especially with diabetes, reduced feeling or poor circulation. ## What is a pressure ulcer, and how common is it? A pressure ulcer is damage to the skin and the tissue under it, usually over a bony area or under a medical device [1]. It's also called a pressure sore, bedsore or decubitus ulcer [2]. The clinical term is pressure injury, which replaced "ulcer" in a 2016 update to the staging system, so you'll see both names [3]. It can look like unbroken skin with redness that stays when pressed, or a blister. At the other end it can be an open ulcer that reaches muscle and bone [1]. Over one in ten adults in hospital have a pressure injury, and most of those that are staged are in the early stages [4]. They also affect people living at home and in long-term care [5]. ## What causes pressure ulcers, and who gets them? They form when sustained pressure on one part of the body interrupts the blood supply to the skin, so the tissue is injured and in time can die [6]. Pressure, shear (a dragging force on the skin) or friction can all cause this [2]. How much harm results depends on how strong the pressure is, how long it lasts and how well the tissue tolerates it [1]. They usually form over bony parts such as the heels, elbows, hips and tailbone [7]. People most likely to get them move less, have reduced feeling or poor circulation, or have fragile skin [5]. Being seriously ill or having a neurological problem, such as a spinal cord injury, also raises the likelihood [2]. Older people and anyone who stays in a bed or chair can develop sores quickly [8]. Among older people in hospital, being older, being immobile, incontinence, poor nutrition and diabetes are all linked with pressure injuries [9]. These are links, not proof of cause. In adults with a spinal cord injury, the tailbone area is the most common site, followed by the sitting bones and the heel [10]. If someone has urinary or faecal incontinence, it's worth paying particular attention to the skin around the anus and buttocks. ## What do pressure ulcers look like, and what can make them serious? Early on, the skin over a bony area looks red or darker and stays that colour when pressed lightly [11]. On brown or black skin the patch can look purple or blue [7]. The area may feel warm, hard or spongy, and you may notice pain, tenderness, itching or tingling [7][11]. Skin can also look shiny, blistered or bruised, or become cracked [6]. Tissue changes can begin before anything shows on the surface [3]. In adults, the tailbone area and the heels are most often affected. The sitting bones are often affected in people who sit a lot, and the hip in people who lie on their side [1]. Sources number the stages differently (grades I to IV, or stages 1 to 4), so labels can vary [3][8]. A clinician looks at the skin and weighs up your risk. Guidelines advise a risk assessment, though that advice is weak [12]. Formal risk scoring tools haven't been shown to be very accurate [5], and in a good-quality trial they didn't lower the number of new ulcers compared with a nurse's judgement [13]. **Features that mark an ulcer as more serious** An ulcer can become infected. The infection can spread to the skin (cellulitis), the blood (septicaemia), or muscle and bone (osteomyelitis), and it can be life-threatening [6]. Untreated sores can also lead to an abscess (a collection of pus) [8]. Signs of infection include hot, swollen or red skin (blue or purple on brown or black skin), pus, a high temperature, and severe or worsening pain [7]. Infection that progresses quickly, or doesn't respond to oral antibiotics, can signal deep or spreading infection [14]. Deep or fast-moving damage is also more serious. Examples are several deep ulcers, ulcers that can't be staged, wounds that are getting worse quickly, and lower-leg cellulitis with extensive tissue destruction [15]. Pressure injuries on the feet or Achilles can sit alongside nerve damage (neuropathy), diabetes, infection, deformity, gangrene or weak pulses [14]. Exposed bone in a long-standing ulcer over the tailbone doesn't always mean the bone is infected, and MRI can wrongly suggest it. Bone biopsy is the gold standard for confirming bone infection [16][17]. ## What helps first? For people at higher risk, guidelines strongly recommend an advanced static mattress or mattress overlay, a type of pressure-relieving surface [12]. This lowers the risk of an ulcer forming; it isn't a treatment for one that's already there. It isn't clear yet how much other preventive measures add beyond usual care [13]. Everyday steps are sensible alongside this: - **Check your skin** at least daily for redness or discolouration [8]. - **Keep skin at the right moisture level.** Skin that's too dry or too moist is damaged more easily [8]. - **Keep active** and move as much as you can [6]. - **Eat a variety of nutritious foods,** including plenty of fruit and vegetables, drink plenty of fluids and avoid smoking [6]. - **Avoid firm massage** over bony areas [6]. Ulcers are generally best managed when they're found early [7]. > [!tip] Try this > Once a day, look and feel over the bony areas: heels, hips, tailbone and elbows. Look for red or darker patches that stay the same colour when pressed, and for warmth, hardness, blisters or cracks. If you can't see an area, a hand mirror or another person can help. ## What helps if that isn't enough? When an ulcer is infected or deep, care goes beyond self-care. For an acute soft tissue infection spreading from the ulcer, a short antibiotic course of up to a week may be used. Longer courses add side effects, secondary infections and resistant bacteria without extra benefit [17]. If bone infection is suspected, antibiotics are usually held until a bone biopsy (a small sample of bone) is done, unless there's sepsis or another urgent reason [17]. Deep or fast-moving wounds are the kind a wound-care team gets involved with. Cellulitis with extensive tissue destruction can need debridement (removal of damaged tissue) [15]. For a pressure injury on the foot or Achilles, care includes checking for the conditions listed above, and a high-risk foot service may be involved [14]. ## What affects recovery, and how can I stop it coming back? A stage number isn't a fixed path. Pressure injuries don't reliably move in a straight line from stage 1 to stage 4: a stage 3 didn't necessarily start as a stage 1, and a stage 1 won't inevitably become a stage 4 [3]. How long healing takes isn't clear yet, so a new skin change over a bony area counts whatever its stage. The steps above are also what help keep pressure ulcers from coming back: a pressure-relieving surface if you're at higher risk [12], daily skin checks, staying active, eating well and keeping skin neither too dry nor too moist. Formal risk assessment is advised, but it isn't clear that using risk tools lowers the number of new ulcers [12][13]. ## Common questions ### Are a pressure ulcer, pressure injury, pressure sore and bedsore the same thing? Yes. They're different names for damage to the skin and underlying tissue caused by pressure, shear or friction. Pressure injury is the newer clinical term, used because early stages have no open wound. Pressure sore, bedsore and decubitus ulcer are older or everyday names, and you'll see all of them in use. ### What are the stages of a pressure ulcer? Stages describe how deep the damage goes. Some sources use grades I to IV, from discoloured skin (usually red, blue, purple or black) to tissue death or damage reaching tendon, joint or bone. A 2016 revision uses numerals 1 to 4 instead, so labels differ between sources. The stages don't always progress in order. ### What should I check on my feet if I'm at risk? Heels are among the most commonly affected spots. Look at the heels and the Achilles area for colour changes that stay when pressed, warmth, hardness, blisters or cracks, and notice new pain, tenderness, itching or tingling. Reduced feeling, diabetes and poor circulation make pressure injuries more likely, so those feet are worth checking daily. ## Further reading - [Pressure ulcers on Clindice](https://clindice.com/pressure-ulcer) - [Pressure ulcer (pressure sore) prevention - University Hospitals Sussex NHS Foundation Trust](https://www.uhsussex.nhs.uk/resources/pressure-ulcer-pressure-sore-prevention/), NHS - [Stop, plan, prevent!](https://www.leicspart.nhs.uk/wp-content/uploads/2025/03/613-Pressure-ulcer-self-help-guide-v4-Sept24-REVIEW-SEPT-2026.pdf), NHS - [Pressure ulcers: prevention and treatment](https://www.rbht.nhs.uk/sites/default/files/Leaflets/NHS%20net%20updated%20leaflets/Pressure%20ulcers%20prevention%20and%20treatment%20(adults)%20-%20March%202022%20net.pdf), NHS - [Pressure ulcers – a guide for patients and carers - The Dudley Group NHS Foundation Trust](https://www.dgft.nhs.uk/pil/pressure-ulcers-a-guide-for-patients-and-carers/), NHS - [Pressure ulcers](https://oxfordhealth.nhs.uk/tissue-viability/conditions/pressure-ulcers/), NHS ## Sources 1. Pressure injury: update on general concepts, clinical aspects, and laboratory findings - Part I · Velozo BC, Hong MV, Bernardo LC et al. · Anais Brasileiros de Dermatologia · 2025. https://doi.org/10.1016/j.abd.2025.501187 2. Support surfaces for pressure ulcer prevention · McInnes E, Jammali-Blasi A, Bell-Syer SEM et al. · The Cochrane Database of Systematic Reviews · 2015. https://doi.org/10.1002/14651858.cd001735.pub5 3. Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System: Revised Pressure Injury Staging System · Edsberg LE, Black JM, Goldberg M et al. · Journal of Wound, Ostomy, and Continence Nursing · 2016. https://doi.org/10.1097/won.0000000000000281 4. Global prevalence and incidence of pressure injuries in hospitalised adult patients: A systematic review and meta-analysis · Li Z, Lin F, Thalib L et al. · International Journal of Nursing Studies · 2020. https://doi.org/10.1016/j.ijnurstu.2020.103546 5. Accuracy and clinical effectiveness of risk prediction tools for pressure injury occurrence: An umbrella review · Hillier B, Scandrett K, Coombe A et al. · PLoS Medicine · 2025. https://doi.org/10.1371/journal.pmed.1004518 6. Pressure ulcers (bed sores) - causes, prevention, early detection · Healthdirect Australia. https://www.healthdirect.gov.au/conditions/skin-conditions/pressure-sores-and-ulcers 7. Pressure ulcers (pressure sores) · NHS · 2023. https://www.nhs.uk/conditions/pressure-sores/ 8. Pressure sores · Better Health Channel · 2000. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/pressure-sores 9. Risk factors of pressure injury in elderly inpatients: a systematic review and meta-analysis · Wu Q, Cheng N, Cao F et al. · BMC Geriatrics · 2025. https://doi.org/10.1186/s12877-025-06517-0 10. Incidence of pressure injuries in patients with spinal cord injury: A systematic review and meta-analysis · Xu J, Jiao Y, Wang N et al. · Journal of Tissue Viability · 2025. https://doi.org/10.1016/j.jtv.2025.100881 11. Pressure Damage Prevention and how to Care for your Skin · North Tees and Hartlepool NHS Foundation Trust · 2023. https://www.nth.nhs.uk/resources/pressure-damage-prevention-and-skin-care/ 12. Risk assessment and prevention of pressure ulcers: a clinical practice guideline from the American College of Physicians · Qaseem A, Mir TP, Starkey M et al. · Annals of Internal Medicine · 2015. https://doi.org/10.7326/m14-1567 13. Pressure ulcer risk assessment and prevention: a systematic comparative effectiveness review · Chou R, Dana T, Bougatsos C et al. · Annals of Internal Medicine · 2013. https://doi.org/10.7326/0003-4819-159-1-201307020-00006 14. Pressure Injury - Adult CPC · SA Health. https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/services/outpatients/cpc/specialities/plastic+and+reconstructive+surgery/pressure+injury+adult+cpc 15. Tissue Viability · Right Decisions. https://www.rightdecisions.scot.nhs.uk/nhs-tayside-refguide/medicine/tissue-viability/ 16. The frequency of osteomyelitis after pressure injury in spinal cord injury: a systematic review and meta-analysis · Jangholi E, Alizadeh SD, Farahbakhsh F et al. · Spinal Cord Series and Cases · 2024. https://doi.org/10.1038/s41394-024-00685-8 17. Osteomyelitis Complicating Sacral Pressure Ulcers: Whether or Not to Treat With Antibiotic Therapy · Wong D, Holtom P, Spellberg B · Clinical Infectious Diseases · 2019. https://doi.org/10.1093/cid/ciy559 --- This is general information, not advice about your own situation. To discuss your issues, book with one of our podiatrists. In an emergency, call 000.