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Pressure injuries on the heels often occur in immobile patients. The risk factors for these injuries stem from the anatomy of the calcaneus, impairments in blood flow to the foot and neuropathic disease. There are many clinical considerations in the prevention of heel pressure injury. This article addresses the epidemiology and economic impact of heel injury, identifies risk factors and differential diagnosis of their development, discusses challenges in prevention across the continuum of care, and provides guidance for selecting appropriate interventions in the prevention of heel pressure injury through the review of existing evidence.