In wound care, we distinguish between primary and secondary layers. Primary dressings (or layers) are in direct contact with the wound while secondary dressings are intended to protect or support the first layer.

When is a secondary layer required?

• If the primary layer does not adhere to the treatment area itself
• To prevent unintended detachment
• To protect the primary layer from contamination and impurities
• To support the primary layer, e.g. by absorbing fluid

What are the advantages of a good secondary layer?

• The primary layer can be used for longer
• Unnecessary dressing changes can be avoided
• Cost of care can be reduced due to fewer bandage changes
• Care can be administered more hygienically due to the extra protection

Changes in the size and shape of feet, e.g. club foot, hallux valgus, or amputations, can complicate medical treatment. Inappropriate foot care may cause pressure or friction, frequently leading to calluses or even open wounds and ulcers.

Avoiding the consequences of atypical foot shapes

Generally, care should be taken to ensure that the foot is not restricted or squashed while at the same time being thoroughly, and gently, protected. Excessive tension should be avoided, as should creases and excess material. Reducing the friction and shear forces against the skin may also prevent irritation and wounds.

1. Lawall, H.; Reike, H. (2009): Diabetisches Fußsyndrom: Der Internist 50(8), S. 936–944.
2. Teichmann, J.; Sabo, D. (2009): Epidemiologie und Klassifikation des diabetischen Fußsyndroms. Der Orthopäde 38(12), S. 1139–1148.
3. Donatelli, R. (1987): Abnormal Biomechanics of the Foot and Ankle. The Journal of Orthopaedic and Sports Physical Therapy 9(1), S. 11–16.
4. Fleischner, G. (2003). Podologische Orthopädie. München.
5. Dahmen, R.; Haspels, R.; Koomen, B; Hoeksma, A.F. (2001): Therapeutic Footwear for the Neuropathic Foot. An algorithm. Diabetes Care 24(4), S. 705–709.

In diabetics, smaller injuries and bruises may lead to a diabetic foot (e.g. due to a too tightly wrapped dressing, tight sock bands, fungal infections, calluses), which also means poorly healing wounds.

If diagnosed too late or not treated properly, this can lead to severe ulcers and necrosis, as well as damage to joints and bones (Charcot foot). The risk of bruises and abrasions also increases. For many patients with advanced diabetic foot syndrome, amputation of the affected structure is the last intervention possible.

Avoiding the consequences of diabetic foot

Many of these ulcers are caused by inappropriate footwear (pressure, friction). Patients suffering from diabetes mellitus should use footwear with an adequate fit that gently touches and protects the skin with seamless material. Regular medical foot care is also necessary, alongside treating even minor wounds.

1. Lawall, H.; Reike, H. (2009). Diabetisches Fußsyndrom: Der Internist 50(8), S. 936-944.
2. Heller, T.; Blum, M; Spraul, M. et al. (2014): Folgeerkrankungen des Diabetes mellitus: Prävalenzen in der Bundesrepublik Deutschland. Deutsche Medizinische Wochenschrift 193, S. 786–791.
3. Morbach, S.; Müller, E.; Reike, H. et al. (2014): Experimental and Clinical Endocrinoloy & Diabetes 122, S. 416–424.
4. Teichmann, J.; Sabo, D. (2009). Epidemiologie und Klassifikation des diabetischen Fußsyndroms. Der Orthopäde 38(12), S. 1139–1148