Trench foot

From WikEM
(Redirected from Trench Foot)
Jump to: navigation, search

Background

  • Considered a nonfreezing cold injury
    • Occurs when ambient temperature above freezing
  • Develops slowly over hours-days when foot is exposed to cold/wet conditions
  • Reversible injury may progress to irreversible injury
  • Rarely seen in civilians, but a significant problem in military operations [1]

Clinical Features [1]

  • Initial signs and symptoms
    • Numbness and tingling
    • Pale, mottled, anesthetic, pulseless, and immobile foot
    • No changes will occur after initial rewarming
  • Hours after rewarming
    • Hyperemic phase
    • Severe burning pain and reappearance of proximal sensation
  • 2-3 days post treatment
    • Edema and bullae may form as perfusion returns
  • Weeks later
    • Anesthesia persists and may be permanent
    • Tissue sloughing and gangrene may occur
  • Months to years
    • Hyperhidrosis and cold sensitivity may persist
    • Some will have permanent disability

Differential Diagnosis

Foot diagnoses

Acute

Subacute/Chronic

Cold injuries

Evaluation

  • Clinical evaluation of the involved extremity. No specific laboratory or imaging is required.

Management

  • Supportive care is mainstay of treatment
    • Keep feet clean, warm, dryly bandaged, elevated
    • Monitor for signs of infection
  • Vasodilators
    • Oral prostaglandins increase skin temperatures
  • Prophylaxis
    • Keep warm, good boot fit, change out of wet socks

Disposition

  • Admission is generally required for observation and serial reexaminations of the extremity.

See Also

References

  1. 1.0 1.1 Ikaheimo T. Frostbite and Other Localized Cold Injuries. In: Tintinalli's Emergency Medicine: A comprehensive study guide. 7th ed. McGraw Hill Medical; 2011: 1331