Trench foot: Difference between revisions
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==Background== | ==Background== | ||
*Considered a nonfreezing cold injury | *Considered a nonfreezing cold injury | ||
** | **Occurs when ambient temperature above freezing | ||
*Develops slowly over hours-days when foot is exposed to cold/wet conditions | *Develops slowly over hours-days when foot is exposed to cold/wet conditions | ||
*Reversible injury may progress to irreversible injury | *Reversible injury may progress to irreversible injury | ||
* | *Rarely seen in civilians, but a significant problem in military operations <ref name=Ikaheimo>Ikaheimo T. Frostbite and Other Localized Cold Injuries. In: Tintinalli's Emergency Medicine: A comprehensive study guide. 7th ed. McGraw Hill Medical; 2011: 1331</ref> | ||
==Clinical Features <ref | ==Clinical Features <ref name=Ikaheimo />== | ||
*Initial signs and symptoms | *Initial signs and symptoms | ||
**Numbness and tingling | **Numbness and tingling | ||
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==Management== | ==Management== | ||
*Supportive | *Supportive care is mainstay of treatment | ||
**Keep feet clean, warm, dryly bandaged, elevated | **Keep feet clean, warm, dryly bandaged, elevated | ||
**Monitor for signs of infection | **Monitor for signs of infection | ||
| Line 40: | Line 39: | ||
*Prophylaxis | *Prophylaxis | ||
**Keep warm, good boot fit, change out of wet socks | **Keep warm, good boot fit, change out of wet socks | ||
==Disposition== | |||
==See Also== | ==See Also== | ||
*[[Cold | *[[Cold injuries]] | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Environmental]] | [[Category:Environmental]] | ||
Revision as of 23:35, 31 December 2016
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
- Foot and toe fractures
- Subtalar dislocation
- Metatarsophalangeal joint sprain (turf toe)
- Acute arterial ischemia
- Calcaneal bursitis
Subacute/Chronic
- Diabetic foot infection
- Peripheral artery disease
- Plantar fasciitis
- Trench foot
- Ingrown toenail
- Paronychia
- Tinea pedis
- Morton's neuroma
- Diabetic neuropathy
Cold injuries
- Generalized
- Freezing
- Non-freezing
Evaluation
- Usually clinical
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