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Trench foot
From WikEM
Contents
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 sprain (turf toe)
- Acute arterial ischemia
- Calcaneal bursitis
Subacute/Chronic
- Diabetic foot infection
- Peripheral artery disease
- Plantar fasciitis
- Trench foot
- Ingrown toenail
- Tinea pedis
Cold injuries
- Generalized
- Freezing
- Non-freezing
- Trench foot
- Pernio (Chilblains)
- Cold panniculitis
- Cold urticaria
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.
