II. Epidemiology
- Among the most common non-freezing, Cold Weather Injury
III. Pathophysiology
- Feet remain wet and cold (32 to 59 F or 0 to 15 C) for at least 2-3 days
IV. Risk Factors
- Homelessness
- Military
- Prolonged winter Cold Weather sports and recreation
V. Symptoms
- Phase 1: Injury
- Phase 2: Postinjury
- Skin becomes blue and mottled after cold exposure is removed
- Numbness continues
- Phase 3: Hyperemic (2 weeks to 3 months)
- Foot becomes erythematous and edematous and severely painful despite rewarming
- Phase 4: Posthyperemic (weeks to years)
- Peripheral sensory and motor deficits
- Pain and Paresthesias
- Increased cold sensitivity
- Hyperhidrosis
VI. Signs
- Foot Odor with foot skin irritation, rash, ulcerations
VII. Management
- See Hypothermia
- See Frostbite
-
General measures
- Move patient to warm, dry environment
- Remove wet clothing
- Rewarm feet gently
- Air dry feet
- Treat other concurrent Cold Weather Injury
- Treat Hypothermia if present
- Treat Frostbite if present
- Painful Neuropathy
- Amitriptyline gradually titrate 10-30 mg up to 75 mg orally nightly
VIII. Complications: Severe Cases
- Flexion contracture
- Clawhand Deformity
- Muscle Atrophy
- Skin Ulceration
IX. Prevention
- Frequently change wet footwear
- Stay active tom promote extremity circulation
X. References
- Civitarese and Sciano (2018) Crit Dec Emerg Med 32(2): 3-16