Environ

Trench Foot

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Trench Foot, Immersion Foot

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