Difference between revisions of "Trench foot"

(Text replacement - "==Diagnosis==" to "==Evaluation==")
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==Background==
 
==Background==
 
*Considered a nonfreezing cold injury  
 
*Considered a nonfreezing cold injury  
**occurs when ambient temperature above freezing
+
**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; significant problem in military operations <ref>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>
+
*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>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 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
**Main focus 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
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*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 Injuries (Non-Freezing)]]
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*[[Cold injuries]]
*[[Foot Diagnoses]]
 
  
 
==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

Subacute/Chronic

Cold injuries

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

Disposition

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