Trench foot: Difference between revisions
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Foot | {{Foot infection}} | ||
{{Cold injuries DDX}} | {{Cold injuries DDX}} |
Revision as of 04:26, 30 October 2017
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 infection
- Cellulitis
- Gangrene
- Trench foot
- Abscess
- Necrotizing soft tissue infections
- Osteomyelitis
- Diabetic foot infection
- Wet-sock erosions
Look A-Likes
Cold injuries
- Generalized
- Freezing
- Non-freezing
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.