Difference between revisions of "Trench foot"

(Clinical Features)
 
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===Background===
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==Background==
 +
*Considered a nonfreezing [[cold injuries|cold injury]]
 +
** Injury caused by cold exposure to tissue not resulting in 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
 +
*Can cause [[gangrene]] or [[skin infection]] acutely, and cold intolerance and pain chronically
 +
*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>
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*Also frequently seen in the homeless population, particularly during winter months (do not have ready access to clean/dry clothes or means to fully dry socks or shoes)
  
===Clinical Features===
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==Clinical Features <ref name=Ikaheimo />==
*Tingling/numbness is initial symptom
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[[File:Case of trench feet suffered by unidentified soldier Cas de pieds des tranchées (soldat non identifié).jpg|thumb|Trench foot as seen on an unidentified soldier during World War I]]
*Foot appears pale, mottled, anesthetic, pulseless, and immobile
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*Initial signs and symptoms
**Initially does not change after rewarming
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**[[Numbness]] and tingling
*Hyperemic phase begins w/in hr after rewarming
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**Pale, mottled, anesthetic, pulseless, and immobile foot
**Assoc w/ severe burning pain and reappearance of proximal sensation
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**No changes will occur after initial rewarming
*As perfusion returns to foot over 2-3d edema and possibly bullae may form
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*Hours after rewarming
*Anesthesia persists for weeks and may be permanent; gangrene may occur
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**Hyperemic phase  
 +
**Severe burning pain and reappearance of proximal sensation
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*2-3 days post treatment
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**Edema and [[vesiculobullous rashes|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
  
===Treatment===
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==Differential Diagnosis==
*Keep feet clean, warm, dryly bandaged, elevated
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{{Foot infection}}
*Monitor for signs of infection
+
 
 +
{{Cold injuries DDX}}
 +
 
 +
==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
 +
*Update tetanus
 +
*Treat systemic hypothermia by rewarming
 +
**Do not actively rewarm extremities with isolated nonfreezing cold injury
 +
*Vasodilators
 +
**Oral prostaglandins increase skin temperatures
 +
 
 +
===Prophylaxis===
 +
*Keep warm, good boot fit, change out of wet socks
 +
 
 +
==Disposition==
 +
*Mild cases can be discharged safely after being provided with strong education including frequenting changing of socks and keeping feet warm and dry
 +
*Admission is generally required for observation and serial reexaminations of the extremity.
  
 
==See Also==
 
==See Also==
[[Cold Injuries (Non-Freezing)]]
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*[[Cold injuries]]
 +
 
 +
==References==
 +
<references/>
  
[[Category:Environ]]
+
[[Category:Environmental]]

Latest revision as of 21:28, 28 January 2020

Background

  • Considered a nonfreezing cold injury
    • Injury caused by cold exposure to tissue not resulting in freezing
  • Develops slowly over hours-days when foot is exposed to cold/wet conditions
  • Reversible injury may progress to irreversible injury
  • Can cause gangrene or skin infection acutely, and cold intolerance and pain chronically
  • Rarely seen in civilians, but a significant problem in military operations [1]
  • Also frequently seen in the homeless population, particularly during winter months (do not have ready access to clean/dry clothes or means to fully dry socks or shoes)

Clinical Features [1]

Trench foot as seen on an unidentified soldier during World War I
  • 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

Look A-Likes

Cold injuries

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
  • Update tetanus
  • Treat systemic hypothermia by rewarming
    • Do not actively rewarm extremities with isolated nonfreezing cold injury
  • Vasodilators
    • Oral prostaglandins increase skin temperatures

Prophylaxis

  • Keep warm, good boot fit, change out of wet socks

Disposition

  • Mild cases can be discharged safely after being provided with strong education including frequenting changing of socks and keeping feet warm and dry
  • Admission is generally required for observation and serial reexaminations of the extremity.

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