Trench foot: Difference between revisions
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==Background== | ==Background== | ||
*Considered a nonfreezing cold injury | *Considered a nonfreezing [[cold injuries|cold injury]] | ||
** Injury caused by cold exposure to tissue not resulting in freezing | ** 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 infection acutely, and cold intolerance and pain chronically | *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> | *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> | ||
*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) | *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 <ref name=Ikaheimo />== | ==Clinical Features <ref name=Ikaheimo />== | ||
[[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]] | |||
*Initial signs and symptoms | *Initial signs and symptoms | ||
**Numbness and tingling | **[[Numbness]] and tingling | ||
**Pale, mottled, anesthetic, pulseless, and immobile foot | **Pale, mottled, anesthetic, pulseless, and immobile foot | ||
**No changes will occur after initial rewarming | **No changes will occur after initial rewarming | ||
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**Severe burning pain and reappearance of proximal sensation | **Severe burning pain and reappearance of proximal sensation | ||
*2-3 days post treatment | *2-3 days post treatment | ||
**Edema and bullae may form as perfusion returns | **Edema and [[vesiculobullous rashes|bullae]] may form as perfusion returns | ||
*Weeks later | *Weeks later | ||
**Anesthesia persists and may be permanent | **Anesthesia persists and may be permanent | ||
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**Keep feet clean, warm, dryly bandaged, elevated | **Keep feet clean, warm, dryly bandaged, elevated | ||
**Monitor for signs of infection | **Monitor for signs of infection | ||
*Update tetanus | |||
*Treat systemic hypothermia by rewarming | |||
**Do not actively rewarm extremities with isolated nonfreezing cold injury | |||
*Vasodilators | *Vasodilators | ||
**Oral prostaglandins increase skin temperatures | **Oral prostaglandins increase skin temperatures | ||
===Prophylaxis=== | |||
*Keep warm, good boot fit, change out of wet socks | |||
==Disposition== | ==Disposition== | ||
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]
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- 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
- 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.