Difference between revisions of "Trench foot"

(Clinical Features)
 
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==Background==
 
==Background==
*Considered a nonfreezing cold injury  
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*Considered a nonfreezing [[cold injuries|cold injury]]
**occurs when ambient temperature above freezing
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** 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
*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>
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*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>
 +
*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>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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==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
**Tissue sloughing and gangrene may occur
+
**Tissue sloughing and [[gangrene]] may occur
 
*Months to years
 
*Months to years
 
**Hyperhidrosis and cold sensitivity may persist
 
**Hyperhidrosis and cold sensitivity may persist
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==Differential Diagnosis==
 
==Differential Diagnosis==
{{Foot diagnoses}}
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{{Foot infection}}
  
 
{{Cold injuries DDX}}
 
{{Cold injuries DDX}}
  
==Diagnosis==
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==Evaluation==
*Usually clinical
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*Clinical evaluation of the involved extremity. No specific laboratory or imaging is required.
  
==Treatment==
+
==Management==
*Supportive
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*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
 +
*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
+
===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]]
*[[Foot Diagnoses]]
 
  
 
==References==
 
==References==
 
<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