Trench foot: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
* | *Initial signs and symptoms | ||
* | **Numbness and tingling | ||
** | **Pale, mottled, anesthetic, pulseless, and immobile foot | ||
*Hyperemic phase | **No changes will occur after initial rewarming | ||
** | *Hours after rewarming | ||
* | **Hyperemic phase | ||
*Anesthesia persists | **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== | ==Differential Diagnosis== |
Revision as of 15:15, 25 August 2015
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; significant problem in military operations [1]
Clinical Features
- 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
- Foot and toe fractures
- Subtalar dislocation
- Metatarsophalangeal joint sprain (turf toe)
- Acute arterial ischemia
- Calcaneal bursitis
Subacute/Chronic
- Diabetic foot infection
- Peripheral artery disease
- Plantar fasciitis
- Trench foot
- Ingrown toenail
- Paronychia
- Tinea pedis
- Morton's neuroma
- Diabetic neuropathy
Cold injuries
- Generalized
- Freezing
- Non-freezing
Diagnosis
- Usually clinical
Treatment
- Keep feet clean, warm, dryly bandaged, elevated
- Monitor for signs of infection
See Also
References
- ↑ Ikaheimo T. Frostbite and Other Localized Cold Injuries. In: Tintinalli's Emergency Medicine: A comprehensive study guide. 7th ed. McGraw Hill Medical; 2011: 1331