Difference between revisions of "Trench foot"

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==Clinical Features==
 
==Clinical Features==
*Tingling/numbness is initial symptom
+
*Initial signs and symptoms
*Foot appears pale, mottled, anesthetic, pulseless, and immobile
+
**Numbness and tingling
**Initially does not change after rewarming
+
**Pale, mottled, anesthetic, pulseless, and immobile foot
*Hyperemic phase begins w/in hr after rewarming
+
**No changes will occur after initial rewarming
**Assoc w/ severe burning pain and reappearance of proximal sensation
+
*Hours after rewarming
*As perfusion returns to foot over 2-3d edema and possibly bullae may form
+
**Hyperemic phase  
*Anesthesia persists for weeks and may be permanent; gangrene may occur
+
**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

Subacute/Chronic

Cold injuries

Diagnosis

  • Usually clinical

Treatment

  • Keep feet clean, warm, dryly bandaged, elevated
  • Monitor for signs of infection

See Also

References

  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