Difference between revisions of "Trench foot"

Line 32: Line 32:
  
 
==Treatment==
 
==Treatment==
*Keep feet clean, warm, dryly bandaged, elevated
+
*Supportive
*Monitor for signs of infection
+
**Main focus of treatment
 +
**Keep feet clean, warm, dryly bandaged, elevated
 +
**Monitor for signs of infection
 +
*Vasodilators
 +
**Oral prostaglandins increase skin temperatures
 +
*Prophylaxis
 +
**Keep warm, good boot fit, change out of wet socks
  
 
==See Also==
 
==See Also==

Revision as of 15:23, 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

  • Supportive
    • Main focus of treatment
    • Keep feet clean, warm, dryly bandaged, elevated
    • Monitor for signs of infection
  • Vasodilators
    • Oral prostaglandins increase skin temperatures
  • Prophylaxis
    • Keep warm, good boot fit, change out of wet socks

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