Trench foot

Revision as of 10:54, 4 January 2017 by Ostermayer (talk | contribs) (Evaluation)


  • 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, but a significant problem in military operations [1]

Clinical Features [1]

  • 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



Cold injuries


  • Clinical evaluation of the involved extremity. No specific laboratory or imaging is required.


  • Supportive care is mainstay 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


  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