Trench foot

· Temperatures above freezing + wet conditions = immersion injury

· Commonly from continuously wearing wet socks and shoes

History

· Repeated exposure to wet and cold

o Homeless, military, outdoor workers

· Occurs over several days to weeks

· Tingling or numbness most common symptom

Exam

· Damp, pale or mottled in color

· Decreased sensation

· Diminished or absent pulses

· Prolonged capillary refill

· In more severe cases, may have impaired motor function

Treatment is supportive

· Keep foot dry, warm, elevated, clean

o Allow slow rewarming, do not rub feet

o Severe burning pain as perfusion returns

· Numbness may take weeks to resolve or may be permanent

· May develop chronic hyperalgesia in affected extremity

· Monitor for infection and bullae

· Rarely have tissue loss

Sources

Rosen, Peter, et al. “Frostbite and Nonfreezing Cold Injuries.” Rosen's Emergency Medicine: Concepts and Clinical Practice, 9th ed., Elsevier, 2018, pp. 1735–1742.

Tintinalli, Judith, et al. “Cold Injuries.” Tintinalli’s Emergency Medicine, 8th ed., McGrath-Hill, 2016, pp. 1353-1357.