Back to Basics: Trench Foot
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.