Trench foot


Trench foot

Description, Causes and Risk Factors:

Alternative Name: Immersion foot, fat foot, chilblains.

Trench foot is a medical condition caused by prolonged exposure of the feet to damp and cold. It was a particular problem for soldiers engaged in trench warfare during the winter months of World War I, and also during the Vietnam conflict.

Trench foot occurs when feet are cold and damp while wearing constricting footwear. Unlike frostbite, trench foot does not require freezing temperatures and can occur in temperatures up to 60 degrees Fahrenheit. Another difference between trench foot and frostbite is that frostbite can easily occur in the absence of moisture.

Trench foot can occur with only 12 hours of exposure. When affected by trench foot, the feet become numb, followed by a change in color to red or blue. As the condition worsens, the feet may swell. Advanced trench foot often involves blisters and open sores, which lead to fungal infections. In such cases trench foot is also known as 'jungle rot'.

Phases:

    PRE-HYPEREMIC PHASE:

  1. This lasts 6-24 hours.

  2. The feet are white and cold with paresthesia.

  3. The toes and ankles are stiff, and walking is difficult.

  4. Ankle jerks and deep tendon sensation are reduced or lost.

  5. Peripheral pulses may be impalpable. The tissues feel resilient.

    HYPEREMIC PHASE:

  1. This lasts up to 2 months.

  2. The feet are hyperemic, hot, painful and edematous.

  3. The swelling is aggravated by heat, movement and the dependant position.

  4. Hemorrhagic or serious blebs appear, sometimes also with ecchymosis and petechiae.

  5. Gangrene may supervene but, if it does so, then it is usually superficial.

  6. Complications are lymphangitis, cellulitis and thrombophlebitis.

  7. Pain and anaesthesia gradually recede.

  8. Muscle atrophy and osteoporosis may follow.

    POST-HYPEREMIC PHASE:

  1. This is a chronic late vasospastic phase with increased and exaggerated sensitivity to cold.

  2. The foot may become permanently cold, with pain on warming, hyperhidrosis and paresthesia.

  3. There is a secondary Raynaud's syndrome.

If left untreated, trench foot usually results in gangrene and then requires amputation. If treated properly and quickly, complete recovery is normal, but recovery is marked by severe short-term pain as feeling returns.

Symptoms:

Signs and symptoms of trench foot may include:

    Red skin that turns pale and swollen.

  • Numbness or burning pain.

  • Leg cramps.

  • No actual freezing of the skin.

  • A slow or absent pulse in the foot.

  • Development of blisters or ulcers after 2 to 7 days.

  • Foot can appear cyanotic (gray).

  • Prickly or heavy feeling.

  • While warming burning can be severe.

  • In severe casesuntreated trench foot can involve the toes, heels, or the entire foot.

Diagnosis:

Diagnosis is usually based on signs, symptoms, complete history and physical exam.

Treatment:

Prevention is the key in treating this condition. Limit exposure to cold is very important in stopping as well as treating trench foot. It is a must to maintain a dry environment inside the shoe. Controlling any excessive perspiration will help. When exposed to wet and cold condition, the feet when possible should be air-dried and elevated and there should be an exchange of wet socks and shoes for dry ones so that trench foot does not begin to develop.

The treatment for this condition is very close to the treatment for frostbite. The following steps should be taken:

    Clean and dry thoroughly the feet.

  • Avoid synthetic type materials such as vinyl or rubber.

  • Wear cloth or leather which can absorb moisture.

  • Use dry, clean socks daily.

  • Use baby powder or talc to keep moisture away.

  • Affected area should be treated by applying warm packs or socking in warm water - 102 degrees to 110 degrees for about 5 minutes.

  • While resting or sleeping, do not wear socks.

Drying agents are helpful to control moisture. Aluminum chloride is the agent most commonly used in the tropics. Formalin is used as well in other prescription medications. Antihistamine an anticholinergic medications should be used in severe cases.

Where there are severe cases of feet sweating, it can also be treated with surgery as well as injections. Risks and benefits must be carefully discussed with the PCP.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

Reference and Source are from:

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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