Trench foot | |
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Other names | Immersion foot |
Trench foot as seen on an unidentified soldier during World War I | |
Specialty | Emergency medicine, podiatry |
Symptoms |
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Complications |
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Causes |
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Treatment |
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Trench foot, also known by other names, is a type of foot damage due to moisture. [1] Initial symptoms often include tingling or itching which can progress to numbness. [1] [2] The feet may become red or bluish in color. [1] As the condition worsens the feet can start to swell and smell of decay. [1] Complications may include skin breakdown or infection. [1]
Trench foot occurs due to prolonged exposure of the feet to cold, damp, and often unsanitary conditions. [1] Unlike frostbite, trench foot usually occurs at temperatures above freezing, [1] and can be classed as a form of non-freezing cold injury. [3] Onset can be as rapid as 10 hours. [1] Risk factors include overly tight boots and not moving. [4] The underlying mechanism is believed to involve constriction of blood vessels resulting in insufficient blood flow to the feet. [1] Diagnosis is based on symptoms and examination. [1]
Prevention involves keeping the feet warm, dry, and clean. [1] After the condition has occurred, pain medications may be required during the gradual rewarming process. [1] Pain may persist for months following treatment. [4] Surgery to remove damaged tissue or amputation may be necessary. [1]
Those in the military are most commonly affected, though cases may also occur in the homeless. [1] The condition was first described during Napoleon Bonaparte's retreat from Russia in the winter of 1812. [1]
Trench foot was an informal name applied to the condition from its prevalence during the trench warfare of World War I. [1] Health officials at the time used a variety of other terms as they studied the condition, but trench foot was eventually formally sanctioned and used. [2] Informally, it was also known as jungle rot during the Vietnam War. [5]
It is also known as immersion foot syndrome [6] and as a nonfreezing cold injury. [2]
Trench foot frequently begins with the feeling of tingling and an itch in affected feet, and subsequently progresses to numbness or pain. [1] [2] The feet may become red or blue as a result of poor blood supply. [1] Later, as the condition worsens feet can start to swell and smell of decay as muscle and tissue become macerated. The feet often feel warm to the touch. [1] [7]
Advanced trench foot often involves blisters and open sores, which lead to fungal infections; this is sometimes called jungle rot. It is marked by severe short-term pain when feeling returns. [4]
Unlike frostbite, trench foot does not require freezing temperatures. It can occur in temperatures up to 16 °C (61 °F) and within as little as 13 hours. Exposure to these environmental conditions causes deterioration and destruction of the capillaries and leads to damage of the surrounding flesh. [7] Excessive sweating (hyperhidrosis) has long been regarded as a contributory cause. Unsanitary, cold, and wet conditions can also cause trench foot. [8]
The diagnosis of trench foot does not usually require any investigations unless an underlying infection of bone is suspected, when an X-ray is performed. A full blood count might show a high white blood cell count if infection is present and inflammatory markers such as an erythrocyte sedimentation rate or C-reactive protein (CRP) might highlight severity. [1]
Trench foot can be prevented by keeping the feet clean, warm, and dry. [1]
Keeping the feet dry is the first line treatment. The initial aim is to protect undamaged tissue of the feet and prevent any further destruction of the feet. [4] [7] Applying emollient helps. [7]
The mainstay of treatment—as with gangrene —is surgical debridement. Severe cases may require amputation. [1]
Self-treatment consists of changing socks two or three times a day and usage of plenty of talcum powder. Whenever possible, shoes and socks should be taken off, the feet bathed for five minutes and patted dry, talcum powder applied, and feet elevated to let air get to them. [1]
Trench foot was first reported in 1812 by the French army surgeon Dominique Jean Larrey when Napoleon’s army was retreating from Russia. [1] [9] It was also a problem for soldiers engaged in trench warfare during World War I, particularly during the winters. [1] Official statistics put the casualty figure for the condition at around 75,000 for the British and 2,000 for the Americans. [2] Amputation was avoided if at all possible and the incidence of trench foot had greatly reduced by the winter of 1917–1918 through improvements to the trenches, modification of soldiers' footwear, and the provision of greases—chiefly whale oil [10] —to prevent damage from excess moisture. [2] It was also discovered that a key preventive measure was regular foot inspections. Rather than leave each soldier to his own devices, they were all paired and each partner made responsible for the feet of the other. As a team, they were more likely to go to the trouble of actually removing their boots and socks, to check for any damage, and to begin treatment at an earlier stage of damage. [10] Trench foot reappeared in the US Army during the Vietnam War in the 1960s and 1970s [5] and in the British Army during the 1982 Falklands War. [1] [11] It has been reported among Ukrainian soldiers in 2022 amid the Russian invasion of Ukraine. [12]
Aside from soldiers, the condition has been documented in coal miners, [5] survivors of shipwrecks and plane crashes, [7] as well as music festival attendees at Glastonbury in 1998 and 2007, [13] [14] elderly shut-ins trapped in their baths [6] and hikers. [15]
Amputation is the removal of a limb by trauma, medical illness, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on individuals as a preventive surgery for such problems. A special case is that of congenital amputation, a congenital disorder, where fetal limbs have been cut off by constrictive bands. In some countries, amputation is currently used to punish people who commit crimes. Amputation has also been used as a tactic in war and acts of terrorism; it may also occur as a war injury. In some cultures and religions, minor amputations or mutilations are considered a ritual accomplishment. When done by a person, the person executing the amputation is an amputator. The oldest evidence of this practice comes from a skeleton found buried in Liang Tebo cave, East Kalimantan, Indonesian Borneo dating back to at least 31,000 years ago, where it was done when the amputee was a young child.
Hypothermia is defined as a body core temperature below 35.0 °C (95.0 °F) in humans. Symptoms depend on the temperature. In mild hypothermia, there is shivering and mental confusion. In moderate hypothermia, shivering stops and confusion increases. In severe hypothermia, there may be hallucinations and paradoxical undressing, in which a person removes their clothing, as well as an increased risk of the heart stopping.
Gangrene is a type of tissue death caused by a lack of blood supply. Symptoms may include a change in skin color to red or black, numbness, swelling, pain, skin breakdown, and coolness. The feet and hands are most commonly affected. If the gangrene is caused by an infectious agent, it may present with a fever or sepsis.
A blister is a small pocket of body fluid within the upper layers of the skin, usually caused by forceful rubbing (friction), burning, freezing, chemical exposure or infection. Most blisters are filled with a clear fluid, either serum or plasma. However, blisters can be filled with blood or with pus.
A callus is an area of thickened and sometimes hardened skin that forms as a response to repeated friction, pressure, or other irritation. Since repeated contact is required, calluses are most often found on the feet and hands, but they may occur anywhere on the skin. Some degree of callus, such as on the bottom of the foot, is normal.
Frostbite is a skin injury that occurs when exposed to extremely low temperatures, causing the freezing of the skin or other tissues, commonly affecting the fingers, toes, nose, ears, cheeks and chin areas. Most often, frostbite occurs in the hands and feet. The initial symptoms are typically a feeling of cold and tingling or numbing. This may be followed by clumsiness with a white or bluish color to the skin. Swelling or blistering may occur following treatment. Complications may include hypothermia or compartment syndrome.
Diabetic neuropathy is various types of nerve damage associated with diabetes mellitus. Symptoms depend on the site of nerve damage and can include motor changes such as weakness; sensory symptoms such as numbness, tingling, or pain; or autonomic changes such as urinary symptoms. These changes are thought to result from a microvascular injury involving small blood vessels that supply nerves. Relatively common conditions which may be associated with diabetic neuropathy include distal symmetric polyneuropathy; third, fourth, or sixth cranial nerve palsy; mononeuropathy; mononeuropathy multiplex; diabetic amyotrophy; and autonomic neuropathy.
Chilblains, also known as pernio, is a medical condition in which damage occurs to capillary beds in the skin, most often in the hands or feet, when blood perfuses into the nearby tissue, resulting in redness, itching, inflammation, and possibly blisters.
Athlete's foot, known medically as tinea pedis, is a common skin infection of the feet caused by a fungus. Signs and symptoms often include itching, scaling, cracking and redness. In rare cases the skin may blister. Athlete's foot fungus may infect any part of the foot, but most often grows between the toes. The next most common area is the bottom of the foot. The same fungus may also affect the nails or the hands. It is a member of the group of diseases known as tinea.
Cold-weather warfare, also known as arctic warfare or winter warfare, encompasses military operations affected by snow, ice, thawing conditions, or cold, both on land and at sea, as well as the strategies and tactics used by military forces in these situations and environments.
Rhinorrhea, rhinorrhoea, or informally runny nose is the free discharge of a thin mucus fluid from the nose; it is a common condition. It is a common symptom of allergies or certain viral infections, such as the common cold or COVID-19. It can be a side effect of crying, exposure to cold temperatures, cocaine abuse, or drug withdrawal, such as from methadone or other opioids. Treatment for rhinorrhea may be aimed at reducing symptoms or treating underlying causes. Rhinorrhea usually resolves without intervention, but may require treatment by a doctor if symptoms last more than 10 days or if symptoms are the result of foreign bodies in the nose.
Pitted keratolysis is a bacterial skin infection of the foot. The infection is characterized by craterlike pits on the sole of the feet and toes, particularly weight bearing areas.
Hereditary sensory and autonomic neuropathy (HSAN) or hereditary sensory neuropathy (HSN) is a condition used to describe any of the types of this disease which inhibit sensation.
Tropical ulcer, more commonly known as jungle rot, is a chronic ulcerative skin lesion thought to be caused by polymicrobial infection with a variety of microorganisms, including mycobacteria. It is common in tropical climates.
Stump socks are tubular medical or clothing accessories with a blind end that are fashioned similar to socks, usually without a heel. They are worn on amputation stumps for a number of reasons. As stump socks are typically worn on body parts that do not contain a foot, their definition is distinct from the average sock type garment.
Immersion foot syndromes are a class of foot injury caused by water absorption in the outer layer of skin. There are different subclass names for this condition based on the temperature of the water to which the foot is exposed. These include trench foot, tropical immersion foot, and warm water immersion foot. In one 3-day military study, it was found that submersion in water allowing for a higher skin temperature resulted in worse skin maceration and pain.
Cold injury is damage to the body from cold exposure, including hypothermia and several skin injuries. Cold-related skin injuries are categorized into freezing and nonfreezing cold injuries. Freezing cold injuries involve tissue damage when exposed to temperatures below freezing. Nonfreezing cold injuries involve tissue damage when exposed to temperatures often between 0-15 degrees Celsius for extended periods of time. While these injuries have disproportionally affected military members, recreational winter activities have also increased the risk and incidence within civilian populations. Additional risk factors include homelessness, inadequate or wet clothing, alcohol abuse or tobacco abuse, and pre-existing medical conditions that impair blood flow.
A diabetic foot disease is any condition that results directly from peripheral artery disease (PAD) or sensory neuropathy affecting the feet of people living with diabetes. Diabetic foot conditions can be acute or chronic complications of diabetes. Presence of several characteristic diabetic foot pathologies such as infection, diabetic foot ulcer and neuropathic osteoarthropathy is called diabetic foot syndrome. The resulting bone deformity is known as Charcot foot.
Non-freezing cold injuries (NFCI) is a class of tissue damage caused by sustained exposure to low temperature without actual freezing. There are several forms of NFCI, and the common names may refer to the circumstances in which they commonly occur or were first described, such as trench foot, which was named after its association with trench warfare. NFCI is caused by microvascular endothelial damage, stasis and vascular occlusion and is characterised by peripheral neuropathy. NFCI generally affects the hands or feet during exposure to temperatures just above freezing, often wet, and is typically found in soldiers.
Diabetic foot infection is any infection of the foot in a diabetic person. The most frequent cause of hospitalization for diabetic patients is due to foot infections. Symptoms may include pus from a wound, redness, swelling, pain, warmth, tachycardia, or tachypnea. Complications can include infection of the bone, tissue death, amputation, or sepsis. They are common and occur equally frequently in males and females. Older people are more commonly affected.