Immersion foot syndromes

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Immersion foot
Case of trench feet suffered by unidentified soldier Cas de pieds des tranchees (soldat non identifie).jpg
Trench foot as seen on an unidentified soldier during World War I
Specialty Dermatology   OOjs UI icon edit-ltr-progressive.svg

Immersion foot syndromes are a class of foot injury caused by water absorption in the outer layer of skin. [1] [2] 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. [3] :26–7 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. [4]

Contents

Causes

Trench foot

Trench foot is a medical condition caused by prolonged exposure of the feet to damp, unsanitary, and cold conditions. The use of the word trench in the name of this condition is a reference to trench warfare, mainly associated with World War I. Affected feet may become numb, affected by erythrosis (turning red) or cyanosis (turning blue) as a result of poor vascular supply, and feet may begin to have a decaying odour due to the possibility of the early stages of necrosis setting in. As the condition worsens, feet may also begin to swell. Advanced trench foot often involves blisters and open sores, which lead to fungal infections; this is sometimes called tropical ulcer (jungle rot).

If left untreated, trench foot usually results in gangrene, which can cause the need for amputation. If trench foot is treated properly, complete recovery is normal, though it is marked by severe short-term pain when feeling returns. As with other cold-related injuries, trench foot leaves those affected more susceptible to it in the future.[ citation needed ]

Tropical immersion foot

Tropical immersion foot (also known as "Paddy foot", [3] and "Paddy-field foot" [5] ) is a skin condition of the feet seen after continuous immersion of the feet in water or mud of temperature above 22 °C (72 °F) for two to ten days. [3] :27

Warm water immersion foot

Warm water immersion foot is a skin condition of the feet that results after exposure to warm, wet conditions for 48 hours or more and is characterized by maceration ("pruning"), blanching, and wrinkling of the soles, padding of toes (especially the big toe) and padding of the sides of the feet.

Foot maceration occur whenever exposed for prolonged periods to moist conditions. Large watery blisters appear which are painful when they open and begin to peel away from the foot itself. The heels, sides and bony prominences are left with large areas of extremely sensitive, red tissue, exposed and prone to infection. As the condition worsens, more blisters develop due to prolonged dampness which eventually covers the entire heel and/or other large, padded sections of the foot, especially the undersides as well as toes. Each layer in turn peels away resulting in deep, extremely tender, red ulcers.

Healing occurs only when the feet are cleansed, dried and exposed to air for weeks. Scarring is permanent with dry, thin skin that appears red for up to a year or more. The padding of the feet returns but healing can be painful as the nerves repair with characteristics of diabetic neuropathy. Antibiotics and/or antifungal are sometimes prescribed.

Foot immersion is a common problem with homeless individuals wearing one pair of socks and shoes for extensive periods of time, especially wet shoes and sneakers from rain and snow. The condition is exacerbated by excessive dampness of the feet for prolonged periods of time. Fungus and bacterial infections prosper in the warm, dark, wet conditions and are characterized by a sickly odor that is distinct to foot immersion. [3] :27 [5]

Prevention

In the British Army, policies were developed to help the soldiers keep their feet dry—the surest way of preventing the disease. Soldiers were told to dry their feet, and keep them dry by changing socks several times a day. After the first year of the First World War, British troops were instructed to keep at least three pairs of socks with them and to frequently change them. The use of whale oil was also successful in combating trench foot. A British battalion in front line positions could be expected to use ten gallons of whale oil every day. [6]

Related Research Articles

<span class="mw-page-title-main">Blister</span> Small pocket of fluid within the upper layers of the skin

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.

<span class="mw-page-title-main">Ulcer (dermatology)</span> Type of cutaneous condition

An ulcer is a sore on the skin or a mucous membrane, accompanied by the disintegration of tissue. Ulcers can result in complete loss of the epidermis and often portions of the dermis and even subcutaneous fat. Ulcers are most common on the skin of the lower extremities and in the gastrointestinal tract. An ulcer that appears on the skin is often visible as an inflamed tissue with an area of reddened skin. A skin ulcer is often visible in the event of exposure to heat or cold, irritation, or a problem with blood circulation.

<span class="mw-page-title-main">Callus</span> Thickened and hardened area of skin

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.

<span class="mw-page-title-main">Frostbite</span> Effect of low temperature on skin and other tissues

Frostbite is a skin injury that occurs when exposed to extreme 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.

<span class="mw-page-title-main">Chilblains</span> Medical condition

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.

<span class="mw-page-title-main">Athlete's foot</span> Skin infection caused by fungus

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.

<span class="mw-page-title-main">Diseases of the foot</span>

Diseases of the foot generally are not limited, that is they are related to or manifest elsewhere in the body. However, the foot is often the first place some of these diseases or a sign or symptom of others appear. This is because of the foot's distance from the central circulation, the heart and its constant exposure to pressures from the ground and the weight of the body.

<span class="mw-page-title-main">Cold-weather warfare</span> Warfare in cold temperatures

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.

Jungle rot may refer to:

<span class="mw-page-title-main">Onychomycosis</span> Medical condition

Onychomycosis, also known as tinea unguium, is a fungal infection of the nail. Symptoms may include white or yellow nail discoloration, thickening of the nail, and separation of the nail from the nail bed. Toenails or fingernails may be affected, but it is more common for toenails. Complications may include cellulitis of the lower leg. A number of different types of fungus can cause onychomycosis, including dermatophytes and Fusarium. Risk factors include athlete's foot, other nail diseases, exposure to someone with the condition, peripheral vascular disease, and poor immune function. The diagnosis is generally suspected based on the appearance and confirmed by laboratory testing.

<span class="mw-page-title-main">Hazards of outdoor recreation</span>

Outdoor recreation, such as hiking, camping, canoeing, cycling, or skiing, entails risks, even if participants do not recklessly place themselves in harm's way. In some circumstances, such as being in remote locations or in extreme weather conditions, even a minor accident may create a dangerous situation that requires survival skills. However, with correct precautions, even fairly adventurous outdoor recreation can be enjoyable and safe.

<span class="mw-page-title-main">Trench foot</span> Injury to the foot due to poor circulation, cold and moisture

Trench foot, also known by other names, is a type of foot damage due to moisture. Initial symptoms often include tingling or itching which can progress to numbness. The feet may become red or bluish in color. As the condition worsens the feet can start to swell and smell of decay. Complications may include skin breakdown or infection.

<span class="mw-page-title-main">Pitted keratolysis</span> Medical condition

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.

<span class="mw-page-title-main">Tropical ulcer</span> Type of chronic ulcerative skin lesion

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.

Sucking blisters are a cutaneous condition on newborns that is present on their extremities at birth. This is not to be confused with sucking pads, which are similar in appearance. Sucking blisters are due to natural neonatal sucking reflexes on the affected areas in utero. These sucking blisters become present at birth when the sucking movements are very aggressive while in the uterus. These blisters are commonly found on the newborn's arms, fingers, or any body part they are able to suck on. It is a very rare condition, seen in less than 1% of newborns. It is difficult to diagnose because its appearance can be mistaken as other skin conditions. Diagnosis is usually done by eliminating other possible cutaneous conditions. This process of elimination includes examining blood culture, lesions, and inflammatory markers. This skin condition is usually self-inflicted, benign and can heal on its own. Sucking blisters do typically not require medical treatment and disappear within a week.

<span class="mw-page-title-main">Cold injury</span> Medical condition

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.

<span class="mw-page-title-main">Skin maceration</span> Skin damage from prolonged exposure to moisture

Maceration is defined as the softening and breaking down of skin resulting from prolonged exposure to moisture. It was first described by Jean-Martin Charcot in 1877. Maceration is caused by excessive amounts of fluid remaining in contact with the skin or the surface of a wound for extended periods.

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.

Two feet-one hand syndrome(TFOHS), is a long-term fungal condition where athlete's foot or fungal toe nail infections in both feet is associated with tinea manuum in one hand. Often the feet are affected for several years before symptoms of a diffuse scaling rash on the palm of one hand appear, which is when most affected people then seek medical help.

References

  1. "Trench Foot or Immersion Foot". cdc.gov. Center for Disease Control and Prevention. Retrieved 10 June 2017.
  2. Wrenn, K (April 1991). "Immersion foot. A problem of the homeless in the 1990s". Archives of Internal Medicine. 151 (4): 785–8. doi:10.1001/archinte.151.4.785. PMID   2012466.
  3. 1 2 3 4 James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN   0-7216-2921-0.
  4. Taplin, David; Zaias, Nardo; Blank, Harvey (6 November 1967). "The role of temperature in tropical immersion foot syndrome". The Journal of the American Medical Association. 202 (6): 546–549. doi:10.1001/jama.1967.03130190152032. PMID   6072324 . Retrieved 10 June 2017.
  5. 1 2 Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN   978-1-4160-2999-1.
  6. Simkin, John (August 2014). "Trench Foot". Spartacus Educational. Retrieved April 10, 2019.