Trench foot

Last updated
Trench foot
Other namesImmersion 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 Emergency medicine, podiatry
Symptoms
  • Tingling, itch and numbness or pain in feet
Complications
  • Infection
Causes
  • Prolonged exposure of feet to damp
Treatment
  • Keep feet dry
  • Surgical debridement

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]

Contents

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]

Names

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]

Signs and symptoms

Trench foot Trench foot.jpg
Trench foot

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]

Causes

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]

Diagnosis

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]

Prevention

Trench foot can be prevented by keeping the feet clean, warm, and dry. [1]

Treatment

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 treatmentas 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]

History

Office of War Information - WWII THIS IS TRENCH FOOT. PREVENT IT^ KEEP FEET DRY AND CLEAN - NARA - 515785.jpg
Office of War Information – WWII

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 19171918 through improvements to the trenches, modification of soldiers' footwear, and the provision of greaseschiefly 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]

See also

Related Research Articles

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<span class="mw-page-title-main">Hypothermia</span> Human body core temperature below 35 °C (95 °F)

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<span class="mw-page-title-main">Gangrene</span> Type of tissue death by infection or lack of blood supply

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.

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

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

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Necrotizing fasciitis (NF), also known as flesh-eating disease, is a bacterial infection that results in the death of parts of the body's soft tissue. It is a severe disease of sudden onset that spreads rapidly. Symptoms usually include red or purple skin in the affected area, severe pain, fever, and vomiting. The most commonly affected areas are the limbs and perineum.

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

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<span class="mw-page-title-main">Rhinorrhea</span> Filling of the nasal cavity with fluid mucus

Rhinorrhea, also spelled rhinorrhoea or rhinorrhœa, 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.

<span class="mw-page-title-main">Foot rot</span> Hoof infection commonly found in sheep, goats, and cattle

Foot rot, also known as foul-in-the-foot, interdigital necrobacillosis or infectious pododermatitis, is a hoof infection commonly found in sheep, goats, and cattle. As the name suggests, it rots away the foot of the animal, more specifically the area between the two toes of the affected animal. It is extremely painful and contagious. It can be treated with a series of medications, but if not treated, the whole herd can become infected. The cause of the infection in cattle is two species of anaerobic bacteria, Fusobacterium necrophorum and Bacteroides melaninogenicus. Both bacteria are common to the environment in which cattle live, and Fusobacterium is present in the rumen and fecal matter of the cattle. In sheep, F. necrophorum first invades the interdigital skin following damage to the skin, and causes interdigital lesions and slight inflammation. The second stage of the disease is marked by the invasion of the foot by the foot rot bacterium Dichelobacter nodosus, a Gram-negative anaerobe. Usually, an injury to the skin between the hooves allows the bacteria to infect the animal. Another cause of foot rot may be high temperatures or humidity, causing the skin between the hooves to crack and let the bacteria infect the foot. This is one of the reasons foot rot is such a major problem in the summer. Foot rot is easily identifiable by its appearance and foul odor. Treatment is usually with an antibiotic medication, and preventing injury to the feet is the best way to prevent foot rot.

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<span class="mw-page-title-main">Immersion foot syndromes</span> Medical condition

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.

<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">Diabetic foot ulcer</span> Medical condition

Diabetic foot ulcer is a breakdown of the skin and sometimes deeper tissues of the foot that leads to sore formation. It may occur due to a variety of mechanisms. It is thought to occur due to abnormal pressure or mechanical stress chronically applied to the foot, usually with concomitant predisposing conditions such as peripheral sensory neuropathy, peripheral motor neuropathy, autonomic neuropathy or peripheral arterial disease. It is a major complication of diabetes mellitus, and it is a type of diabetic foot disease. Secondary complications to the ulcer, such as infection of the skin or subcutaneous tissue, bone infection, gangrene or sepsis are possible, often leading to amputation.

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.

References

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