Trench Foot-What is it?

What is it?
Trench foot, also known as immersion foot syndrome, develops
when feet are cold and wet for prolonged periods of time
without the ability to warm or dry the skin. This can result
in pain, swelling, and numbness in the feet. This condition
received its name during the 1st World War as this became a
serious problem for soldiers on the battlefield, contributing to
tens of thousands of casualties.
Symptoms/Risks
Symptoms may include, but are not limited to, tingling, itching,
swelling, pain, coldness, numbness, pain, prickliness, and
blotchy skin. Blisters may form which eventually lead to skin and
soft tissue dying and sloughing off. In severe cases, an untreated
foot may involve the entire foot destroying not just the skin but
the soft tissues and bones of the feet. Exposure to extreme cold
may cause frostbite or gangrene to develop, which are both
devastating conditions with lifelong consequences and potential
disability if not treated immediately.
Sports Medicine Evaluation & Treatment
As the skin of the feet becomes macerated, the underlying
tissues are exposed to potentially infectious organisms. Skin
is the first line of defense and a protective barrier to bacteria,
fungi, and parasites. However, when the skin is compromised,
these organisms may infiltrate into the tissues deep to the skin
and cause infections. If there is any concern for an infection,
medical care should be sought out immediately as these
infections may penetrate into the blood stream, leading to
shock and death.
Your doctor should inspect the feet carefully. Typically the
diagnosis of a skin infection can be made clinically; however, lab
tests and cultures may be ordered to rule out infections within
the blood stream. X-ray and/or MRI tests are also sometimes
ordered if there is concern of infection deep to the skin or in
the bone. Your doctor may prescribe oral antibiotics if necessary
to treat a suspected infection. Some infections in the feet may
require hospitalization. Frostbite and gangrene may also require
hospitalization. Dead skin and tissues require debridement as
they serve as a nidus for infection and continued inflammation.
AMSSM SPORTS MEDICINE TOPICS
TRENCH FOOT
Patient Resource Courtesy of SportsMedToday.com.
Injury Prevention
Trench foot may be prevented by keeping feet dry. Wet shoes
and wet socks should be exchanged for dry ones. Shoes should
be well-fitted and not overly-tight. Keep feet clean and check
for any developing foot wounds at least once daily. Remove
socks and shoes whenever resting or sleeping to allow the
feet to air-dry. Athletes who tend to sweat profusely may
use an aluminum-containing antiperspirant on their feet to
prophylactically reduce the risk of trench foot.
Return to Play
Athletes may return to play when the feet are fully healed, the
skin is intact, and there are no signs or symptoms of infection.
Returning to play too early may not allow the skin to resume its
protective barrier for the body, leading to further irritation and
potential for infection.

AMSSM Member Author: Scott Marberry, MD
References:
Fudge JR et al. Medical Evaluation for Exposure Extremes: Cold. Clin J Sport Med.
Sept 2015;25(5):432-436.
“Trench foot or Immersion Foot.” Centers for Disease Control and Prevention.
Last updated Jun 20, 2014. https://www.cdc.gov/disasters/trenchfoot.html
Atenstaedt, RL. Trench foot: the medical response in the First World War
1914–18. Wilderness & environmental medicine. 2006;17(4):282-289.
Schwartz RB, McManus JG, Swienton RE. Trench foot (immersion foot). Tactical
Emergency Medicine. Lippincott, Williams & Williams. 2008: 80.