Trench foot
From IDWiki
Background
- Also known as nonfreezing cold injury, sea boot foot, and bridge foot
Pathophysiology
- Not entirely clear
- Requires moisture
- Possibly related to sustained vasoconstriction with ischemia
- Possibly related to reperfusion injury
Clinical Manifestations
- Occurs in people with cold, wet extremities (0 to 8 ºC) lasting at least 1 to 3 days (and as little as 14 hours)
- Stage I: cold exposure with loss of sensation
- May have difficulty walking
- Limbs often bright red, then becomes pale or white due to vasoconstriction
- Painless
- Stage II: post-exposure, after rewarming
- Skin mottles and blue
- Limbs cold and still numb, may have swelling
- Lasts hours to days
- Stage III: hyperemic stage
- Bright red and swollen, though pulses now strong
- Ongoing delayed capillary refill
- Numbness resolves but now there is pain and possibly allodynia
- May have blisters
- Lasts days or weeks
- Stage IV: post-hyperemic stage
- Limb returns to normal appearance
- New cold sensitivity, prolonged even after brief exposure to cold
- May have syndrome similar to complex regional pain syndrome
- Lasts for weeks to years, can be permanent
Differential Diagnosis
- Frostbite, characterized by exposure to below-freezing temperatures, though can coexist with trench foot and some of the signs and symptoms can overlap
Management
- Rewarming and treatment of hypothermia, if present
- Care is otherwise supportive
- Pain management may include amitriptyline 50 to 100 mg p.o. QHS or gabapentin
Further Reading
- Nonfreezing Cold Injury (Trench Foot). Int J Environ Res Public Health. 2021;18(19):10482. doi: 10.3390/ijerph181910482. PMID: 34639782; PMCID: PMC8508462.
