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Overview :
Prolonged
exposure of the feet to cold but not freezing water for prolonged periods can
result in immersion foot. This was particularly common on the Western Front
during World War I, when it was termed "trench foot."
Settings:
(1) prolonged
exposure of the feet to cold water
(2) lack of
footwear, or improper footwear for conditions
(3) repeated
trauma to the feet or prolonged standing
Clinical
findings: one or more of the following:
(1) numbness
(2) erythema
(3) blistering
(4) swelling
(5) painful
paresthesias
(6) leg cramping
(7) muscle
weakness or atrophy
(8) ulceration
(9) cellulitis
(10) gangrene
Three clinical
states are recognized:
(1) ischemia: vasoconstriction resulting
in the distal extremity being pale and pulseless
(2) hyperemia: vasodilatation with
increased circulation, resulting in red, swollen and painful feet with a
bounding pulse
(3) posthyperemic
Therapy:
• Mild forms may
respond to cleaning, rest and elevation of the feet.
• Ischemic: Rewarming needs to be done
carefully, since overheating of tissue may result in tissue infarction and
gangrene.
• Hyperemic:
Careful cooling is required to reduce the increased circulation.
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