Trench foot 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 An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable di ...

. Trench foot occurs due to prolonged exposure of the feet to cold, damp, and often unsanitary conditions. Unlike

frostbite 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 t ...

, trench foot usually occurs at temperatures above

freezing Freezing is a phase transition where a liquid turns into a solid when its temperature is lowered below its freezing point. In accordance with the internationally established definition, freezing means the solidification phase change of a liquid ...

, and can be classed as a form of non-freezing cold injury. Onset can be as rapid as 10 hours. Risk factors include overly tight boots and not moving. The underlying mechanism is believed to involve constriction of blood vessels resulting in insufficient blood flow to the feet. Diagnosis is based on symptoms and examination. Prevention involves keeping the feet warm, dry, and clean. After the condition has occurred, pain medications may be required during the gradual rewarming process. Pain may persist for months following treatment. Surgery to remove damaged tissue or

amputation Amputation is the removal of a limb by trauma, medical illness, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on indi ...

may be necessary. Those in the

military A military, also known collectively as armed forces, is a heavily armed, highly organized force primarily intended for warfare. It is typically authorized and maintained by a sovereign state, with its members identifiable by their distinct ...

are most commonly affected, though cases may also occur in the

homeless Homelessness or houselessness – also known as a state of being unhoused or unsheltered – is the condition of lacking stable, safe, and adequate housing. People can be categorized as homeless if they are: * living on the streets, also kn ...

. The condition was first described during

Napoleon Bonaparte Napoleon Bonaparte ; it, Napoleone Bonaparte, ; co, Napulione Buonaparte. (born Napoleone Buonaparte; 15 August 1769 – 5 May 1821), later known by his regnal name Napoleon I, was a French military commander and political leader wh ...

's retreat from Russia in the winter of 1812. The word ''trench'' in the name is a reference to

trench warfare Trench warfare is a type of land warfare using occupied lines largely comprising Trench#Military engineering, military trenches, in which troops are well-protected from the enemy's small arms fire and are substantially sheltered from artille ...

, mainly associated with

World War I World War I (28 July 1914 11 November 1918), often abbreviated as WWI, was List of wars and anthropogenic disasters by death toll, one of the deadliest global conflicts in history. Belligerents included much of Europe, the Russian Empire, ...

Signs and symptoms

Trench foot frequently begins with the feeling of tingling and an itch in affected feet, and subsequently progresses to numbness or pain. The feet may become red or

blue Blue is one of the three primary colours in the RYB colour model (traditional colour theory), as well as in the RGB (additive) colour model. It lies between violet and cyan on the spectrum of visible light. The eye perceives blue when ...

as a result of poor blood supply. 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 touch. Advanced trench foot often involves

blister A blister is a small pocket of body fluid ( lymph, serum, plasma, blood, or pus) within the upper layers of the skin, usually caused by forceful rubbing ( friction), burning, freezing, chemical exposure or infection. Most blisters are filled ...

s and

open sore A wound is a rapid onset of injury that involves laceration, lacerated or puncture wound, punctured skin (an ''open'' wound), or a bruise, contusion (a ''closed'' wound) from blunt force physical trauma, trauma or compression. In pathology, a '' ...

s, which lead to fungal infections; this is sometimes called jungle rot. It is marked by severe short-term pain when feeling returns.

Causes

Unlike

, trench foot does not require freezing temperatures; it can occur in temperatures up to 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. Excessive sweating (

hyperhidrosis Hyperhidrosis is a condition characterized by abnormally increased sweating, in excess of that required for regulation of body temperature. Although primarily a benign physical burden, hyperhidrosis can deteriorate quality of life from a psychologi ...

) has long been regarded as a contributory cause; unsanitary, cold, and wet conditions can also cause trench foot.

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 A complete blood count (CBC), also known as a full blood count (FBC), is a set of medical laboratory tests that provide information about the cells in a person's blood. The CBC indicates the counts of white blood cells, red blood cells and ...

if infection is present and inflammatory markers such as an

erythrocyte sedimentation rate The erythrocyte sedimentation rate (ESR or sed rate) is the rate at which red blood cells in anticoagulated whole blood descend in a standardized tube over a period of one hour. It is a common hematology test, and is a non-specific measure of ...

or C-reactive protein (CRP) might highlight severity.

Prevention

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

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. Applying

emollient A moisturizer, or emollient, is a cosmetic preparation used for protecting, moisturizing, and lubricating the skin. These functions are normally performed by sebum produced by healthy skin. The word "emollient" is derived from the Latin verb ''m ...

helps. The mainstay of treatment, like the treatment of

gangrene 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 gan ...

, is surgical

debridement Debridement is the medical removal of dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue. Removal may be surgical, mechanical, chemical, autolytic (self-digestion), and by maggot therapy. I ...

, and often includes

. 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.

History

Trench foot was first reported in 1812 by the French army surgeon Dominique Jean Larrey when

Napoleon Napoleon Bonaparte ; it, Napoleone Bonaparte, ; co, Napulione Buonaparte. (born Napoleone Buonaparte; 15 August 1769 – 5 May 1821), later known by his regnal name Napoleon I, was a French military commander and political leader wh ...

’s army was retreating from Russia. It was also a problem for soldiers engaged in

during the winters of

(hence the name). It was also discovered in World War I that a key preventive measure was regular foot inspections; soldiers would be paired and each partner made responsible for the feet of the other, and they would generally apply

whale oil Whale oil is oil obtained from the blubber of whales. Whale oil from the bowhead whale was sometimes known as train oil, which comes from the Dutch word ''traan'' (" tear" or "drop"). Sperm oil, a special kind of oil obtained from the head ...

to prevent trench foot. If left to their own devices, soldiers might neglect to take off their own boots and socks to dry their feet each day, but when it was made the responsibility of another, this became less likely. The condition has been documented in survivors of shipwrecks and downed aeroplanes. Trench foot made a reappearance in the British Army during the

Falklands War The Falklands War ( es, link=no, Guerra de las Malvinas) was a ten-week undeclared war between Argentina and the United Kingdom in 1982 over two British dependent territories in the South Atlantic: the Falkland Islands and its territorial ...

, in 1982. The condition was reported at the 1998 and 2007

Glastonbury Festival Glastonbury Festival (formally Glastonbury Festival of Contemporary Performing Arts and known colloquially as Glasto) is a five-day festival of contemporary performing arts that takes place in Pilton, Somerset, England. In addition to contemp ...

References

External links

* {{Portal bar, Medicine, World War I Foot diseases Skin conditions resulting from physical factors Effects of external causes Trench warfare Gangrene Immersion foot syndromes World War I Military medicine in World War I