Trench foot

Immersion foot
Trench foot as seen on an unidentified soldier during World War I
Classification and external resources
Specialty	Emergency medicine
ICD-10	T69.0
ICD-9-CM	991.4
DiseasesDB	31219

Trench foot is a medical condition caused by prolonged exposure of the feet to damp, unsanitary, and cold conditions. It is one of many immersion foot syndromes. The use of the word trench in the name of this condition is a reference to trench warfare, mainly associated with World War I, which started in 1914.

Signs and symptoms

Affected feet may become numb, affected by erythema (turning red) or cyanosis (turning blue) as a result of poor blood supply, and may begin emanating a decaying odor if the early stages of necrosis (tissue death) set in. As the condition worsens, feet may also begin to swell. Advanced trench foot often involves blisters and open sores, which lead to fungal infections; this is sometimes called tropical ulcer (jungle rot).

If left untreated, trench foot usually results in gangrene, which may require amputation. If trench foot is treated properly, complete recovery is normal, though it is marked by severe short-term pain when feeling returns.

Causes

Unlike frostbite, trench foot does not require freezing temperatures; it can occur in temperatures up to 16° Celsius (about 60° Fahrenheit) and within as few as 13 hours.^[1] The mechanism of tissue damage is not fully understood. Excessive sweating (hyperhidrosis) has long been regarded as a contributory cause; unsanitary, cold, and wet conditions can also cause trench foot.^[2]

Prevention

Trench foot can be prevented by keeping the feet clean, warm, and dry. It was also discovered in World War I that a key preventive measure was regular foot inspections; soldiers would be paired and each made responsible for the feet of the other, and they would generally apply whale oil 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 if it were the responsibility of another, this became less likely.^[3] Later on in the war, instances of trench foot began to decrease, probably as a result of the introduction of: the aforementioned measures; of wooden duckboards to cover the muddy, wet, cold ground of the trenches; and of the increased practice of troop rotation, which kept soldiers from prolonged time at the front.

History

Trench foot was first documented by Napoleon's army in 1812. It became prevalent during the retreat from Russia and was first described by French army surgeon Dominique Jean Larrey.^[4] It was also a problem for soldiers engaged in trench warfare during the winters of World War I,^[5] World War II, and the Vietnam War.

Trench foot made a reappearance in the British Army, during the Falklands War in 1982.^[6] The causes were the cold, wet conditions and insufficiently waterproof DMS boots.

Some people were even reported to have developed trench foot at the 1998 and 2007 Glastonbury Festivals, the 2009 and 2013 Leeds Festivals, as well as the 2012 Download Festival, as a result of the sustained cold, wet, and muddy conditions at the events.^[7]

In popular culture

In Hell on Wheels season 1, episode 8 ("Derailed"), Eva warns Lily to lay down planks in her tent, to avoid getting trench foot. Lily replies that she's well acquainted with trench foot, having spent a year in the field [as a surveyor for the Union Pacific Railroad].

References

Wikimedia Commons has media related to Trench foot.

↑ "Trench Foot". All Health Site - Health Articles and News.
↑ "CHRONIC TRENCH FOOT: A STUDY OF 100 CASES". Annals.org. 1951-05-01. Retrieved 2011-10-20.
↑ David, Saul (presenter) (February 2012). Bullets, Boots and Bandages (episode 1/3). BBC Four.
↑ Régnier C (2004). "Etiological argument about the Trench Foot". Hist Sci Med (in French) 38 (3): 315–32. PMID 15617178.
↑ Atenstaedt RL (2006). "Trench foot: the medical response in the first World War 1914-18". Wilderness Environ Med 17 (4): 282–9. doi:10.1580/06-WEME-LH-027R.1. PMID 17219792.
↑ Chris Ryan (April 28, 2010). "Chris Ryan: I’m not sure I could deal with Afghanistan". London: The Daily Telegraph. Retrieved April 28, 2010.
↑ "I got trench foot at Glastonbury". BBC News. June 23, 2008. Retrieved May 26, 2010.

Consequences of external causes (T66–T78, 990–995)

Temperature/radiation	elevated temperature Hyperthermia Heat syncope reduced temperature Hypothermia Immersion foot syndromes Trench foot Tropical immersion foot Warm water immersion foot Chilblains Frostbite Aerosol burn Cold intolerance Acrocyanosis Erythrocyanosis crurum radiation Radiation poisoning Radiation burn Chronic radiation keratosis Eosinophilic, polymorphic, and pruritic eruption associated with radiotherapy Radiation acne Radiation cancer Radiation recall reaction Radiation-induced erythema multiforme Radiation-induced hypertrophic scar Radiation-induced keloid Radiation-induced morphea

Air	Hypoxia/Asphyxia Barotrauma Aerosinusitis Decompression sickness High altitude Altitude sickness Chronic mountain sickness HAPE HACE

Food	Starvation

Maltreatment	Physical abuse Sexual abuse Psychological abuse

Travel	Motion sickness Seasickness Airsickness Space adaptation syndrome

Adverse effect	Hypersensitivity Anaphylaxis Angioedema Allergy Arthus reaction Adverse drug reaction

Other	Electric shock Drowning Lightning injury

Ungrouped skin conditions resulting from physical factors	Dermatosis neglecta Pinch mark Pseudoverrucous papules and nodules Sclerosing lymphangiitis Tropical anhidrotic asthenia UV-sensitive syndrome environmental skin conditions Electrical burn frictional/traumatic/sports Black heel and palm Equestrian perniosis Jogger's nipple Pulling boat hands Runner's rump Surfer's knots Tennis toe Vibration white finger Weathering nodule of ear Wrestler's ear Coral cut Painful fat herniation Uranium dermatosis iv use Skin pop scar Skin track Slap mark Pseudoacanthosis nigricans Narcotic dermopathy

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