What is Trench Foot?
Trench foot is a type of immersion foot, a condition that could occur when feet are constantly wet. It is categorized as a non-freezing cold injury (NFCI), which means that it happens due to prolonged exposure to cold, damp, and sometimes dirty conditions, but not when it’s freezing. Trench foot can lead to damage of skin and tissues, making you more likely to develop an infection. This increases the overall sickness and risk of death related to this condition.
What Causes Trench Foot?
During World War I, a lot of soldiers suffered from a condition called ‘trench foot’. Beginning in 1914, the soldiers were fighting in trenches in Europe for long periods. The conditions inside those trenches were often wet, cold and muddy. Standing in these waterlogged trenches for extended periods led to the soldiers developing trench foot.
Between the winter of 1914 and 1915, it’s reported that more than 20,000 British troops were treated for this condition. What’s more, trench foot is likely to have contributed to the deaths of around 2,000 American and 75,000 British soldiers.
This condition was first talked about in 1812 when Napoleon’s army was retreating from Russia. Dr. Dominique Jean Larrey, a surgeon in the French army, first described the condition. Even though nowadays it’s widely known how to prevent this condition, it still occurred as recently as 1982 during the Falklands War with the British Army.
Trench foot is a clear example of how conditions of war can lead to unexpected health issues, and why it’s crucial to apply preventive measures even in challenging environments.
Risk Factors and Frequency for Trench Foot
- Military personnel are often the group most likely to be affected by trench foot.
- In recent times, there have been clusters of cases among civilians during large music festivals where the conditions can cause the disease.
- In everyday medical care, homeless populations are also prone to getting trench foot because they often lack shelter and are exposed to damp, cold environments for extended periods.
Signs and Symptoms of Trench Foot
Trench foot is a medical condition that starts off with a tingling or itching sensation. This tends to progress to numbness, especially when exposed to cold. A lack of good blood flow can result in the feet turning red or blue. As the disease progresses and the feet get warm again, sufferers may experience a heightened sense of touch.
If left untreated, the disease may cause a bad smell, suggesting the beginning of tissue decay. The feet can also become significantly swollen, sometimes even doubling in size. It commonly affects the heels or toes, but can also extend above the foot. As the disease gets worse, the skin color might change and patients can develop blisters and open sores which could further lead to fungal and bacterial infections. If still not treated, the top layer of skin and tissue may start to slough off. Eventually, gangrene might set in, which could require amputation to prevent the disease from spreading and leading to other serious complications like sepsis or even death.
However, it’s important to note that if trench foot is identified and treated early on, a complete recovery can be expected. Nevertheless, when feeling returns to the affected area, there might be a significant amount of temporary pain.
Testing for Trench Foot
Trench foot diagnosis is purely based on a doctor’s assessment. It’s crucial to recognize the environments where it’s common, and a thorough physical exam is key. It’s important to make sure there aren’t any other infections, so a test that counts white blood cells might be needed. This is because white blood cells are the body’s main defense against harmful substances and infections.
Certain ‘inflammation indicators’ like C-reactive protein (CRP) or erythrocyte sedimentation rate tests could be beneficial. The C-reactive protein test measures the level of a specific protein that indicates inflammation in your body, while the erythrocyte sedimentation rate test determines how quickly red blood cells settle at the bottom of a blood sample. Both can help understand if there’s an infection or inflammation in the body.
If there’s a possibility of osteomyelitis (infection in the bone), a radiograph (a type of X-Ray) or a bone scan may be necessary. These imaging tests can help visualize the bones to check for any irregularities or signs that point to an infection.
Treatment Options for Trench Foot
Trench foot is a condition that can be avoided by tending to the feet properly. During World War I, soldiers discovered that daily foot checkups could decrease the risk of developing this disease. Soldiers would pair up and remind each other to take off their boots, let their socks and feet dry, and keep an eye on foot health. In order to further prevent the issue, they were instructed to always have three pairs of socks, changing and rotating between them at least twice a day. They would also coat their dry, clean feet in whale oil to protect against trench foot.
Another method of protection involved covering the wet and muddy ground of the trenches with wooden boards. This helped soldiers’ feet keep warm and dry. Rotating troops also helped limit each individual’s exposure to the harsh conditions that could lead to trench foot. These strategies helped lower the occurrence of trench foot as World War I wore on.
Though, prevention is the best treatment for trench foot, different treatment methods were developed during the war. At first, soldiers were recommended to rest. Various agents were also used, like lead and opium, alcohol, mercuric chloride, tincture of iodine, oil of wintergreen, picric acid, chloral hydrate with camphor, and different powders like boric acid, starch, and zinc. Advanced methods like radiant heat, massage, and electrical stimulation were also used. In severe cases, if the foot condition wasn’t improving, surgical intervention falling in line with gangrene treatment was required, which often led to amputation.
The current recommendation for treating trench foot is to slowly re-warm the affected foot. Proper pain management is also crucial, which may involve medications for nerve pain. It’s vital to check for signs of hypothermia and to protect the foot from the environmental causes that led to the condition in the first place.
What else can Trench Foot be?
Sufficient patient history and a thorough physical examination should enable a healthcare provider to distinguish between conditions like trench foot, frostbite, and cellulitis, as well as other diseases affecting a specific area of the body.
What to expect with Trench Foot
These days, trench foot, a painful condition affecting the feet, is usually caught early and the treatment is simple. It’s essential to keep the feet dry and warm. Resting and elevating the affected foot can help by preventing new injuries and blisters. Painkillers like NSAIDS (Nonsteroidal Anti-inflammatory Drugs) help with any discomfort and help reduce swelling. If you can’t take NSAIDS, then drugs like acetaminophen or aspirin can help to relieve the pain, but they may not reduce swelling.
According to the Center for Disease Control and Prevention (CDC), preventing and treating trench foot is pretty straightforward. Here are their recommendations:
- Take off your socks.
- Avoid wearing dirty socks to bed.
- Clean the affected area right away.
- Dry your feet thoroughly.
- Apply heat packs to the affected area for up to 5 minutes.
If the above steps don’t improve the condition, the CDC suggests getting a further evaluation from a healthcare professional.
Possible Complications When Diagnosed with Trench Foot
Complications are unusual and are typically due to improper care. In more advanced situations, infections of the skin and soft tissues, such as cellulitis or gangrene, might occur. These can be managed with suitable antibiotics or antifungal treatments. Long-lasting or chronic nerve pain is more common, and there are many ways to tackle this type of pain.
If not managed or treated correctly, rare cases might experience lasting changes to how they feel sensation or might require amputation.
Common Complications include:
- Soft tissue skin infections
- Cellulitis or gangrene
- Chronic nerve pain
- Permanent sensory changes
- Possibility of amputation
Preventing Trench Foot
It’s important for patients to understand how to identify injuries caused by cold temperatures that don’t involve freezing, along with the factors that can increase the risk of these injuries. Doctors should advise patients to stop smoking, drink enough water, and take good care of their feet. Patients are also advised to avoid drinking alcohol, taking medications that can narrow the blood vessels, and consuming caffeine as these substances can worsen the injury.
