What is Trench foot?

Trench foot derived it’s name from trench warfare in World War I. It is also called NFCI (Non Freezing Cold Injury). More than 20000 soldiers were affected between 1914-1915.

It affected the soldiers who spent longer periods of time in wet, muddy and unsanitary conditions of the trenches. Due to wet, cold, poor circulation and secondary infection the skin breakdown which increases the risk of infection. People who are more susceptible to trench foot are military, flood rescue teams, the homeless and farmers.

Understanding Trench foot

Due to cold weather, the blood supply to the affected area will be affected, usually the feet. If it sustains for a long period the cells will become compromised and die due to lack of oxygen and nutrients. Since the skin will be extremely soft it will be more prone for injury and infections. 

Symptoms

• Redness
• Swelling
• Pain 
• Numbness
• Blisters or open sores
• Red skin
• Prickly or heavy sensation in the foot

Stages of trench foot 

The progression of the trench foot can be often overlooked, due to subtle symptoms.

• Early symptoms are tingling, itching, and numbness accompanied with pale or blotchy skin
•  As the condition progresses, the body’s immune response further complicates, leading to swelling, redness, and a heavy, painful situation. The skin may appear red or blue hue indicating potential damage to underlying blood vessels. At this stage mobility might be compromised
• In advanced stages, the damage can extend to deeper tissues and muscles, resulting in severe pain, numbness and permanent nerve damage. The skin may become dry and cracked leading to infections. This is particularly a dangerous stage due to the increased risk of complications such as gangrene

Recognising secondary infections

Secondary infections occur most commonly due to bacteria and fungi.

Bacterial infections

• Common bacteria (Staphylococcus aureus, Pseudomonas aeruginosa)
• Signs include redness, warmth, pus, foul odor, systemic fever

Fungal infections

• Common fungi (Trichophyton, Candida)
• Signs include itching, peeling, discoloration, persistent moisture

Risk factors for infection

• Prolonged moisture exposure- The important risk factors for trench foot are moisture and pressure and not how cold the feet are. Exposure of the feet to damp wet conditions leads to constriction of the blood vessels in the feet in an attempt by the body to retain heat. Blood vessels then dilate to restore warmth in the feet. Soft tissue injury occurs if this continues
• Poor hygiene and improper wound care
• Compromised immunity (diabetes, malnutrition, chronic illness)

Management and treatment

Immediate care for trench foot

Trench foot could be treated if diagnosed in the early stages. Initial treatment includes keeping the feet warm and clean, slow passive warming is advisable. Additional treatment includes resting and elevating the feet above the heart, which will prevent new wounds and blisters. Antibiotics might be prescribed for the prevention of secondary infections. To minimise pain, painkillers will be advised.

Treatments for bacterial and fungal infections

Most common bacterial infection is cellulitis. Symptoms include redness, swelling and pain in the affected area. Tests like blood tests, MRI scans ( if the infection is affecting deeper levels of skin and bone ) may be advised depending on the severity of infection. The soft tissue infections will be managed by cleaning the wound and keeping the area dry and warm. Antibiotics will be prescribed to get rid of the infection. In extremely severe cases where there is tissue death due to gangrene, the only option may be amputation.

Topical antifungals and drying agents will be advised for fungal infections. In severe cases, oral
Oral antifungals might be prescribed.

Prevention strategies

The best treatment for trench foot is prevention.

The centre for disease control and prevention ( CDC ) recommends the following measures

• Take off socks and inspect your feet periodically
• Avoid wearing dirty socks to bed
• Wash the affected area with water
• Dry feet completely
• Apple heat packs to the area for about 5 minutes
• Wearing properly fitting shoes or boots

FAQ’s

What are the complications of trench foot?

Potential complications include the following:

• Cellulitis - This occurs due to bacterial infection of the soft tissues. Symptoms include redness, swelling and pain.
• Neuropathic pain- Burning pain which may be constant. Sensitivity to touch, pain and temperature might be increased.
• Gangrene- Death of soft tissue due to loss of blood supply. Signs include blue or black skin, foul odour and loss of feeling in the foot.
• Sepsis- It is basically the reaction of the body to infection. Symptoms include fever, rapid breathing, increased heart rate and shortness of breath. It is a medical emergency and needs immediate medical care.

Summary

Trench foot is different from frostbite. It develops when your feet are in a cold, damp environment for a longer period of time. It leads to bacterial and fungal infections of the feet and even gangrene if it's not treated. In the past it was a serious condition that could lead to death. However, today it could be treated if it's caught early.