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Subjective: Symptoms
Initially cold, wet feet progressing to numbness. Upon warming the torso and feet, they become hot and very
painful. The patient is unable to wear boots or walk. Those that can have a shuffling gait and will describe
walking as if on “wooden limbs.”
Objective: Signs
Initially pale, pulseless, and numb tissue that has slow capillary refill. Upon warming, they are edematous,
bright red or purple, hot and painful. Digital pressure produces pitting and slow rebound. After a number
of days, liquefaction necrosis or mummification of distal parts occurs. Fever develops and debridement is
necessary.
Assessment: The history of being cold and wet along with visualization of the limbs is diagnostic.
Differential Diagnosis:
Frostbite requires below freezing temperatures and produces a dry, mummifying gangrene (see Frostbite).
Chilblains are the early stages of trenchfoot and results in just swelling and itching of the extremity, which
subsides in 24 hours.
Pernio are thin, necrotic plaques on the dorsum of the hands or feet. They may be proximal to a more
serious distal trenchfoot injury.
Plan:
Treatment
Primary: Pat dry, DO NOT RUB. Elevate the feet, warm the torso and hydrate orally. Use urine output
(color, frequency) as hydration gauge. Pain meds help to some degree. NSAIDs may help. Most patients need
litters, and may need sleep meds.
Patient Education
General: Keep feet dry. Wounds will have a long, slow healing process. Patients may have residual
symptoms for years. Fanning the feet at night might help sleep.
Diet: High calorie, high protein diet, and adequate hydration.
Medications: NSAIDs and sleep meds.
Prevention and Hygiene: Change to dry socks daily in cold, wet conditions. Gently massage feet at night to
improve blood flow. Treat and/or evacuate those with early symptoms to avoid serious injury.
Wound Care: If necrotic, auto amputation occurs, clean the wound and use loose dry dressings. Evacuate.
Follow-up Actions
Evacuation/Consultant Criteria: Patients who are unable to ambulate or perform their mission, have
recurrent injury, have auto amputation of digits or develop osteomyelitis should be evacuated.
Chapter 24: Heat-Related Illnesses
Heat-Related Illnesses: Introduction
LTC Richard Kramp, MC, USAIntroduction: The body sweats to maintain a constant body temperature when stressed by heat. Adequate
intake of both water and sodium are essential to replace losses from sweating. Insufficient water intake leads
to dehydration while inadequate sodium intake or excessive water intake can lead to hyponatremia.
Acclimatization: It takes about 2 weeks to fully acclimate to a hotter environment. During this time the
member should gradually increase his heat exposure and activity. This reduces the likelihood of becoming