Trench Foot

Trench foot is the more commonly recognized name of the immersion syndromes that is well known in military history. The most recent and more appropriate name for this is nonfreezing cold injury (NFCI) (frostbite is a freezing cold injury). The cause is due to a prolonged exposure to conditions where are feet are in a non-freezing, damp, cold and usually unsanitary environment for a period of time. The name trench foot arose as it was a common problem of soldiers fighting in the trenches during World War I, even though it was first described during the Napoleonic Wars in the early 1800's. The French army surgeon Dominique Jean Larrey was the first to document it.  At one point in the first world war it affected over 20 000 British soldiers on the front which seriously hampered the winter 1914 campaign. A large number of cases were reported in the British army during the 1982 Falklands war. The British army boot was not as waterproof as the Argentinian boot, apparently making the Argentinian boot a prized bounty of battle.

Trench Foot and nonfreezing cold injury

While trench foot is most publicly associated with warfare and the moisture in trenches, the condition can occur at any time the foot is damp and cold (not frozen) conditions for a prolonged period of time. While trench foot or nonfreezing cold injury continues to be a problem for the military, it can also occur it may also occur in civilian populations taking part in extreme outdoor activities such as mountaineering and in those who work in hostile environments such as the fishing industry or cold storage. It is becoming increasingly recognized in homeless populations. There have been cases reported of of it occurring in an elderly man who suffered a fall spent time on a cold floor and of it also occurring in attendees at a music festival that is regularly held on muddy grounds. A report from the BBC noted:

Podiatrist Amber Kibby is a trustee director of Festival Medical Services, a charity which provides medical services at Glastonbury. Its 13 festival podiatrists are familiar with the symptoms of trench foot.
"The team started its work in 1998, which was the worst year for trench foot. We were seeing approximately 90 cases a day. Over the years, we have seen less and less of the condition. On the whole people are better prepared and they bring socks and wellies, they understand that there will most likely be mud."

Many aspects of the pathophysiology are:

  • It is not clear what the exact mechanism of injury is: it is probably due to be damage to the neuro-endotheliomuscular elements of the walls of the smaller blood vessels. Obviously, intense and prolonged vasoconstriction is the major factor in its development. It is also complicated by direct effects of cold on the nerve function and damage due to reperfusion following the ischaemia.
  • It is also not clear if the damage is actually vascular or neural in origin or a combination of both.
  • So, its not entirely clear if the primary pathophysiologic cause of the tissue damage is: thermal; ischaemic; the post-ischaemic reperfusion; or is hypoxic in origin.

Clinical Features of Trench Foot:

Trench Foot

Early Stages of Trench Foot

Staging of Trench Foot:
Four stages are generally clinically recognized, with significant merging and overlap between the stages. The staging was first recognized by Ungley in 19421:

Stage One:

  • prehyperaemic phase; occurs during the initial exposure to the cold environment; can start within an hour of exposure;
  • loss of sensation/numbness and other sensory disturbances (such as proprioception) that affects gait;
  • initially, may be a bright red colour, but almost all change to a pale colour due to intense vasoconstriction; skin has a blanched appearance;
  • pain and swelling absent at this stage;
  • rewarming at this stage could induce stage three

Stage Two:

  • hyperaemic phase starts; this follows immediate removal from the cold exposure
  • lasts from a few hours to a few days; follows reperfusion of ischaemic tissues
  • change colour from the blanched white to a mottled pale blue
  • remains cold and numb with sensory and motor disturbances; swelling may start

Stage Three:

  • this is the hyperaemia stage with increased blood flow for from several days and up to several months; onset of this stage is usually abrupt; becomes a reddish colour
  • capillary refill time test is delayed significantly; but pulses bounding.
  • numbness resolves and is usually replaced with pain and increased sensitivity to light touch; pain often worse at night.
  • oedema progresses; blister can often form.
  • anhidrosis

Stage Four:

  • in mild cases, they may not get to this stage; this is the final stage lasting from weeks to months (though can go on forever in some individuals).
  • increased sensitivity to cold in the extremity (may depend on severity of initial injury).
  • many have persistent pain triggered by cold exposure.
  • some have hyperhidrosis that can be very pronounced; some loose nails.

Long term, there can be neuromotor disabilities, chronic pain; increased sensitivity to cold.

Treatment of Trench Foot:
Those with trench foot are at high risk for hypothermia which can be life threatening; core temperature needs to be raised while keeping extremities cool. The rewarming needs to take place slowly as a rapid rewarming may intensify injury. They need to be checked for dehydration and also for any signs of frostbite. The best rewarming is considered to be by exposure to warm air alone, and they must not be immersed in warm water for this. The early period after re-warming can be very painful. There are no specific drug treatments, except what may be needed for pain management. Any local wounds will need appropriate wound management.

Prevention of Trench Foot:

  • still a threat to military operations in cold weather; most military's have extensive preventative documentation and practices that they use.
  • prevent by keeping the feet warm and dry; keep moving; changing frequently into dry clothing; fatigue and malnourishment may play a role.
  • the stress associated with military operations is vasoconstrictive, so this further adds to the risk factors.
  • It was also noted that in World War I that a key preventive measure was regular foot inspections by officers.

Recently, there were concerns that the actor Brad Pitt may be at risk for trench foot after spending days filming in mud:

Standing in mud up to his knees has left Brad with nasty feet and producers have apparently hired a chiropodist to ensure their leading man doesn’t get trench foot.

Related Topics:
Chilblains | Military Medicine | Frostbite

Amazon Kindle eBook:

External Links:
Wikipedia entry on Trench Warfare

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...b. subtilis after the instantaneous cold shock, which was not observed with s. cerevisiae. this irreversible effect of the rapid cold shock on the membrane correlated...the principal cause of the cold shock injury....
Journal: Applied Microbiology and Biotechnology - APPL MICROBIOL BIOTECHNOL, vol. 77, no. 6, pp. 1379-1387, 2008
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...tolerance when exposed to low nonfreezing temperatures, a process known as cold acclimation. other plants including tomato, solanum lycopersicum, are chilling sensitive and incur injury during prolonged low temperature exposure...
Journal: Plant Molecular Biology - PLANT MOL BIOL, vol. 67, no. 5, pp. 483-497, 2008
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Although mungbean (Vigna radiata (L.) Wilczek) is commonly used as human food; the genomic resources of this species available in databases are limited. This study aims to develop expressed sequence tag (EST) resources for mungbean genes informative to early seedling development and chilling response. Two mungbean varieties that differ in disease resistance were found to also differ in their susceptibility ...
Journal: Plant Cell Reports - PLANT CELL REP, vol. 27, no. 3, pp. 535-552, 2008
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...seedling tolerance to drought and cold stresses in both arabidopsis thaliana...a subset of drought and cold stress marker genes. transcriptional changes...
Journal: Planta, vol. 225, no. 2, pp. 353-364, 2007
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...was expressed during recovery from cold, and was up-regulated during desiccation. desiccation and starvation (but not cold) elicited increased expres- sion response to starvation or cold. hsp70 expression increased after 1 h of recovery from cold exposure, but was unchanged in...
Journal: Insect Molecular Biology - INSECT MOL BIOL, vol. 16, no. 4, pp. 435-443, 2007
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...effects of nutrient‐solution application and cold acclimation on temperature at which...unacclimated and cold‐acclimated conditions. freezing injuries in cold‐acclimated plants were significantly...
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...the two mutant strains. in cold ac- climation experiments, c-repeat...plants, but subsequent transcription of cold-regulated ( cor ) genes was reduced...
Journal: Plant Cell, vol. 15, no. 3, pp. 626-638, 2003
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...temperature (1.5 °c) induces chilling injury in fruit of fortune mandarin...3 days at 37 °c prevented chilling injury. the use of suppression subtractive...
Journal: Planta, vol. 218, no. 1, pp. 65-70, 2003
Posted: July 27, 2016, 3:50 pm
...tolerance in response to low, nonfreezing temperatures, a phenomenon known as cold acclimation. previous studies established that cold acclimation involves rapid expression of...of gene expression occurs during cold accli- mation. of the cold-responsive genes, 48 encode known...
Journal: Plant Cell, vol. 14, no. 8, pp. 1675-1690, 2002
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...plants are subject tible to injury due to the cold. reestablishment of dam- to injury during winter conditions along lipids were cess of cold acclimation occurs seasonally when plants extracted and the polar lipids separated by thin-layer chromatography. are exposed to low, nonfreezing temperatures before fatty acids were...
Journal: Crop Science - CROP SCI, vol. 42, no. 6, 2002
Posted: July 27, 2016, 3:50 pm
In woody plants, chilling stress occurs during the early spring growth and can have important economic consequences. The aim of this study was to compare the reliability of two different experimental systems, 3-month-old softwood cuttings and in vitro-grown shoots, to study chilling effects in a poplar clone (Populus tremula×P. tremuloides cv. Muhs1). Different parameters were recorded: lignin ...
Journal: Plant Cell Reports - PLANT CELL REP, vol. 19, no. 10, pp. 954-960, 2000
Posted: July 27, 2016, 3:50 pm
...and photoperiod cycles on the cold-hardening process. rearing temperatures significantly affected cold tolerance of larvae. in constant temperature regimes, as rearing temperature decreased, cold tolerance increased. cyclic temperature regimes caused a significantly higher cold tolerance than did constant temperatures...
Journal: Environmental Entomology - ENVIRON ENTOMOL, vol. 29, no. 5, pp. 868-873, 2000
Posted: July 27, 2016, 3:50 pm
...l.) seedlings exposed to low nonfreezing temperatures (0–10° c) that promote cold acclimation, synthesize a variety cold-acclimation proteins and at the...evidence implies that responses to cold acclimation and water stress involve...
Journal: Planta, vol. 188, no. 2, pp. 265-270, 1992
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Journal: Cryobiology, vol. 28, no. 2, pp. 177-184, 1991
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...additional index words. chilling injury, cold acclimation, cloning, freezing tolerance, raffi...freezing in response to low nonfreezing temperatures, while studies on the deacclimation process have been largely neglected. in some plants, cold acclimation is accompanied by an...
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...offers a 33% reduction in foot print and permits a significantly...
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...regularly arranged through- holes or trenches are first fabricated by photoelectrochemical...μm; pitch =1 4μm) and trenches (depth = 320 μm; width =4...
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...are fabricated in a shallow trench process. the transmission spectra of...maximum 450 nm. these small foot-print cavities act as band...
Published in 2011
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...the field by piling and trenching, supported by laboratory analyses. colluvium in on- and foot-slope positions, 9% are stored...
Journal: Holocene, vol. 21, no. 7, pp. 1093-1104, 2011
Posted: June 25, 2016, 9:57 pm
...palaeoseismic trenching along the central ostler fault...earthquakes. a 26 m long trench excavated into a last-glacial...
Journal: New Zealand Journal of Geology and Geophysics - N Z J GEOL GEOPHYS, vol. 54, no. 4, pp. 367-378, 2011
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John Lavery's The First Wounded, London Hospital, August 1914 records a memorable event in the First World War. This painting and the archives of the Royal London Hospital provide a fascinating insight into the nursing and medical care of these early war casualties.
Journal: Medical Humanities, vol. 37, no. 1, pp. 23-26, 2011
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...applications, mos-controlled devices with trench gates are the most desirable...increase in conduction loss in trench gate-insulated gate bipolar transistor...
Journal: IEEE Transactions on Power Electronics - IEEE TRANS POWER ELECT, vol. 25, no. 3, pp. 583-591, 2010
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...the deposits exposed in two trenches excavated in the upper part...derived from the 45m long trench dug in the closed depression developed at the foot of the head scarp of...
Journal: Geomorphology, vol. 124, no. 3, pp. 124-136, 2010
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The quantitative properties and circulation of the lower layer of circumpolar water in the Scotia Sea with density 28.16 < γ n θ > 0.2°C) are investigated using the original procedure for determination of boundaries between water masses. The primary objective of this work is data analyses of four Russian sections, which were occupied in the vicinity of ...
Journal: Oceanology, vol. 50, no. 1, pp. 1-17, 2010
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  1. Ungley CC, Blackwood W: Peripheral vasoneuropathy after chilling “immersion foot and immersion hand”. Lancet 1942, 2:447-451 []
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