Last
week we talked about how to dry your boots, this week we will talk about what
will happen to your feet if you don’t!
The
more things change, the more they stay the same, and if your socks, sandals,
shoes, boots, or moccasins get wet, your feet get wet, and if your feet stay
wet for an extended period, you risk “immersion foot”!
Immersion foot can strike in the
summer or winter, in cold or warm climates, it is a medical term that
is used to describe three related traumas, all of which start when some part of
you has been wet for a long time. All
three maladies are different, but they all share some similarities, too. All have occurred for as long as people have
gotten their feet wet and have all been called by many names over the
centuries. And don’t forget immersion
foot isn’t just a problem of the feet, although that is the body part that is most
affected, it can impact
your hands, ankles, and buttocks, too!
All
members of this cluster of maladies, have the following related symptoms, which
will appear in the following order.
A mild case of immersion foot showing maceration, from Wikimedia HERE.
First,
a pruning or softening of the skin, known medically as maceration, will
appear. This wrinkling, which can be mild
to severe, is caused by hyperhydration of the skin layers. The skin will appear pale or white and
wrinkled. Second, is the separation of
the dermal layers, the epidermis from the dermis, especially in people who have
thick, heavy callouses in the affected areas.
And third, the affected areas will display tenderness, swelling,
blisters, and skin abrasions, or raw spots, over any pressure
points.
All immersion foot injuries start
with being wet; warm-wet or cold-wet, either from sweat
or immersion, AND with waterlogging, or hyperhydration, of your skin. However ,what separates them into two
distinct groups is temperature, warm versus cold, because cold-wet can reduce the
blood supply to the skin, and once the blood supply has been reduced for long
enough, the skin will begin to die.
Once
you understand this difference, you will be able to diagnose trench foot”
which is a non-freezing cold injury (NFCI), from
the other two types of immersion foot, “warm water immersion foot” (WWIF) , and its second stage “tropical immersion foot”
(TIF)1.
Immersion Foot ... Trench Foot!
From “Nonfreezing cold water (trench foot) and warm water immersion injuries”, by Ken Zafren, MD, HERE.
Trench
foot2, is a non-freezing cold injury (NFCI), caused by exposure to wet
and cold, but not necessarily freezing, conditions, of 32° to 59°F (0° to 15°C)
over a period two to three days, or even longer. It can occur much faster, in as little as 14
to 22 hours, if your feet have been continuously immersed in 32° to 46°F (0° to
8°C) temperature water, however.
But it isn’t only continuous
immersion in cold water that leads to trench foot, it can be caused by the
prolonged wearing of damp or wet socks and footwear in cold conditions. Wet clothing cools the feet very rapidly, and
as the feet cool, the small arteries supplying blood to the feet and ankles
constrict (vasoconstriction) and reduce circulation by approximately 10%3. Blood flow to the feet can also be reduced by
inactivity, particularly when the feet are below the level of the heart. The reduced circulation deprives the feet of
oxygen, warmth and nutrition and the cells begin to die. At first, only the skin and tissues
immediately below the skin are affected, however if the feet are not dried and
rewarmed, even the deeper tissues of the feet can be injured. Wearing tight socks or boots can further
impede circulation and worsen the condition, particularly when the feet begin
to swell.
Most
victims of non-freezing cold injuries (NFCIs),
besides being exposed to cold and wet conditions, have also been subjected to
fatigue, malnutrition, periods of limited movement, and have been wearing the
same boots or shoes constantly for many days.
Among civilians, those at risk for NFCI are hikers, homeless people,
shipwreck survivors, who are immersed in cold water or aboard lifeboats, and
survivors of wilderness accidents, like plane crashes or capsized boats, who
must survive in wet clothes and boots.
Symptoms of trench foot are a pruning
of the skin, although with less maceration than with WWIF of TIF4, numbness
as if the foot was a block of wood, and when rewarmed, itching or pain, which is
sometimes described as a burning feeling.
The feet swell and first turn red, then white, and when rewarmed, turn a
mottled pale blue.
Immersion
Foot ... WWIF and TIF!
.png)
of the third day of exposure, it is nearly guaranteed, that a person will be affected to some degree or another with warm water immersion foot 5. Typically, it takes three or more days of constant exposure to warm-wet conditions, to advance to the second, more serious stage, of warm water immersion foot, which is tropical immersion foot (TIF). Both are caused by the waterlogging, or hyperhydration of the skin, through exposure to water between 59oF to 90oF (15o C to 32oC). Tropical immersion foot is caused by the passage of water through the compromised outer layer of skin, the epidermis, into inner layer of skin, or the dermis6.
Just like trench foot, WWIF and its
second stage TIF, can be caused both by constant immersion in water, or by
wearing wet or damp socks and boots for a prolonged time, in warm conditions. For example, a hiker, walking in wet boots
and socks for a week in 60o to 80oF (15o to 27oC)
was diagnosed with TIF and an enlisted nurse working at a United States
Airforce base, working 12 hour shifts, where she wore the same combat boots
daily, for two weeks, was diagnosed with “boot foot” a non-immersion
variant of WWIF7.
The earliest symptom of WWIF is
hyperhydration and pruning of the soles of the feet, which become pale, white,
tingling, or painful, which victims describe as feeling like “walking on a
rope”8. TIF is
characterized by a burning pain, which is more severe on the top, or dorsal
surface, than on the bottom of the foot. Other symptoms are a redness affecting the feet,
particularly on the tops, and the ankles, with swelling, or edema, and a sensitivity
to touch all over the affected area. Walking
becomes increasingly difficult and painful and if the victim takes off their
boots to examine their feet, they won’t be able to put them back on, due to the
swelling. Small skin abrasions, or raw
spots, over pressure points are also commonly found with TIF.
Now
that we know how to diagnose which type of immersion foot we
are presented with, whether it is trench foot (NFCI), warm water immersion foot
(WWIF) or tropical immersion foot (TIF), by observing whether we have been
exposed to warm-wet or cold-wet conditions and by observing the maceration of
the skin and other symptoms, we can work to prevent or manage the condition so
that we don’t end up in the hospital with permanent, ongoing issues.
For
more about immersion foot, read “Accidental Lessons … Boots Freeze!©”, HERE,
“Survival Tips From Jack London, Part One©”, HERE,
and “Winter Survival for Tommy...Part Two©”, HERE.
Don’t forget to come back next week and read “Wet
Feet! ... Immersion Foot!? Part Two©”, where we will talk about how to prevent
and manage and treat immersion foot!
I
hope that you continue to enjoy The Woodsman’s Journal Online and look for me
on YouTube at BandanaMan Productions for other related videos, HERE. Don’t forget to follow me on both The
Woodsman’s Journal Online, HERE,
and subscribe to BandanaMan Productions on YouTube. If you have questions, as always, feel free
to leave a comment on either site. I
announce new articles on Facebook at Eric Reynolds, on Instagram at
bandanamanaproductions, and on VK at Eric Reynolds, so watch for me.
That
is all for now, and as always, until next time, Happy Trails!
Notes
1
For an excellent article on immersion foot and the other related maladies, read
“Maceration, Immersion Foot and Backpacking”, by Ryan
Jordan, HERE.
2 A
French army doctor first described immersion foot, in 1812, but the name “trench
foot” was first coined in the trenches of World War One,
during the early 20th century and it continued to be used to
describe NFCI injuries that were experienced by Allied soldiers on the European
Front of World War Two. It has also been
called “sea boot foot” or “bridge foot”, because it afflicted
sailors standing four hour watch during World War Two, while remaining
relatively motionless and wearing rubber sea boots.
3 From “Nonfreezing cold water (trench foot) and warm water
immersion injuries”, by Ken Zafren, MD.
4 From
“Maceration, Immersion Foot and Backpacking”, by Ryan Jordan”
5 From Internal Medicine in
Vietnam: Skin Diseases in Vietnam, 1965-72, Vol. I, by Lt Col. Alfred M.
Allen, page 115.
6 From
“Nonfreezing cold water (trench foot) and warm water immersion injuries”, by Ken
Zafren, MD., “My Feet Are
Killing Me: A Hiker’s Journey”, by Neil McCormack, MD., and Cindy Carol Bitter,
MD, MPH., and Internal Medicine in Vietnam: Skin Diseases in Vietnam,
1965-72, Vol. I, by Lt Col. Alfred M. Allen, page 109.
7
From “My Feet Are Killing Me: A Hiker’s Journey”, by
Neil McCormack, MD., and Cindy Carol Bitter, MD, MPH., and “‘Boot
foot’ with pseudomonas colonization”, by Brett Sloan, MD’, and Jeffrey J.
Meffert, MD
8
From Internal Medicine in Vietnam: Skin Diseases in Vietnam, 1965-72,
Vol. I, by Lt Col. Alfred M. Allen, page 105.
Sources
Allen, Alfred M., Lt Col.; Internal Medicine in Vietnam:
Skin Diseases in Vietnam, 1965-72, Vol. I, [Office of the Surgeon General
and Center of Military History, Washington, D.C., 1977], p 102-117, https://books.google.com/books?id=Quw5DlbHKt0C&pg=PR17&dq=Internal+Medicine+in+Vietnam:+Skin+Diseases+in+Vietnam,+1965-72&hl=en&newbks=1&newbks_redir=0&sa=X&ved=2ahUKEwiw1cjXjqP9AhWID1kFHf7qBEoQ6AF6BAgEEAI#v=onepage&q=Internal%20Medicine%20in%20Vietnam%3A%20Skin%20Diseases%20in%20Vietnam%2C%201965-72&f=false, accessed 2/19/2023
Jordan,
Ryan; “Maceration, Immersion Foot and Backpacking”, September 15, 2019, [©
Beartooth Media Group Inc.], https://backpackinglight.com/maceration-immersion-foot-and-backpacking/,
accessed February 21, 2023
McCormack, Neil MD., and Bitter, Cindy Carol MD., MPH., “My Feet Are Killing Me: A Hiker’s Journey”, Wilderness & Environmental Medicine 2020; June 2020, Volume 31, Issue 2, pages 245 – 246, https://www.wemjournal.org/article/S1080-6032(20)30009-0/fulltext#articleInformation, accessed February 17, 2022
Sloan, Brett MD., and Meffert,
Jeffrey J., MD.; “‘Boot foot’ with pseudomonas colonization”, Journal of
American Academy of Dermatology, Volume 52, Issue 6, June 2005, page1109 - 1110,
https://www.jaad.org/article/S0190-9622(05)00986-2/fulltext,
accessed February 25, 2023
United States Army, “Baby Your Feet”, Army Talks, Vol. III, No. 5, February 10, 1945, page 7-9, 18, http://www.90thidpg.us/Reference/Army%20Talks/foxhole.pdf, accessed January 18, 2023
United States Army Medical Service; Cold Injury, Ground Type, in World War II, Medical Department of the United States Army in World War II, [The Office of the Surgeon General, Washington, D.C., 1958],page 123-124, https://books.google.com/books?id=FGcwAAAAIAAJ&pg=PA122&lpg=PA122&dq=%22War+Department+Circular+No.+312.+section+IV,+dated+22+July+1944%22&source=bl&ots=BA1svMxtQ9&sig=ACfU3U1mOBWMsSPXvQ1GCQ2N3WQGQb4yYQ&hl=en&sa=X&ved=2ahUKEwi0sOnI7vr8AhV4QjABHdSEBrwQ6AF6BAgIEAM#v=onepage&q=%22War%20Department%20Circular%20No.%20312.%20section%20IV%2C%20dated%2022%20July%201944%22&f=false, accessed February 3, 2023
Zafren, Ken, MD.; “Nonfreezing
cold water (trench foot) and warm water immersion injuries”, [© 2023 UpToDate,
Inc., updated October 26, 2022], https://www.uptodate.com/contents/nonfreezing-cold-water-trench-foot-and-warm-water-immersion-injuries#:~:text=NFCI%20or%20frostbite%20can%20usually,to%20cold%20or%20warm%20water,
accessed February 17, 2023
