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Trench foot in an older person following a fall

Discussion in 'Gerontology' started by Hylton Menz, Nov 2, 2005.

  1. Hylton Menz

    Hylton Menz Guest

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    From the latest issue of Age and Ageing :

    Trench foot following a collapse: assessment of the feet is essential in the elderly

    Gethin L. Williams, Anthony E. Morgan and John S. Harvey


    A frail 79-year-old man who lived alone was admitted to hospital after being discovered by neighbours on his kitchen floor in the month of February. The temperature at the time of his admission was relatively mild; although cold, the ambient temperature was above freezing. He remembered losing his balance and falling to the floor, but being unable to get back to his feet. He sustained no head injury or bony fractures, but was on the tiled floor of his kitchen for 48 hours. He was known to have carcinoma of his prostate gland; the attending paramedics noted that his trousers and the slippers he wore on his feet were soaked in a pool of urine.

    On admission he was hypothermic (34°C) and profoundly dehydrated. There was no evidence of myocardial infarction or any thromboembolic event. The following day it was noted for the first time that his feet were markedly discoloured. Examination revealed that both feet were swollen and cold with signs of ischaemia of all ten toes; there was no surrounding erythema, no pressure sores and all pedal pulses were manually palpable bilaterally. Arterial duplex of his lower limbs showed no major arterial disease of his vessels down to his posterior tibial and dorsalis pedis arteries and no evidence of emboli. A diagnosis of bilateral trench foot was made. He was initially treated conservatively with bed rest, intravenous antibiotics, elevation and correction of his dehydration.

    Over the following fortnight dry gangrene developed in both feet along with an obvious line of demarcation (Figure). Since his improvement following his admission it was decided at 4 weeks to electively amputate the gangrenous toes of his left foot and his affected right forefoot. His stumps healed well but he succumbed to bronchopneumonia 17 days postoperatively.

    (more here...)
  2. NewsBot

    NewsBot The Admin that posts the news.

    Trench foot

    Trench foot: the medical response in the first World War 1914-18.
    Wilderness Environ Med. 2006;17(4):282-9
    Atenstaedt RL
  3. NewsBot

    NewsBot The Admin that posts the news.

    The BBC are reporting:
    I got trench foot at Glastonbury
    Full story
  4. Cameron

    Cameron Well-Known Member


    Trench foot was first described in the Great War and was attributed to the feet being immersed in very cold mud for long periods of time. It was also known but not described as a condition during the Napoleonic Wars when the French troops were deployed to Russia with inferior footwear. A long tradition with Russian servicemen was to wear Ugg boots (called valenki) to prevent frostbite and Trench Foot. In the Great War the forces footwear was no match for the atrocious conditions of the water filled trenches. When soldier’s legs and feet were immersed in cold muddy waters for weeks on end their ligaments gave way and their feet collapsed. This left the combatant unable to move. More and more complained of symptoms ranging from cold feet, pins and needles (paraesthesia) to no feeling whatsoever. Walking in severe cases was impossible and when the casualties mounted this created a major problem which was met with greater attention to foot hygiene. This event most certainly had an effect upon the general importance given to chiropody after the Great War. During the Second World War footwear supplies to the front were fatally delayed because vital supplies were misappropriated by Black Marketeers. It was quite common to find non-combat units wearing superior footwear intended for their colleagues at the front. In the Second World War, trench foot was responsible for putting more Allied Forces out of action than the German 88 (artillery). In December 1944, Northern Europe's witnessed it's coldest winter during which 45,000 men - the equivalent of three full infantry divisions, were pulled out of the front line because of trench foot. Three days before the Battle of the Bulge began so great were the casualties to trench foot, men unable to walk were carried from sheltered pillbox positions at night to firing positions in the day time. Behind the US Lines it was decreed any soldier suffering trench foot would be tried for court martial. Senior officers were suspicious some soldiers were hoping to avoid combat by actively encouraging symptoms of trench foot. One reason why trench foot was so common was soldiers slept with their boots on. During engagement they were recommended to dry and warm their feet as best they could, and sleep with their boots off. This was often impractical and most ignored the directive. Conditions in the Falklands War were extreme. The British soldiers were severely challenged by their inferior boots. The direct moulded sole failed to keep their feet dry and water poured through the lace holes. The impermeable sole provided a perfect reservoir and feet was immersed in cold water for long periods. Trench foot was commonplace and a major concern to the assault forces. The Argentine boot was superior in every way and provided ideal protection to the elements; hence it became a valued prize of war. A morbid and sordid fact of war was the boots of the dead were removed in order to continue combat. In the Falklands War there was a reoccurrence of Trench Foot because the boots of the British Forces' were unsuitable for the weather conditions. Some military experts have postulated had the Argentineans been prepared to prolong hostilities they would have won because of the British casualties to Trench Foot.

    Loss, hunger and mass displacement are just some of the problems of a natural disaster. With tens of thousands of Katrina hurricane survivors crowded into shelters around the New Orleans and others refusing or were unable to leave spots contaminated by floodwaters, disease plays a major problem. Trench Foot was identified and did not discriminate between survivor and rescuer. The present floods in the US and natural disaster in China are likely to see similar incidences. Trench Foot is now sadly commonly reported in homeless people living rough ion the streets of towns and cities.

    A similar condition to Trench Foot is Immersion Foot and is associated with prolonged exposure to warm and wet conditions. This was common in Second World War and Vietnam, where fighting in the jungle swamps necessitated combatants remained in warm moist conditions for long periods of time. Immersion Foot was seen more recently in the 2004 Asian Tsunami.

    The misfortunes of a US boot making companies were transformed with the wars in Afghanistan and Iraq. Although 90% of US shoes are manufactured overseas there is a US federal law which states all military footwear should be made from cow hides of American cattle. War meant a new lease of life for ailing traditional industries. At first the mountainous terrain of Afghanistan was a major challenge to the boot designers. During the winter in the mountains the snows can be anything from waist height to over the head and since much of the campaign covert tell tale boot prints gave away the presence of strangers. Landmines were a major problem and despite the sophistication of design and material, no army boot has yet been able to prevent injury. Official US Government research indicates the spectrum of lower leg injuries is the same whether wearing sandals or standard army boots. At best the purpose of the army boot is to prevent below knee amputation for small charges and above the knee for large charges. Combat troops keen to avoid detection wore sandals made from old tyre treads.

  5. Admin2

    Admin2 Administrator Staff Member

    Trench foot

    Trench foot is a type of foot damage due to moisture.[1] Initial symptoms often include tingling or itching which can progress to numbness.[1][2] The feet may become red or bluish in color.[1] As the condition worsens the feet can start to swell and smell of decay.[1] Complications may include skin breakdown or infection.[1]

    Trench foot occurs due to prolonged exposure of the feet to cold, damp, and often unsanitary conditions.[1] Unlike frostbite, trench foot usually occurs at temperatures above freezing.[1] Onset can be as rapid as 10 hours.[1] Risk factors include overly tight boots and not moving.[3] The underlying mechanism is believed to involve constriction of blood vessels resulting in insufficient blood flow to the feet.[1] Diagnosis is based on symptoms and examination.[1]

    Prevention involves keeping the feet warm, dry, and clean.[1] After the condition has occurred, pain medications may be required during the gradual rewarming process.[1] Pain may persist for months following treatment.[3] Surgery to remove damaged tissue or amputation may be necessary.[1]

    Those in the military are most commonly affected, though cases may also occur in the homeless.[1] The condition was first described during Napoleon Bonaparte's retreat from Russia in the winter of 1812.[1] The word trench in the name is a reference to trench warfare, mainly associated with World War I.[1]

    1. ^ a b c d e f g h i j k l m n o p Bush, Jeffrey S.; Lofgran, Trevor; Watson, Simon (2020), Trench Foot, StatPearls Publishing, PMID 29493986
    2. ^ Cite error: The named reference Atenstaedt2006 was invoked but never defined (see the help page).
    3. ^ a b Cite error: The named reference Tactical was invoked but never defined (see the help page).
  6. admin

    admin Administrator Staff Member

    They are afraid that Brad Pitt may be at risk for Trench foot filming on location:
    Full story
  7. NewsBot

    NewsBot The Admin that posts the news.

  8. NewsBot

    NewsBot The Admin that posts the news.

    Trench Foot or Non-freezing Cold Injury as a Painful Vaso-Neuropathy: Clinical and Skin Biopsy Assessments
    Praveen Anand et al
    Front. Neurol. | doi: 10.3389/fneur.2017.00514
  9. NewsBot

    NewsBot The Admin that posts the news.

    Trench Foot discovery paves way for new treatment

    The physical cause of trench foot has been uncovered more than 100 years after the painful and debilitating condition was first identified in the First World War.
    Non-freezing cold injury, better known as 'trench foot' when first described during the First World War, can permanently damage hands and feet, causing chronic pain and long-lasting numbness and tingling sensations. A characteristic feature is that subsequent exposure to cool conditions may lead to a dramatic worsening of symptoms. Severe cases can result in loss of employment and leave individuals limited in their ability to partake in physical activities.
    Unlike frostbite, non-freezing cold injury develops after prolonged exposure to cold temperatures, where soft tissue is cooled but not frozen. Although it has long been recognised as a serious medical condition, the underlying cause of the pain and sensory damage, as well as the reason why some individuals are affected and not others exposed to the same conditions, has remained a mystery. It has previously been shown that people of African heritage are considerably more susceptible to the condition than Caucasians.
    Researchers at the University of Oxford, Imperial College London and Johns Hopkins University studied serving armed forces personnel and veterans with the condition. They discovered that patients with the condition have a significant reduction in the number of nerve fibres within the upper layers of the skin - intraepidermal nerve fibres - in the affected areas. It is this damage to the sensory nerve fibres within the skin that causes the chronic pain experienced by these patients.
    Professor David Bennett of the Nuffield Department of Clinical Neurosciences, said: 'Non-freezing cold injury is a life-changing condition for many people that can severely limit the physical work they can do as well as causing long term distress. Finally understanding the root cause of their symptoms will open the way for new treatments, as well improving ways to prevent the condition in people who are most susceptible.
    'Developing clear diagnostic criteria for the condition will also enable faster diagnosis of new cases to prevent repeated cold exposure, ongoing screening for neuropathic pain in at-risk individuals, and the provision of therapies that are proven to target neuropathic pain.'
    Professor Andrew Rice of Imperial College London commented: 'We now have a much better understanding of the cause of the chronic pain which can afflict some people for many years after suffering a non-freezing cold injury. This distressing condition has cut short many promising military careers. Using robust diagnostic criteria for neuropathic pain in such cases, we will be able to treat their symptoms more appropriately.'
  10. NewsBot

    NewsBot The Admin that posts the news.

    Preventing and treating trench foot: validation of an educational manual for military personnel.
    Mendes B et al
    J Wound Care. 2018 Oct 1;27(Sup10):S33-S38. doi: 10.12968/jowc.2018.27.Sup10.S33.

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