It was well after midnight when the doorbell rang. No one wants to hear a doorbell frenetically pressed by someone in the middle of a night! It is a particularly unpleasant experience if you are working a night shift at the emergency medicine ambulance.
We jumped out to check whats happening, and there was an old guy (apparently homeless) with a long beard standing in the hallway, pressing the big red emergency button like there was no tomorrow. As soon the man saw us, he started to talk: “Please, take a look, it hurts so bad!”- “Sir, I will examine you, what happened?”- He thanked me and started to walk toward the exam room slowly. He was leaving a reddish jelly trail as he walked. Vlada, the medical assistant, and I thought it was ketchup dripping out of the plastic bags he was carrying.
As he was taking off his shoes, he was complaining of a pain in his feet. A moment later I saw it, I felt the smell of it, and I will remember the scene for the rest of my life- trench foot at its worst! His feet were decomposing- the reddish trail was a decomposition fluid.
“A few days ago everything was ok, what is this?!”- he was crying…
MudRun by Jada Bloom | Public Domain
Trench foot can occur only hours after exposing feet to the cold and wet environment (wet shoes) and sometimes can result in months of pain and walking difficulties, even partial or complete amputation of the affected foot.
What draws together the Trench Foot and the trenches?
World War I will be remembered in the annals of warfare as a “Trench War.“ The firepower of the artillery, mortars, machine guns and rifles improved in WWI. These improvements came with a price- the mobility had to be sacrificed. New weapons were devastating but too heavy to move. All these changes lead to warfare known as “trench warfare”. The infamous “Western Front” is even today studied as a “trench warfare masterpiece” at military academies all around the world.
It was cold and wet in the trenches. Soldiers would spend days in boots soaked with cold water. As a result, their feet would swell and hurt. If left untreated, severe damage would occur, and sometimes gangrene. The condition and its cause were quickly recognized, therefore the name- “Trench Foot.”
Did it exist before the WWI? Yes, it did, but its significance wasn’t recognized earlier because it never affected so many people in such a short period (approx. 115,000 British soldiers died because of it).
Today, Trench Foot is seen in people exposed to a cold and wet environment such as soldiers, homeless, fishermen, campers, mountain climbers…
But you, too, can be at risk. As winter settles in, the chances of you being stuck in a cold, wet environment increase. It could be something as simple as your vehicle getting stuck in a snowbank. Your warm feet melt the snow that attaches to them, soaking your socks and shoes. Then, before you know it, the cold begins to overtake the warmth of your feet.
By knowing a few basic signs and some treatment methods, you should be able to recognize and prevent trench foot before it’s too late.
Diagnosing trench foot
Exposure to a cold and wet environment
The colder it is- the faster the condition develops. Sometimes, it takes up to 7 days, while in others 12 hours is enough. Anything longer than 10 hours puts you at the risk of getting trench foot.
Red flag: 10 hours of exposure
The condition develops over days or weeks.
|Minimal changes||Reddening of the skin. Numbness, tingling or pain.||The symptoms are reversible.|
|Mild||Swelling, reddening, discoloration of the foot. Numbness, tingling, the pain becomes a dominant symptom.||The symptoms are reversible, but it may take a few weeks to a few months to a complete recovery.|
|Moderate||Swell, reddening, blisters filled with clear fluid or blood. Numbness, tingling, the pain becomes even more noticeable.||Irreversible nerve damage. Numbness and tingling will resolve to a certain degree, but not completely.|
|Severe||Swell, reddening, blisters filled with blood, bleeding into the skin and the surrounding tissues, decomposition of the soft tissues. Risk of sepsis. Necrotic tissue is numb while the parts of the feet that still have blood circulation may be painful.||Gangrene. Complete or partial amputation of the feet is needed.|
Treatment and prevention
Treatment and prevention include the following measures:
- Keep the feet dry and clean
- Wear dry footwear
- Change socks if they get wet
- Foot massage
- If swollen, lift the feet above the heart level- it will help the drainage of the swelling.
Sometimes, surgical treatment is needed. It involves the removal of the necrotic tissue from the wound or an amputation. It requires a hospital setting.
If you find yourself in a situation with cold, wet feet, take a break every few hours to take preventative steps. If you have extra socks available, change them out and allow your feet to warm up. No extra socks? Attempt to wrap another piece of dry cloth around your feet to warm and dry them. If someone else is with you, you can place your feet inside each other’s shirts for 15-20 minutes. Keep them there until the feet have regained their natural temperature and are dry.
The homeless guy from the begging of the story
A few days later I called a hospital he was admitted in to ask about his condition. It ended with a partial amputation of the feet.
Although extreme, this case is a reminder how a life-threatening condition can emerge even in an urban environment due to an unusual cause- wet and cold shoes.