Trench Foot

Trench Foot is a condition caused by prolonged exposure to damp, cold, unsanitary conditions.  The foot become numbs, changes colour, swells and starts to smell due to damage to the skin, blood vessels and nerves in the feet. 

It can take 3-6 months to fully recover and prompt treatment is essential to prevent gangrene and possible foot amputation. 

Trench Foot originates back to 1812 with Napoleon’s Army but is most commonly associated with the trench soldiers in the First World War where it affected approximately 20,000 soldiers in the British Army alone in the winter of 1914-15.  Numbers of casualties dropped dramatically with improved trench drainage and conditions, but the condition still affects people today.  This medical term for this condition is Non Freezing Cold Injury (NFCI) and it is also known as Immersion Foot.

What Causes It?

Trench Foot

Trench Foot is caused by prolonged exposure to damp, cold conditions and poor environmental hygiene.  The blood vessels constrict in an attempt to keep warm by reducing blood flow to the extremities.  This reduces the amount of oxygen and nutrients to the feet which can result in tissue and nerve damage.  Unlike frostbite, it doesn’t require freezing temperatures.  It can develop in temperatures up to 160C (600F) and can even affect people indoors.  Any wet environment, be it from excessive sweating to wearing damp socks and shoes can cause Immersion Foot.

It can take less than a day of exposure to poor conditions for Trench Foot to develop.  Nowadays, it is most commonly seen in builders, hikers, extreme-sports enthusiasts, security guards, campers, aid-workers and festival goers.  Indeed at the 1998 Glastonbury music festival, doctors were seeing approximately 90 people a day with Immersion Foot.

Symptoms

Trench Foot can affect the heels, toes or entire foot.  The classic presentation is a cold, swollen, white/grey foot that can feel numb, heavy, painful and prickly.

Unidentified WW1 soldier with Trench Feet

In the early stages, blood vessels constrict in cold, moist conditions resulting in a lack of oxygen to the tissues.  The foot becomes cold, numb and mildly swollen, painful and discoloured. 

If allowed to progress, tissue and nerve damage occur. Swelling increases and a constant pins and needles sensation develops.  In extreme cases, blisters and ulcers develop, skin starts to peel off and tissues begin to die, resulting in gangrene.

Treatment

Prompt treatment is vital to prevent permanent tissue damage from Immersion Foot. 
1)  Thoroughly clean and dry the feet.  Use an anti-bacterial, anti-fungal dressing and air the feet regularly
2)  Gently re-warm the feet to improve circulation.  Warm the feet for approximately 5 minutes at a time either by soaking in warm (not hot) water or using heat packs.  Make sure you test the temperature first to avoid the risk of burning especially while the sensation is reduced.
3)  A Potassium Permanganate foot bath can help draw fluid out of the affected area.
4)  In severe cases were gangrene has set in, amputation is required

Recovery Process

As Trench Foot starts to heal, swelling reduces and the foot colour returns to normal.  Blisters often form and there can be temporary severe pain as the tissues warm and feeling returns.  There can be ongoing problems with itching, pins and needles, excessive sweating and cold sensitivity that can last for several months.

Prevention

As always, prevention is better than cure as Trench Foot can be extremely painful and it can take up to 6 months to fully recover.

WW1 Poster about preventing Trench Foot

1)  Wear clean, dry socks: change socks daily or more frequently if in damp conditions.
2)  Use Polypropylene sock liners: specially designed to draw moisture away from the feet
3)  Don’t wear socks in bed: allow the feet to “air”
4)  Keep feet clean: wash and dry feet daily
5)  Apply talcum powder or Vaseline: to the feet to keep moisture away
6)  Ensure shoes fit well: avoid shoes that are too loose or too tight
7)  Ensure footwear is dry: it may help to alternate shoes/boots daily to ensure they dry out fully
8)  Avoid synthetic materials: eg rubber and vinyl
9)  Control excessive perspiration: use drying agents like aluminium chloride or with extreme cases Botox may help.  Always discuss with a doctor before undergoing any treatment. 

Celebrity Trench Foot Sufferers

1)  JRR Tolkien, author of Lord of The Rings, contracted Immersion Foot during WW1
2)  Actor Jeremy Irvine got Trench Foot whilst filming War Horse
3)  Actress Joanna Lumley suffered from the disease when cast away on a desert island filming the TV documentary Girl Friday

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