Trench foot, a debilitating non-freezing cold injury, became a widespread medical problem for soldiers enduring the static, waterlogged conditions of the Western Front during World War I. This condition resulted from the prolonged exposure of the feet to cold, damp, and unsanitary environments, typically at temperatures above freezing. The perpetually flooded trenches, often containing mud, water, and human waste, created the perfect environment for the injury. Trench foot was a serious circulatory and nerve issue that incapacitated tens of thousands of troops.
Early Prevention Efforts
Proactive measures were implemented by military authorities to prevent trench foot, recognizing that sanitation and dryness were the primary lines of defense. Mandatory daily foot inspections were established, often enforced through a “buddy system.” Soldiers checked one another’s feet for initial signs of swelling, numbness, or discoloration, as early detection was essential.
Another preventative tactic involved applying protective greases to the feet, primarily whale oil. This thick, water-repellent oil was rubbed into the skin to create a barrier against constant moisture. Logistically, a single battalion could utilize as much as ten gallons of whale oil daily for this purpose.
Frequent sock changes were also mandated whenever possible, despite the immense logistical challenge of providing dry footwear. Soldiers were encouraged to carry multiple pairs of dry socks and change them several times a day, though this was often difficult to sustain in the front lines. Engineering solutions included the construction of wooden duckboards, placed on trench floors to elevate the men’s feet above the standing water and mud.
Initial Field Treatment and Management
Once trench foot was diagnosed in early or moderate stages, immediate field treatment focused on halting the injury’s progression. The first action was the prompt removal of all wet and restrictive footwear, including boots and socks, to relieve pressure and allow the feet to dry. The afflicted soldier was then evacuated to a regimental aid post or a mobile dressing station.
Gentle cleansing and thorough drying of the feet were performed, followed by elevation to improve circulation and reduce swelling. Aggressive rubbing was strictly discouraged, unlike preventative massaging, because the damaged tissue was fragile and susceptible to further injury. Soldiers were placed on bed rest and forbidden from walking to prevent mechanical trauma to compromised capillaries and nerves.
Specific topical applications, such as antiseptic powders or emollient dressings, were sometimes applied to prevent secondary bacterial or fungal infections in the damaged, often blistered, tissue. Foot washes, occasionally containing compounds like lead or opium, were used to soothe pain and inflammation. These conservative treatments encouraged natural healing and restored blood flow without surgical intervention.
Advanced Medical Care and Surgical Intervention
For severe cases of trench foot that progressed beyond initial stages, evacuation to a base hospital was necessary, where more advanced medical and surgical interventions could be performed. This stage was reached when damage to nerves and blood vessels was irreversible, leading to tissue necrosis or gangrene. The mainstay of treatment for these advanced, infected cases was surgical debridement, involving the removal of dead or decaying tissue.
Amputation was the ultimate intervention for limbs where infection or necrosis was too extensive to control. Surgeons performed these procedures to prevent the systemic spread of infection, a common and potentially fatal complication in the pre-antibiotic era. Amputation was a last resort, but often the only viable option to save the soldier’s life when gangrene had set in.
Following surgery, the long-term prognosis was complex, often involving prolonged rehabilitation. Many soldiers who underwent amputation required secondary operations to refine the stump for a prosthetic fitting. Even for those who avoided amputation, long-term complications were common, including persistent nerve pain (neuropathy) and hypersensitivity to cold, requiring ongoing medical management long after the war concluded.