Trench foot, formally known as Non-Freezing Cold Injury (NFCI), results from prolonged exposure of the feet to cold and damp environments. Sustained moisture and cold cause the blood vessels in the feet to constrict, significantly reducing blood flow and oxygen supply to the tissues. This lack of circulation damages the skin, nerves, and muscles, even at temperatures up to 60°F (15°C). If not addressed promptly, the condition can progress to severe tissue damage, open sores, infection, or gangrene, which may necessitate amputation.
Immediate Care Steps
The first step in treating trench foot is immediately removing the affected feet from the cold, wet, and restrictive environment. Carefully remove any wet or constricting footwear, including boots and socks, to allow the feet to begin drying and rewarming. Rough handling or friction must be avoided because the tissues are extremely fragile and susceptible to further injury.
Once clothing is removed, the feet must be gently cleaned and dried using a clean cloth or air drying. Gradual rewarming should be initiated, typically using ambient air temperature or warm blankets. Direct heat sources, such as fires, radiators, or very hot water, must not be used, as rapid rewarming causes intense pain and further damage to the compromised tissue.
Elevating the affected feet helps reduce the inevitable swelling that occurs as blood flow returns. The feet should be kept elevated above the level of the heart whenever possible. It is important that the person avoids standing, walking, or bearing weight on the injured feet until they have been medically assessed.
Clinical Intervention and Acute Medical Treatment
Once the patient is stabilized, professional medical intervention focuses on managing symptoms, preventing secondary infection, and addressing tissue damage. Pain management is a primary concern, as the rewarming phase often brings severe, temporary pain as sensation and circulation return. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are commonly used to manage both the pain and the associated swelling.
If the skin is broken, or if blisters and open sores are present, the risk of bacterial or fungal infection is high. Healthcare providers will administer appropriate antibiotics or antifungal treatments if signs of soft tissue infection, such as cellulitis, are present. A tetanus shot is often administered or updated, especially if the wounds were sustained in an unsanitary environment. Specialized wound care is applied to protect the fragile skin and prevent deeper infection. This may involve sterile dressings, hydrocolloid coverings for ulcers, or surgical debridement to remove dead tissue in severe cases.
Long-Term Recovery and Managing Chronic Effects
Recovery from trench foot can be prolonged, lasting weeks to months, and often involves managing persistent symptoms resulting from nerve damage. The most common chronic effect is neuropathy, which manifests as persistent tingling, numbness, or a burning pain in the feet. This neuropathic pain may require specific nerve-pain medications, such as certain antidepressants or anticonvulsants, for long-term control.
Many individuals also develop hyperhidrosis, which is excessive sweating of the feet, making them more susceptible to future cold injury or fungal infection. Managing hyperhidrosis through specialized powders or antiperspirants is part of ongoing care to maintain a dry environment. Physical therapy and rehabilitation exercises may be necessary to restore muscle strength and range of motion diminished after extended immobility. The feet remain highly sensitive to cold, sometimes permanently, even after the acute injury has resolved, requiring patients to take precautions to avoid future cold exposure and use specialized, well-insulated footwear to prevent recurrence. Ongoing dermatological care helps manage skin changes, ensuring the integrity of the foot’s protective barrier is maintained.