RT Book, Section
A1 Beltran, Gerald (Wook)
A2 Cydulka, Rita K.
A2 Fitch, Michael T.
A2 Joing, Scott A.
A2 Wang, Vincent J.
A2 Cline, David M.
A2 Ma, O. John
SR Print(0)
ID 1143143164
T1 Cold Injuries
T2 Tintinalli's Emergency Medicine Manual, 8e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9780071837026
LK accessemergencymedicine.mhmedical.com/content.aspx?aid=1143143164
RD 2025/07/13
AB Trench  foot  is  a  direct  soft  tissue  injury  that  results  from  prolonged  exposure  to  nonfreezing  cold  and  moisture.  The  foot  is  initially  pale,  mottled,  pulseless,  and  anesthetic  and  does  not  improve  quickly  with  rewarming.  Several  hours  after  rewarming,  the  foot  becomes  hyperemic  and  painful  as  perfusion  returns  after  2  to  3  days.  Bullae  and  edema  are  late  findings.  Anesthesia  may  persist  for  weeks  or  even  permanently.  Hyperhidrosis  and  sensitivity  to  cold  are  late  features  and  may  last  for  months  to  years.  Chilblains  (pernio)  are  painful  inflammatory  lesions  typically  affecting  the  ears,  hands,  and  feet  caused  by  chronic  exposure  to  intermittent  damp,  nonfreezing  conditions.  Localized  edema,  erythema,  and  cyanosis  appear  up  to  12  hours  after  the  exposure  and  are  accompanied  by  pruritis  and  burning  paresthesias.  Tender  blue  nodules  may  form  after  rewarming  and  can  persist  for  several  days.  Treatment  of  trench  foot  and  chilblains  includes  drying,  elevation,  warming,  and  bandaging  of  the  affected  body  part.  With  chilblains,  add  nifedipine  20  mg  PO  three  times  daily,  pentoxifyline  400  mg  PO  three  times  daily,  or  limaprost  20  μg  PO  three  times  daily,  as  well  as  topical  corticosteroids,  such  as  0.025%  fluocinolone  cream.