From Big Medical Encyclopedia

TRENCH FOOT — the special form of freezing injury of the lower extremities arising at moderated (at air temperature it is above zero), but continuous long or repeated cooling of legs. Such cooling is promoted by long wearing wet footwear.

T. by page it was observed more often at the military personnel in the conditions of position military operations in the spring and in the fall, it is preferential in the parts occupying the entrenchments flooded with water (from here and the name «trench foot»). This type of freezing injury meets also in the conditions of sea service, napr, at accidents, ship-wrecks, rescue drowning and other incidents when people are forced to be in a cold water for a long time. In these cases the disease is called submersible (immersion) foot. At very low temperatures when conditions for developing of freezing injuries up to the heaviest are created, to T. the page almost does not meet.

Pathogeny of T. page the same, as freezing injuries (see). Unlike a usual form of freezing injury at T. the page the eclipse period (i.e. an interval between influence of low temperature and the beginning of the reactive phenomena) is absent since vasculomotor, and then dystrophic changes develop gradually against the background of the continuing cooling. If before emergence of the first signs of damage of a leg it is possible to dry and warm, and then they get wet again and are exposed to cooling, then a picture T. the page can develop at once and violently, as at freezing injury.

In dynamics of defeat (usually bilateral) distinguish four phases, or stages. The I phase arises after 12 — 15 days of stay on cold in wet footwear, but sometimes quicker (in 3 — 4 days). It is characterized by paresthesias and spontaneous pains in feet, especially in fingers, forcing patients to go, going into heels. At the same time disturbance of all types of sensitivity on feet is found, the reflex can disappear akhill, weakness of muscles of feet appears. Arteries and saphenas of an extremity at the same time are not changed.

Soon process passes into the II phase — the hypostasis which is followed by the small dermahemia especially noticeable on fingers sometimes extending to skin of a shin and even hips. All these phenomena are reversible therefore process, development to-rogo is limited to I or II phases, regard as an easy form of a disease, edges meets in 80 — 90% of cases of T. page.

In more exceptional cases process reaches the III phase, for a cut formation of phlyctenas with a yellow jellylike or hemorrhagic exudate, the localized hl is characteristic. obr. on fingers and in a bottom fold. The bottom of the opened bubbles quickly turns into dense black crusts — sites of a necrosis of skin, to-ry can extend on an extent and in depth. After rejection of crusts ulcers are formed, it is sometimes very long not healing. Upon transition of process to this phase it is regarded as a moderately severe disease.

Heavy forkhma of T. the page meets even less often (approximately in 1% of cases). At it process reaches the IV phase which is characterized by a deep necrosis of fabrics, to-ry often passes into wet gangrene (see) or is complicated by a mephitic gangrene (see).

Treatment is most successful in reversible (I and II) phases of defeat. Thermal procedures are shown, it is preferential UKV-teragshya, and also UF-radiation, locally and on area lumbar gangliyev. Treatment of T. page in III and IV phases same, as at freezing injuries. At inf. complications urgent amputation can be required (see).

Prevention of T. page — wearing waterproof footwear, creation of conditions for its drying, drainage of entrenchments. All these actions during the Great Patriotic War provided almost total absence of cases of T. page in the Soviet Army.

See also Perfigeration, Pathology military.

Bibliography: And r e in T. Ya. Thermal defeats, page 585, D., 1966; Field surgery, under the editorship of. To. 1VX. Lisitsyna and Yu. G. Shaposhnikov, page 191, M., 1982.

S. A. Rusanov.