Frostbite: What are the signs and how do I treat and prevent this!?

Frostbite: What are the signs and how do I treat and prevent this!?

By: Dr. Colin Graney

Winter is in full force in Wisconsin, and as temperatures drop the risk of frost bite to the extremities (feet and hands) can become a real threat.  Frostbite, which can also be referred to as trench foot, is the death of soft tissue (such as the skin) due to prolonged exposure to the cold or wet conditions.  This can be seen in our local conditions as hunting season is upon us and with temperatures dropping.  The growing homeless population is also at risk.

 Trench foot became a commonly known term during the Vietnam and Korean wars as soldiers were marching through swamps, bogs, and rice fields where their feet were exposed to harsh conditions.  As the soldiers would march for hours their boots and socks would become saturated and remain cold for hours.  This extensive period of cold exposure caused the skin to turn black and die.  But, why did this happen?

In cold temperatures the blood vessels react by contracting (vasoconstriction) to try and force more blood to the vital organs in the chest.  As the blood vessels contract this limits the amount of blood flow and oxygen to the areas furthest from the heart (toes and fingers).  As time progresses the continued decrease in blood flow then causes the skin to not get enough oxygen and blood. This decrease in blood is what turns the fingers and toes white initially. 

White toes or fingers are the first stages of frostbite.  At this stage soft tissue damage is not permanent if treated appropriately.  Early treatment is critical to prevent against potential damage.  This include rapid rewarming of the injured part.  This means placing the injured part in hot water (temperatures of 104^o – 108^o F) to allow the blood vessels to increase blood flow.  Oral anti-inflammatory medication (NSAIDS) is also given to prevent inflammation to the area causing further damage.  This is best done by a medical professional who can monitor the rewarming process and give proper medication.  Medical personnel will also treat development of any blisters, skin damage, as well as repeat the rewarming process as needed.

The late stage of Frostbite, as seen in Mr. Deeds with Adam Sandler, is blistering followed by necrosis, or the death or the skin.  This stage of frostbite can then lead to more serious conditions that may has potential for severe infection and amputation.

Tips to prevent frostbite:

1. Protective clothing and footwear (synthetic or insulating fabrics).
2. Good nutrition and hydration prior to cold exposure.
3. Eliminate smoking and alcohol use during and prior to cold exposure.
4. Wear clothing in layers, include a wind and water-resistant outer shell.
5. Layered footwear and gloves with a waterproof barrier
6. Moisture wicking material is recommended
7. Take frequent breaks to re-warm foot and hands and remove saturated equipment to let dry prior to reapplying.

Most importantly, it is safer to be evaluated by a medical professional than to neglect an emergency.

Author

Colin T Graney, DPM AACFAS Colin Graney, DPM, is a fellowship-trained foot and ankle surgeon who is board-qualified in foot, rearfoot, and reconstructive ankle surgery. Dr. Graney is honored to serve the community of Madison, Wisconsin, at Madison Advanced Foot & Ankle.