Trench foot, or immersion foot syndrome, secondary to prolonged cold-water treatment in symptom control of erythromelalgia: An illustrative case report and review of the literature.
James Bozzi1, Harriet Semple1, Peter Maitz1, Andrea Issler-Fisher1, 1Concord Repatriation General Hospital, Concord, NSW, Australia
Abstract
Erythromelalgia is a rare, often insidious, bilateral clinical syndrome characterised by episodic, erythematous, hot, painful burning extremities, usually involving both feet. Patients often resort to extreme measures to cool these areas and hence relieve pain; however, misuse of such therapies can result in impaired integumentary and microcirculatory systems with characteristic lymphovenous stasis and vessel occlusion, resulting in non-freezing cold-water immersion foot syndrome, or trench foot.
We present the case of one such 49-year-old female, who presented to ED seeking analgesia for severe trench foot, after immersion of her feet for up to 23 hours daily for approximately 12 weeks to treat the burning associated with a diagnosis of erythromelalgia. Within 5 days of cessation of water immersion, her severely macerated skin demarcated into full thickness necrotic eschars of the dorsum of the feet and ankles bilaterally. The thick glabrous skin of the soles was spared. She was subsequently admitted to the Burns Unit at Concord Hospital and successfully underwent a two-stage debridement and split thickness skin grafting to deficits of both feet and ankles with complete graft take. She was subsequently discharged home, post rehabilitation once her erythromelalgia was well controlled with regular aspirin and an NSAID.
Scarce scientific literature exists on trench foot, with most focusing on prevention, likely reflective of incidence. This photographic report presents a modern-day case of trench foot and aims to provide insights into the surgical management of severe cases with skin loss.
References
Davis MD. Immersion foot associated with the overuse of ice, cold water, and fans: a distinctive clinical presentation complicating the syndrome of erythromelalgia. JAmAcadDermatol.2013;69(1):169-171. doi:10.1016/j.jaad.2013.02.021
Davis MD, O’Fallon WM, Rogers RS 3rd, Rooke TW. Natural history of erythromelalgia: presentation and outcome in 168 patients. ArchDermatol. 2000;136(3):330-336.doi:10.1001/archderm.136.3.330
Mann N, King T, Murphy R. Review of primary and secondary erythromelalgia. ClinExpDermatol.2019;44(5):477-482. doi:10.1111/ced.13891
Biography
Dr James Bozzi is an unaccredited plastic and reconstructive surgery registrar based in NSW with an interest in burns