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Immersion foot syndromes

What's new

Added 2023 WMS guidelines for the diagnosis and management of immersion foot syndromes.

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of immersion foot syndromes are prepared by our editorial team based on guidelines from the Wilderness Medical Society (WMS 2023), the American Academy of Family Physicians (AAFP 2019), and the Infectious Diseases Society of America (IDSA 2014). ...
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Screening and diagnosis

Diagnosis, nonfreezing cold injuries: as per WMS 2023 guidelines, consider diagnosing nonfreezing cold injury in patients with an extremity being cold and numb for hours to days in conditions sufficient to cause significant peripheral cooling, especially in a wet, cold environment with a water temperature < 15 °C (59 °F).
B
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  • Diagnosis (warm water immersion injuries)

Diagnostic investigations

History and physical examination
As per WMS 2023 guidelines:
Elicit environmental exposure history, assess for clinical manifestations, and perform a physical examination to distinguish nonfreezing cold injuries from frostbite, pressure necrosis, infection, and Raynaud's phenomenon.
B
Assess for other causes in case of worsening of symptoms attributed to nonfreezing cold injuries after the first 2-3 days following the injury.
B

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  • Diagnostic imaging

  • Blood and skin cultures

Medical management

Prehospital care: as per WMS 2023 guidelines, advise patients with swollen feet not to walk unless walking is necessary for evacuation. Advise wearing thick socks for padding in nonconstricting footwear, if possible, if patients must walk.
B
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  • Management of hypothermia

  • Management of pain

  • Antibiotic therapy

  • Tetanus prophylaxis

  • Therapies with no evidence for benefit

Nonpharmacologic interventions

Passive rewarming: as per WMS 2023 guidelines, allow extremities with nonfreezing cold injury to rewarm passively at room temperature,
A
with bed rest, elevation, and air drying at room temperature.
B

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  • Drying

  • Elevation and protection

Surgical interventions

Indications for surgery: as per WMS 2023 guidelines, obtain emergent surgical consultation for suspected tissue necrosis.
B

Preventative measures

Primary prevention, nonfreezing cold injuries: as per WMS 2023 guidelines, advise the following measures to prevent nonfreezing cold injuries:
limit exposure to cold, wet conditions
A
ensure adequate nutrition
B
wear insulating, nonconstricting clothing to keep personnel hands and feet warm and dry
B
keep feet as dry as possible
A
keep hands dry and warm
B
change into dry socks 2-3 times daily in wet conditions
apply asbestos-free talcum powder in addition to regular changes of socks when using vapor barrier boots
do not use neoprene socks
B
do not use grease or oils on feet or hands
A
rotate personnel regularly out of cold, wet environments
A
encourage personnel to move around frequently and to avoid having the legs and feet dependent
B
train personnel for operations in cold, wet conditions
B
do not re-expose patients with previous nonfreezing cold injuries to cold environments.
A

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  • Primary prevention (warm water immersion injuries)

Follow-up and surveillance

Recovery
As per WMS 2023 guidelines:
Obtain an assessment, including intraepidermal nerve fiber density, to aid in the diagnosis and prediction of recovery time in patients with neuropathy.
B
Refer patients with chronic neuropathic pain and complex regional pain syndrome to a pain specialist.
B

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