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Appendix C

Contents

APPENDIX C

HEADQUARTERS FIFTH ARMY
    Office of the Surgeon
    A. P. O. #464, U. S. Army

24 NOVEMBER 1943

MEDICAL CIRCULAR
NUMBER 6

TRENCH FOOT


    1. Approximately 200 men have been admitted to army hospitals in the past five days suffering from trench foot.
    2. Most of those afflicted report having worn wet socks and shoes for 3 to 14 days without change. Some, but not all, have been exposed to near freezing temperatures.
    3. The symptoms include first numbness or loss of sensation. Later, some swelling develcps. Some who have removed their shoes have been unable to get them on again. At first the feet appear white, perhaps slightly wrinkled and furrowed, and quite cold and insensitive. If th.e feet are rubbed or warmed, more swelling and pain develops. Heat, walking or any trauma to the feet increases the escape of fluid and blood into the tissues. Later, vesiculation may develop. Anesthesia is replaced by hyperesthesia and paresthesia. The patient complains of shooting pains in the ball of the foot or on the dorsum of the foot. A varying degree of arythema appears. The foot is hot and the posterior tibial pulse is full and bounding. In the more severe cases anesthesia persists in some areas and necrosis of those parts may occur.
     4. Management of this problem is directed primarily toward prophylaxis. However, proper treatment, once the condition has developed, will do much to lower morbidity and will return more of these men to duty. The following regime is suggested:
        a. Those patients should be hospitalized.
        b. The feet should not be exposed to heat, and the men are best kept out of heated tents or buildings.
        c. The shoes should not be removed until the patient is recumbent and the feet slightly elevated.
        d. All walking and other trauma is to be avoided.
        e. The feet are gently washed with cold water and soap, using pledgets of cotton. They are then carefully dried, small pledgets of dry cotton placed between the toes, and a light dressing of sterile gauze applied.
        f. The feet are kept elevated and are not covered with blankets. The patient is kept in a cool room or tent. In very severe cases, and when ice or snow is available a heavier dressing is applied and ice bags are applied. The ice bag covers must be kept dry.
        g. Vesicles should not be opened.
        h. The cold treatment is kept up for several days to several weeks depending upon the amount of swelling, vesiculation, and necrosis.
        i. Vitamin B and Vitamin C should be given orally as vitamin deficiency may be an etiological factor.


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        j. Exercises should be started as soon as swelling has disappeared and open lesions have healed. These exercises should be carried out at hourly intervals consisting of toe flexion and anterior tibial setting. The length of the initial period of exercise should be governed by the comfort of the patient, increasing as tolerance permits.
        k. Paravertebral novocaine block of the sympathetic trunk should not be done.

        For the Surgeon:
            /s/ C.P. BRUCE
            /t/ C.O.  Bruce
            Lt. Col., Medical Corps,
                Executive.