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Appendix D

Contents

APPENDIX D

HEADQUARTERS
NORTH AFRICAN THEATER OFOPERATIONS
UNITED STATES ARMY

 
21 DECEMBER1943
 
SUBJECT: Trench Foot.
To: Commanding General, Fifth Army, APO 464.
        Commanding General, Seventh Army, APO 758.
        Commanding General, Peninsular Base Section, APO 782.
 
    1. Trench Foot, Immersion Foot, or Shelter Foot which was a very common disabling injury of the feet encountered during the winter months of World War I, is beginning to occur in troops of this theater. This is a very serious but preventable condition and all organization and unit commanders must become familiar with the measures required for its prevention.
    2. When troops are subjected to exposure, frequent inspections will be made to ensure that they are taking proper care of their feet. Insofar as the situation permits, all deficiencies found will be the cause for immediate corrective action.
    3. Trench foot is produced by standing or sitting about over a long period of time with cold wet feet. Intense cold is not a necessary factor, as the condition can develop at temperatures as high as 50 degrees F. The most important factors are moisture, cold, and lack of activity. Frequently, there is an associated history of constriction of the limbs by boots and clothing.
    4. Individuals experiencing this condition usually first complain that their feet feel heavy, woody and numb, and are insensitive to pain, touch, or temperature. The insensitive areas are most marked around the toes. At this stage the feet are usually cold to touch, swollen and waxy white in color with a few scattered bluish areas present in the skin. When the feet are warmed up they become markedly swollen, red, hot and painful. Blisters may develop and the feet may turn purple in color.
    5. Once trench foot has developed, the feet should not be massaged or warmed up but should be kept cool and elevated above the level of the rest of the body. The patient should not be permitted to walk and should be promptly sent to a hospital where adequate treatment can be given. If this type of injury is not handled in this manner it may lead to serious disability and possible loss of the feet.
    6. The prevention of this condition is of great importance and consists primarily in keeping the feet clean, dry and warm. Under winter combat conditions it is often difficult to fulfill these requirements but constant attention to the following will minimize or prevent the occurrence of this condition.
        a. The necessity of frequently removing shoes, leggings, and socks in order to wash, dry and massage the feet, apply foot powder and to put on dry socks if possible.
        b. Improvised methods of washing and drying socks and shoes. For instance, in wet weather when nothing else is available, socks can be dried by pinning them to the inner side of the overcoat or field jacket or placing them over the shoulders under the jacket.
c. The necessity to keep moving when feet are cold and wet and dry socks and shoes are not available. If troops have to keep in one place they should mark time or make vigorous, frequent, movements of the legs.When sitting down they should elevate the feet higher than the buttocks, being careful that nothing is constricting or interfering with the circulation
  


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of the legs. (If the circulation is normal the legs will not develop a numb or tingling sensation). If these sensations occur, the legs and feet should be exercised until they feel normal and warm.
        d. The fact that regardless of how cold it may be it is important not to sleep with shoes on if feet are wet. If this is done there will be interference with the circulation, and the shoes, socks and feet will be prevented from drying.
 
By command of General EISENHOWER:
    J. K. ROBERTS,
    2nd Lt., AGD,
    Asst Adj Gen.