Episode 16 | Maceration and Immersion Foot Diseases

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Summary

As backpackers, we spend a lot of time thinking about and managing our feet. One problem that crops up a lot (especially for those of us who choose to utilize ultralight footwear, hike in damp or snowy environments, or both) is wet feet. Feet that get wet and stay wet can cause all kinds of nasty issues – starting with maceration (wrinkly, pale, soft skin) and progressing through to immersion foot diseases like trench foot, tropical immersion foot, and warm water immersion foot.

In this SKILLS SHORT, Ryan and Andrew break down the causes, symptoms, and results of immersion foot diseases. After a fairly exhaustive and somewhat nasty primer (you’ll hear the phrase “sloughing skin” more than once) the guys discuss strategies to prevent and manage immersion foot diseases and their symptoms. The pod wraps up with a discussion on when you should get off the trail (blackened skin = big trouble), and Ryan shares some of his favorite resources and further reading on foot care.

 Outline

• Definition of immersion foot diseases
  • What is maceration?
  • Trench foot
  • Tropical immersion foot
  • Warm water immersion foot
  • What symptoms do the three diseases share in common?
    • Extreme maceration
    • Dermal layer separation
    • Redness
    • Tenderness
    • Swelling
    • Blisters
    • Sloughing skin
    • Open sores
• What is the difference between the three?
  • Pathology
    • TF – cold induced vasoconstriction
    • TIF / WWIF maceration-induced separation of dermal layers
  • Variations in speed of disease progress?
• How can these diseases be prevented?
  • Maceration vs immersion foot disease – a warning sign that needs to be addressed.
  • How much water can the skin absorb?
  • Preventing and managing maceration should be the PRIMARY FOCUS. If you handle that, you won’t get immersion foot.
    • Management and Prevention Strategies
      • Hydrophobic balm – one of Ryan’s recommendations is Body Glide Foot Glide
      • During hike AND BEFORE HIKE
      • Merino vs synthetic socks
      • Change blisters dressings and tapes frequently
      • Wear shoes that drain
      • Drain your footwear after a river crossing
      • Take off your shoes and socks at rest breaks
      • Change into dry socks during the day
      • Slow down your pace
      • Stop and camp

Recommended anti-maceration and anti-blister balm: Body Glide Foot Glide

• When do I need to get off the trail?
  • Redness
  • Tenderness
  • Swelling
  • Open sores / sloughing skin
• When should I see a doctor?
  • Discoloration and dying skin – or, just for safety sake, if you have any of the symptoms listed in “when do I need to get off the trail.”
• References and Resources
  • Ryan’s favorite book on foot care
    • Fixing Your Feet (John Vonhof) – the bible of foot care for runners and hikers. The new 6th edition is expanded, and an essential upgrade. 
  • Further Reading
    • Immersion Foot Syndromes (Wikipedia) – not a terrific summary, but I suppose it’s worth starting somewhere if you don’t have the patience to dig into medical writing.
    • Nonfreezing cold water (trench foot) and warm water immersion injuries (UpToDate) – a much better summary of immersion foot disease than the Wikipedia article linked above, probably because this one’s actually put together by medical experts in the field.
    • Identifying, managing and preventing skin maceration: a rapid review of the clinical evidence (Journal of Wound Care) – an outstanding and up-to-date medical review of the state of causes, prevention, and treatment of maceration.
    • The Role of Temperature in Tropical Immersion Foot Syndrome (Journal of the American Medical Association) – a profound study that emphasizes how cold vs. warm temperatures cause very different diseases.
    • Andrews’ Diseases of the Skin, 12th Ed. (Elsevier) – one of the gold standard textbooks in medical derma care.
    • A Microbiological Cause for Trench Foot (Microbiology Society) – discusses the relationship between immersion foot and microbiological activity; it’s interesting to me that we still don’t understand exactly what’s going on here – are immersion foot diseases caused by microbial activity, or does the onset of immersion foot disease simply predispose the foot to an increase in microbial activity?
    • Maceration (Blister Prevention) – a good discussion about what is happening at the cellular level.

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Credits

• Backpacking Light – Executive Producer
• Ryan Jordan – Director and Host
• Andrew Marshall – Producer, Host, and Editor
• Look for Me in the Mountains – Music
  • Written by: Chris Cunningham and Ryan Jordan
  • Performed by: Chris Cunningham (acoustic guitar, lead and harmony vocals, harmonica), Chad Langford (upright bass), and Tom Murphy (mandolin).
  • Produced by: Basecamp Studios in Bozeman, Montana

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