Frostbitten feet

I have had poor circulation in my feet for some time (healthy otherwise) but I beleive I frostbit them on a long hike last weekend I used disposible foot warmers but neglected to change them after 4-5 hrs. Anyway, I have numbness in most toes and they lose color at different intervals or when cold now. No blackness, just yellowish/white and mottled looking. I am watching them carefully but wonder if anyone has experience with hiking post frostbite.How long does the numbness last? I really want to finish out my winter 46!Thanks for any input.

I'm curious, have you ever been diagnosed with Raynaud's Syndrome? It's quite common in females, but males can get it too. The main symptoms are chronic cold in the hands and feet. I used to date a girl who had it, and she was more subject to getting frostbite.

In anycase, I'd see a doctor, just to be on the safe side. Best of luck.

Leenie said:

Anyway, I have numbness in most toes and they lose color at different intervals or when cold now. No blackness, just yellowish/white and mottled looking. I am watching them carefully but wonder if anyone has experience with hiking post frostbite.How long does the numbness last? I really want to finish out my winter 46!Thanks for any input.

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Not necessarily frostbite. It is possible to get nerve damage by chilling one's feet to near freezing for an extended period. The appearance is consistent with compromised circulation. Worth having it checked out by a doctor.

When a friend had a similar problem, IIRC, it was over a month for the nerves to heal (regrow?). His feet remained sensitive to the cold for a long time afterwards (months to years).

If you get any blisters, protect them from breaking and see a doctor.

Sounds to me like you need a warmer pair of boots. (Super gaitors or overboots can help too.) Relying on external foot warmers is a dangerous strategy--if you are unable to change them or run out (perhaps because you are delayed), you set youself up for a potentially serious injury.

One other thing--if you smoke, don't do it in the cold. Smoking is a vasoconstrictor.

Doug

Yes, I have had symptoms of Raynauds for years, usually mild. I have never smoked. It doesn't matter what type of boot I wear or how much insulation it has my feet get cold. (I wear expedition smartwool socks too). I am currently using a winter hiking boot with thinsulate-it seems to be the best so far, until now. I can be doing very strenuous hiking and sweating profusely and my feet will be cold.I do have an appt with my Doc, mainly to document this, I'm not sure what can be done at this point. I know I need to be more diligent about the heaters now-again- any other input is welcome-Thanks!

Plasic Boots

If you are intent on finishing the W46 this season I would not take any chances with the feet. I strongly suggest you rent double plastic boots. The mountaineer in Keene Valley rents them.

www.mountaineer.com

I agree. It sounds like you are a good candidate for plastics.

-percious

My hands get cold as a matter of course. My toes did the same even with -20F rated removable felt lined rubber boots.What confidently got me back into the winter woods was the artic expes rented then purchased from the mountaineer. They have an extra large toe space that does not constrict around my wide high feet. I use a antiperspirant, a liner a platic bag then a mid weight hiking sock. These are way overkill for the average hiker. They are also heavy and klunky if barebooting (they are always on snowshoes) but I no longer worry too much about my toes. My very dificult to fit feet also finds them to be very comfortable.

Leenie said:

Yes, I have had symptoms of Raynauds for years, usually mild. I have never smoked. It doesn't matter what type of boot I wear or how much insulation it has my feet get cold. (I wear expedition smartwool socks too). I am currently using a winter hiking boot with thinsulate-it seems to be the best so far, until now. I can be doing very strenuous hiking and sweating profusely and my feet will be cold.I do have an appt with my Doc, mainly to document this, I'm not sure what can be done at this point. I know I need to be more diligent about the heaters now-again- any other input is welcome-Thanks!

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There is a classical conditioning treatment for Raynauds syndrome devised by Dr. Murray Hamlet (an expert on cold problems). You should be able to find it with a google search. (The treatment involves soaking one's feet/hands in warm water and going out into the cold. Get the details from the search results.) Cheap and simple to try. Seems to help many.

You might also be able to do better with double boots (leather or plastic outers). Vapor barrier socks also help: a thin wool liner, the vapor barrier, then a heavy wool sock, and finally a possible outer barrier (for wet conditions). The vapor barriers can be improvised with plastic bags (they don't last long, but the price is right) or commercial vapor barrier socks. Anti-persperant can also help to keep feet--and insulation drier. Make sure that the boots have enough space for the socks--tight shoes or socks cut off the circulation and are an invitation for problems.

The ultimate in warm footwear is the white [mickey] mouse boot. Military surplus: rubber inside, felt, rubber outside. Guaranteed dry insulation (as long as there are no holes in the boot...) Not much foot support, but they are warm. (They were designed for use in Antarctica.) Have a nipple on the side above the ankle to allow one to equalize the pressure (for use at altitude). Wear with a high (above the top of the boot) wool sock. Your feet will be soaked in sweat at the end of the day, but they will be warm (and will clear the room when you take the boots off ). May be hard to get.

There are also black mouse boots. Not as warm as the white ones (also no pressure adjustment nipple), but still quite warm. Get only US or Canadian surplus--not any other versions. (Some of the others are inferior.) Mouse boots are also known as Korean boots (originally developed for use by ground troops during the Korean conflict).

Mouse boots work well with snowshoes and there are some crampons that work well with them, but be very careful with the type and fit. Be careful with the bindings--the boot's upper is very flexible and you can cut off circulation if the binding is too tight.

My college outing club used to require that beginners use them. (The club also rented them.) [Almost] goofproof.

Doug

Warm pants

Warm pants, such as fleece, under your outer shell might help. Even if you feel warm overall, the blood coursing down a cool leg will reach the feet at a slightly lower temperature. Every little bit helps.

(I assume you are using VBLs.)

Leenie,

Don't know if this will help but use the Mickey mouse boot knowing that you will always need dry socks after. You need to keep your feet dry in cold conditions and they will sweat like crazy. I am the same way. My feet can be cold and they still sweat.

Also the army didn't even pass out Mickey mouse boots to us unless it was substanially below zero. Never used the white ones. In Germany I only saw the black ones. They had more cases of frostbite using them because of the wet socks and people then standing around after their feet were soaked with persperation. I spent a lot of time running patrols in sub zero weather and only once had MM boots. Rubber overboots over standard combat boots were the dress of choice on most winter dismounted patrols with lots of dry pairs of socks to change into afterwards. I did this for years and it works. Never had a frostbite problem.

Proper fitting of the footwear is most important. Most people add more socks. That is fine if your boots have the room which most don't. You need to size your boots for the number of insulating layers you are going to wear so you don't crush the vessels that bring blood to your feet.

I also can't stress this enough. Were a hat. A good insulating hat. Allowing your head to be warm keeps your body from shunting blood away from the extremities to make it (head) warm.

Good luck,
Keith

SAR-EMT40 said:

Leenie,

Don't know if this will help but use the Mickey mouse boot knowing that you will always need dry socks after. You need to keep your feet dry in cold conditions and they will sweat like crazy. I am the same way. My feet can be cold and they still sweat.

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The whole idea of mouse boots is that the insulation is sealed in rubber and cannot get wet. At the end of the day, your feet will look like prunes and your socks will be soaked with sweat. Wet, but warm and wet. You can think of them as super moisture barrier boots if you like. (You can also walk through shallow streams with them. And if the water goes above the boot, just take it off, drain it, and put it back on. )

Warm and wet feet are more subject to friction problems than are warm and dry feet, but they are still safe from cold injuries. Dry socks are required for multi-day hikes or for when you get back to the car.

I own and used to hike with black mouse boots. The white ones are overkill for most people hiking in the White Mtns/DAKS, however they might be useful for Leenie.

Doug

Understood Doug. They can't get wet from exterior sources. But it makes no difference to your feet if they get wet from being bathed in sweat or from a stream dunking. The damage, similar to trench foot damage if it is for long periods of time, will be the same. My feet sweat very heavily normally (no I am not bragging ). Put them in a pair of MM and they sweat profusely. That pruning is the damage already starting. Add the friction of a bad fit and they will really chew the heck out of them.

At least my experience.

YMMV
Keith

SAR-EMT40 said:

Understood Doug. They can't get wet from exterior sources. But it makes no difference to your feet if they get wet from being bathed in sweat or from a stream dunking. The damage, similar to trench foot damage if it is for long periods of time, will be the same..

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Agree that wet is wet, no matter where the water comes from. But the critical difference here is warm vs cold.

Trench foot requres extended cold and wet. The damage is due to circulation being continuously shut down by the cold for a long period (days). Mouse boots should be warm and wet. Just being wet does not cause trench foot (the water is a heat loss medium, the cold is the primary cause of the injury).

Wearing the mouse boots during the (hiking) day (with no sock changes) and removing them and changing into dry socks (and perhaps booties) for the night never caused anyone any damage that I have heard of.

Military combat or survival (bivy or lifeboat) situations may require sock changes (and foot warming) by dicipline if they are not built into the daily routine. Even mouse boots may not keep one's feet warm enough under such conditions.

I'm not aware of problems due to continuous warm and wet. (Didn't find anything in a quick check of my medical books and a network search.) If there are any, I'd expect them to be skin problems. (In trench foot, the deeper tissues are more susceptable to damage than the skin.)

Disclaimer: I have no formal medical training, I'm just an interested layman.

Doug

Reynoud's Syndrome

Ask you friendly local MD for a scrip for Nifedipine. It belongs to a class of drugs called calcium channel blockers. It prevents vasoconstriction in Reynoud's. You don't need to take it every day, only when you are exposed to conditions that usually precipitate your Reynoud's. Works with fingers (much more common) as well as toes. Usually 30 mg. or 60 mg. will do the trick.

Yeah Doug. It isn't really well known but it is called Warm water immersion foot. Immersion foot is just another name for trench foot. It was very prevelant in Vietnam and hard to combat except by continually changing socks and drying feet. Regular trenchfoot can occur at room type temperatures and below around 65 degrees.

Topics on Trench foot

The term immersion foot is used to describe both cold and warm weather injuries. Warm water immersion foot and tropical immersion foot describe two clinical types of tissue damage that occur with prolonged exposure to moisture. Warm water immersion foot can occur in folks with excessive perspiration who work in enclosed rubber boots. Warm water immersion foot and tropical immersion foot symptoms include painful thickening and maceration of the skin of the bottom of the foot. Warm water immersion foot and tropical immersion foot is most common in adolescents and young adults.
Quite often we'll see that a person's occupation contributes to warm water immersion foot. Workers who wear boots, particularly rubber boots and insulated boots, are most susceptible to trench foot and warm water immersion foot. The jungles of Vietnam and combat boots were a 'shoe in' for tropical immersion foot.

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Disclaimer: I do have some formal medical training but am obviously no expert.

Keith

Keith (SAR-EMT40),

Checked your reference.

OK, the info on warm-water immersion foot looks reasonable, but the symptoms look different than the symptoms of trench foot. The cold version includes deep tissue injury but the warm version appears to be a skin problem.

I had the vague recollection that extended exposure to warm and wet could cause skin ulcers (couldn't back it up, so I didn't mention it). Sounds similar to warm-water immersion foot.

My references state that trench foot and immersion foot are different names for the same injury. Mixing the term "warm-water immersion foot" into the term "immersion foot" could be confusing--two different injuries under the same name (even if there is a commonality in the conditions which cause them). Your reference is a .com site--I have no idea what the accepted medical terminology is.

Doug

Did a search on "warm water immersion foot" and came up with some good info. It is real. and the name "warm water immersion foot" appears to be standard medical terminology.

http://www.wramc.amedd.army.mil/fieldmed/dermatology/Derm_Textbook_Ch-4.pdf
is a very informative reference.

Thanks Keith, a new one to add to my "list" of environmental injuries.

Doug

SAR-EMT40 said:

Understood Doug. They can't get wet from exterior sources. But it makes no difference to your feet if they get wet from being bathed in sweat or from a stream dunking. The damage, similar to trench foot damage if it is for long periods of time, will be the same. My feet sweat very heavily normally (no I am not bragging ). Put them in a pair of MM and they sweat profusely. That pruning is the damage already starting. Add the friction of a bad fit and they will really chew the heck out of them.

At least my experience.

YMMV
Keith

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Things were looking too clear, so I thought I would toss in my $.02.

I wore the white Mouse boots in Alaska, and yes, they make your feet wrinkle. I hated the damn things, but the worked very well.

If Leenie has Raynaud's he may not be so prone to sweating and damp nastiness caused by vapor barrier boots. Changing socks will certainly make your feet feel better.

Barbarossa said:

I wore the white Mouse boots in Alaska, and yes, they make your feet wrinkle. I hated the damn things, but the worked very well.

If Leenie has Raynaud's he may not be so prone to sweating and damp nastiness caused by vapor barrier boots. Changing socks will certainly make your feet feel better.

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I'll agree, they (in my case the black mouse boots) worked, but I'll admit that I prefer my leather double boots. In Leenie's case, the trade-offs might be a little different.

I originally fitted my mouse boots with one wool sock which became soaked by the end of the day. (My feet tend to be warm and damp.) I finally found that I by wearing double wool socks, my feet were only damp at the end of the day. Much better. (There was adequate room in the boot for the double wool--the struggle was to get the boots on and off.)

A friend who has cool feet and somewhat uncomfortable plastic boots still wears her mouse boots on occasion.

Doug

Thank you all for the info- I have actually tried 'mouse boots' years ago-but I am convinced my feet need external heat sources. I have used -20 boots, dry socks, always wear fleece pants under my gore tex, warm hat, several layers on torso, ect. I haven't tried 'warm water immersion' yet. Sounds painful but may give it a try. I have some hot-tronic ski boot heaters but they are bulky and I thought I could get away with disposible heaters. I'm 10 days out from the hike and the feet seem minimally better-toes still numb. MD appt tomorrow! Thanks again!