Immersion foot is the result of prolonged exposure of the foot to a moist, nonfreezing (but below 60°F, 15.56°C), occlusive environment. Immersion foot is classically seen in military operations, but the homeless civilian population is also particularly at risk. Prolonged cooling of the extremities produces direct soft tissue injury, with the peripheral nerves being most affected. Wet conditions accelerate the injury, as do factors that reduce circulation to the extremities. These factors include constrictive footwear, prolonged immobilization, hypothermia, smoking, dehydration, nutritional deficiencies, trauma, and underlying disease. When first seen, the injured area is pale, anesthetic, pulseless, immobile, but not frozen. After several hours of rewarming, a vigorous hypermia develops associated with severe burning pain and reappearance of proximal sensation. Edema and bullae, at times sanguinous, may develop as perfusion increases. This hyperemic phase may last weeks, and hyperhidrosis is a prominent late feature. Patients may develop fever and lymphadenopathy. The injury evolves slowly, and anesthesia may be permanent. Differential diagnosis includes cellulitis and fungal infections. Treatment is conservative and includes admission for bedrest, leg elevation, and air drying of feet at room temperature. Antibiotics play little or no role in the recovery process but should be given if superinfection is present. 3536
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