The biting chill of winter can do more than make your toes tingle. Prolonged exposure to cold (directly or indirectly) can lead to various foot injuries, ranging from mild discomfort to severe tissue damage. Understanding these conditions, their symptoms, and prevention strategies is crucial for enjoying winter activities safely.

Types of Cold Injuries

• Frostbite: This is the most serious cold injury resulting from freezing skin and underlying tissues.
  • Superficial frostbite affects the outer layers of skin, causing numbness, tingling, and a white or grayish appearance. It is usually seen with direct exposure to the cold.
  • Deep frostbite: Penetrates deeper tissues, potentially damaging muscles, bones, and nerves. Symptoms include severe pain, blistering, and tissue death or necrosis.
  • Treatment includes gradual rewarming of the part if seen immediately after the injury. Care must be taken to protect the injured skin and to avoid pressure on those injured parts. Wound care is needed if there has been significant tissue damage, with the understanding that, depending on the depth of the injury, it may take days or weeks for all the tissue to return.
    

   

• Pernio (Chilblains): This non-freezing injury occurs due to repeated exposure to cold or after prolonged exposure, typically above-freezing temperatures. It causes itchy, red, and sometimes blotchy painful skin lesions, often on the toes, fingers, ears, and nose.
  • Treatment is gradual rewarming of the part and NSAIDS for the pain and inflammation post-warming.  There is usually no tissue damage.

   

• Raynaud's Phenomenon: This condition causes blood vessels in the extremities to constrict excessively (severe vasospasm) in response to cold, resulting in reduced blood flow. Symptoms include numbness, tingling, and color changes in the fingers and toes (white, blue, then red), with multiple digits exhibiting these color changes simultaneously.

• Prevention is the key here, including wearing wool or synthetic socks, avoiding tight-fitting shoes, and avoiding situations where prolonged cold exposure may be a factor.

Symptoms

Early recognition of cold injury symptoms is crucial for prompt treatment and preventing further damage. Common symptoms include:

• Numbness and tingling: A common early sign of reduced blood flow.
• Coldness: The affected area feels significantly colder than surrounding tissues.
• Pain: Can range from mild discomfort to severe, throbbing pain.
• Color changes: Skin may appear purple, white, blue, red, or gray.
• Swelling: May occur in some cases, particularly with trench foot.
• Blistering: A sign of more severe frostbite.
• Deep tissue contusions: often seen in pernio.

Treatment

• Mild Cold Injuries: Gentle rewarming is key. Gradually warm the affected area with warm water (not hot) or by placing it in skin-to-skin contact with a warm body part. Avoid rubbing the affected area.
• Frostbite: Seek immediate medical attention. Do not attempt to rub or massage frostbite areas.
• Pernio: It is crucial to keep the affected areas warm and dry. Over-the-counter pain relievers and topical corticosteroids may help alleviate symptoms, and NSAIDS will help with the pain and swelling.

Prevention

• Proper Clothing: Wear multiple layers of warm, insulating clothing, including waterproof and windproof outer layers.
• Footwear: Choose insulated, waterproof boots that fit properly and provide adequate space for thick socks. Avoid tight-fitting footwear that restricts circulation.
• Socks: Wear multiple layers of moisture-wicking socks. Wool or synthetic materials are generally preferable to cotton, which can retain moisture.
• Stay Dry: Keep feet dry at all times. Change wet socks immediately.
• Regular Breaks: Take frequent breaks in warm, dry shelters to allow feet to warm up.
• Dietary Considerations: Ensure adequate nutrition and hydration, as these can help maintain body temperature.
• Monitor for Symptoms: Regularly check for signs of cold injury, especially in extreme conditions.

Footwear Fit and Sock Selection

Proper footwear and sock selection are critical for preventing cold injuries. Boots should be slightly larger than your normal shoe size to accommodate thick socks and allow for some wiggle room. Avoid boots that are too tight, as this can restrict circulation.

Choose socks made from wool and synthetic materials like polypropylene, polyester, or both. These materials wick moisture away from the skin, keeping feet dry and warm. Avoid cotton socks, as they retain moisture and increase the risk of cold injury.

Conclusion

Cold weather injuries to the feet can range from mild discomfort to severe tissue damage. By understanding the risks, taking appropriate precautions, and knowing how to recognize and treat these injuries, you can enjoy winter activities safely and comfortably. If you experience any symptoms of cold injury, seek medical attention promptly.

Pete Smith, DPM, is a Board-Certified Podiatrist practicing in the Lancaster, PA area. He is a past president of the Pennsylvania Podiatric Medical Association and a board member of its educational component, The Goldfarb Foundation.