Trench Foot and How Socks were an Unlikely Hero

Lest we Forget this ANZAC Day, 25th April 2024.
Have a read of this post to learn how socks were an unlikely hero during WWI.
Cecilia, a Podiatrist here at New Step Podiatry has taken the time to reflect on a condition that was first collectively termed in WWI.

Back in my university days, ‘Trench Foot’ was discussed in our dermatology unit. I have never treated advanced trench foot, thankfully. Today seems like an appropriate day to discuss what is Trench Foot, what causes it and does it still occur today.
What is Trench Foot? What are the Symptoms?

Foot damaged due to prolonged exposure to cold and moisture. Trench foot occurs when cold temperatures and moisture combine, causing restricted blood flow to the foot. Symptoms of trench foot include numbness, pain, redness and swelling.
Advanced trench foot often involves blisters, open sores and infections which may require surgical debridement and in severe cases, amputation.
Unlike frostbite, trench foot usually occurs at temperatures above freezing.

 

Trench foot – from Wikipedia
What increases the risk of getting Trench Foot?

– Exposure to cold temperatures.

-Moisture in and around the shoes.

-Overlying tight shoes/boots.

-Being still for long periods of time.

-General poor health.

How did the term ‘Trench Foot’ come?

During WWI, the prevalence of trench foot increased due to, you guessed it, trench warfare, where soldiers stood in waterlogged, muddy, cold trenches for long periods of time. More than 20,000 British troops were treated for trench foot between 1914 and 1915. Apparently the condition was first reported in 1812 by a French army surgeon in Napoloen’s army.

Other terms used:

-Jungle Rot during Vietnam war.

-Nonfreezing cold injury.

-Immersion foot or immersion foot syndrome which is what I would diagnose someone with if I were to see it.

How was Trench Foot prevented during war times?
Ever heard of people knitting for soldiers? Socks seem an unlikely hero, but in the mud-filled trenches, a clean, dry pair of handknit socks could be the difference between life and death.
Over 1.3 million pairs of socks were sent overseas from Australia. Often knitters would include a small message to the digger.
Soldiers were also educated about the importance of keeping the feet warm, dry, and unconstricted by tight boots.
Bundling socks, ‘War Chest’ Sock Appeal, Sydney, May 1917, photographer G. A. Hills. State Library of NSW
Can People Still get Trench Foot (Foot Immersion Syndrome)?
Yes, if exposed to the conditions mentioned above. It can easily happen if someone wears wet socks or boots for days at a time. Groups of people more at risk  of this includes;

-Military personnel during training and service. This injury can occur outside trenches!

-People who are homeless in unsanitary, cold, wet environments.

-People who stand in water for extended periods of time for their work without adequate foot protection e.g. fish processors

-People who attend music festivals and neglect to change out wet sock and shoes.

-People doing a long hikes, multi-day hikes and competing in multi-day challenge events like adventure racing and Eco Challenge / World’s Toughest Race with Bear Grylls.

Air drying feet mid multi-day race. Picture from https://www.furtherfaster.co.nz/blogs/furtherfaster/how-to-avoid-blisters-and-trench-foot-when-racing

 

How long does it take to get Immersion Foot Syndrome?

Most cases of immersion foot syndrome require exposure to cold, wet conditions for 1-3 days but it can occur in 10-14 hours.

How is Immersion Foot Syndrome treated?

By slowly rewarming the feet. Too fast will cause pain and swelling. Antibiotics may be required if a bacteria infection is suspected by health professionals. When sleeping or resting, don’t wear socks.

How can Immersion Foot Syndrome be prevented?

By keeping the feet clean, warm, and dry. Think talc use, good socks, good shoes, washing feet and drying them out after exposure to wet. Not wearing socks when sleeping can help dry the skin out. Seems simple, but just not during war time.

Check out this blog article here about how to prevent immersion foot for a multi day sporting events. It provides great detail on what a number adventure racers do to save their feet.

 

Even the royal family knitted

 

‘The Sock Knitter’ by Grace Cossington-Smith, 1915. The subject of the painting is Madge, the artist’s sister, knitting socks for soldiers serving on the frontline in World War I. Distinctly modern in its outlook, ‘The sock knitter’ counterpoints the usual narratives of masculine heroism in wartime by focusing instead on the quiet steady efforts of the woman at home. According to the Gallery of NSW, this painting has been acclaimed as the first post-impressionist painting to be exhibited in Australia.

 

picture from https://www.elinorflorence.com/blog/wartime-knitting/ which has a few more interesting sock knitting pictures
References

– https://www.sl.nsw.gov.au/stories/woollen-comforts-home

-https://camdenhistorynotes.com/2020/03/10/wartime-sock-knitting/

-https://theconversation.com/one-million-pairs-of-socks-knitting-for-victory-in-the-first-world-war-30149

-https://news.yahoo.com/technology-socks-time-war-152954728.html?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAABZm0Q_SDMNPktF9v1yW9h7flv-DlGZjgIqPQxYJkpWW5Uf5VzVlG9iRhrLH_TC5SqvA1Bf86QpByW3GlUcDZd0uBtckvAnIiJdU4Tsagkwu7mjsaxNR-hJEPoddb8ZwI9bly2Zzx2HU8LmSgYyGIu2DsTXoPJ6daQ-Eij05VKXO

https://en.wikipedia.org/wiki/Trench_foot#/media/File:Trench_foot.jpg

https://www.furtherfaster.co.nz/blogs/furtherfaster/how-to-avoid-blisters-and-trench-foot-when-racing

https://www.artgallery.nsw.gov.au/collection/works/OA18.1960/#places

https://journals.sagepub.com/doi/full/10.1580/06-WEME-LH-027R.1

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