Review article CED Clinical and Experimental Dermatology CPD A review of trench foot: a disease of the past in the present K. Mistry, 1 C. Ondhia 2 and N. J. Levell 1,2 1 Norwich Medical School, University of East Anglia, Norwich, UK; and 2 Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, UK doi:10.1111/ced.14031 Summary From the French Invasion of Russia in 1812, to Glastonbury festival in 2007, trench foot has been reported, yet the exact nature of the condition remains unclear. This review explores the pathogenesis and treatment of trench foot. Trench foot is consid- ered to be a nonfreezing cold injury often complicated by infection, in which expo- sure to cold temperatures just above freezing, combined with moisture, results in a peripheral vasoneuropathy. The presence of physical trauma, bacterial or fungal infections, malnutrition, venous hypertension and lymphoedema mean that some individuals are at greater risk of trench foot. Trench foot may be prevented by warming the feet, changing socks, staying active, rubbing the skin with oil and reg- ularly inspecting the feet. Avoiding risk factors may help prevent the condition. The management of trench foot is less clear. Vasodilators such as iloprost and nicotinyl tartrate or sympathectomy may help. Trench foot may lead to necrosis, cellulitis, sepsis and amputation. It remains a poorly understood condition. History of trench foot In the brutal Russian winter of 1812, as Napoleon’s Grande Armee retreated to France, trench foot was described for the first time by Dr Dominique Jean Lar- rey, a French surgeon. 1,2 In World War I, it was esti- mated that trench foot contributed to the deaths of approximately 75 000 British soldiers. Soldiers living ankle-deep in muddy and wet conditions wearing tight, cold and wet boots noticed their feet became cold, pale, sweaty, swollen and painful. 3 Over time, the soldiers observed skin changes such as mottling and hyperkeratosis with accompanied muscle stiffness and low grade fever. 4,5 Worse cases, where tissue per- fusion was severely compromised, led to the absence of foot pulses and development of paraesthesia (numb- ness, tingling, itching) followed by erythema, xerosis and warmth upon hyperaemia. Complicated cases resulted in a black and blistered gangrenous foot that required amputation. 4 Trench foot is not a disease limited to the past. Recent cases have been described in homeless individ- uals, and in 1998 and 2007 in over 270 revellers at the large, multiday Glastonbury festival in the UK, where there were sustained cold, wet and muddy con- ditions. 6 Immersion foot is the pseudonym for trench foot seen in sailors following prolonged exposure to cold water, with a similar pathogenesis and clinical course. 5 Understanding the true nature of trench foot is a challenge, which this review aims to address. Pathogenesis of trench foot: frostbite or cellulitis? Many theories exist around the pathogenesis of trench foot, ranging from venous hypertension and stasis to tinea infections and physical trauma. The most established theory regarding the patho- genesis of trench foot is that of nonfreezing cold injury (NFCI), first suggested in 1942. This described trench foot as a cold immersion syndrome: exposure to cold temperatures just above freezing with sufficient dura- tion and severity results in neurovascular changes Correspondence: Mr Khaylen Mistry, University of East Anglia Faculty of Medicine and Health Sciences, Norwich Medical School, Norwich, NR4 7TJ, UK E-mail: khaylen.mistry@uea.ac.uk Conflict of interest: the authors declare that they have no conflicts of interest. Accepted for publication 18 June 2019 ª 2019 British Association of Dermatologists 10 Clinical and Experimental Dermatology (2020) 45, pp10–14