Between 2010 and 2022, there were nearly 5,000 cases reported of UK armed forces personnel having non-freezing cold injury (NFCI). NFCI has always been an issue for those who served in the armed forces. For example, 64% of soldiers who served in the Falklands had experienced symptoms of a non-freezing cold injury.
Despite being common, there seems to be many misconceptions and misinformation surrounding the issue. Luckily, we are here to set the record straight. In this blog, we detail the signs, symptoms, causes, and treatment for NFCI.
What Causes Non-Freezing Cold Injury?
Non-freezing cold injury, commonly known as trench foot or immersion foot, is tissue damage caused by prolonged exposure to cold and wet conditions without actually freezing, hence the name. NFCI can lead to numbness, pain and, potentially, long-term nerve damage.
Being exposed to cold and wet conditions for a prolonged period of time causes blood vessels to constrict, reducing blood flow to the affected tissue. While NFCI is often associated with frostbite, this is not technically correct. Whereas frostbite involves injuries relating to freezing temperatures and ice crystal formation, NFCI occurs at temperatures above freezing and is a different injury entirely.
Because those who serve in the armed forces have to operate in wet and cold conditions, which frequently cause NFCI, non-freezing cold injuries are one of the most common illnesses suffered by armed forces personnel. However, what is perhaps just as (if not more) surprising is the fact that military personnel are particularly susceptible to NFCI during training as well, meaning you can still suffer from this illness while never actually partaking in combat operations.
Factors That Increase The Risk of NFCI
Fatigue and Malnutrition
Generally, feeling tired and suffering from malnutrition can increase the likelihood of developing NFCI.
Underlying Medical Conditions
Certain conditions like peripheral vascular disease, Raynaud’s phenomenon, and diabetes can increase susceptibility to non-freezing cold injuries.
Constrictive Shoes or Boots
Constrictive shoes can restrict blood flow, which can increase the risk of NFCI.
Being A Smoker
Being a smoker can negatively impact circulation; unsurprisingly, this increases the risk of developing NFCI.
Symptoms of Non-Freezing Cold Injuries
Non-Freezing Cold Injury Early Signs
Symptoms and early warning signs of non-freezing cold injuries can often be overlooked, especially in cold temperatures. Signs of NFCI often include:
Swelling
It is not uncommon to experience swelling or a feeling of swelling, even if there hasn’t been a visible enlargement. This feeling is often accompanied by a feeling of tightness in the skin.
Cold To The Touch
Rather unsurprisingly, affected areas will feel incredibly cold to the touch.
Numbness and Tingling
Feelings of numbness and tingling are common among those who suffer from non-freezing cold injuries. This loss of sensation usually occurs in the hands or feet.
Skin Discolouration
Skin discoloration will usually appear, with the affected areas appearing pale or white and then progressing to white or bluish-purple.
Rewarming Symptoms
The above may not be the only signs and symptoms. As the skin is rewarmed, some of the following symptoms can occur:
Pain
The affected area can become extremely painful, especially during the rewarming process.
Blistering
In some cases, blistering may occur, but it is worth noting that this is only in severe cases.
Throbbing Pain
A throbbing, burning, or sharp sensation may occur, especially in the affected area of skin.
Altered Sensation
Sensations may be altered in affected areas, often leading to feelings of reduced sensation.
Swelling
Swelling or red skin may occur after the rewarming process, but this is uncommon.
Long-Term Symptoms
Despite all the above symptoms, some chronic, long-term symptoms may persist, including:
Chronic Pain
Chronic and long-term pain is, unfortunately, a common symptom of most chronic illnesses. While the pain is often cited as persistent, many point to the fact that the pain can intensify at night.
Tingling, Burning, or Pins and Needles
As mentioned previously, NFCI is likely to result in tingling, burning or a pins and needles-like sensation. If suffering from long-term symptoms, these feelings will persist.
Hyperhidrosis
While rare, the affected area can suffer from hyperhidrosis, which is where the area can become sweaty even when it isn’t warm.
Sensitive To The Cold
Sensitivity to cold conditions is a common side effect of long-term NFCI.
How To Prevent Non-Freezing Cold Injury
Some of the most effective ways to prevent non-freezing cold injuries include:
- Avoid exposure to the cold and harsh conditions, especially without the necessary equipment (such as insulating clothing layers with windproof and waterproof shells, hats, gloves, and boots, etc).
- Seek shelter or increase activity levels as soon as symptoms start to develop.
- Reduce exposure time in conditions of increased risk.
- Stay hydrated.
- Remove wet and cold clothing. If possible, replace them with a dry set.
- Not everyone has the same reaction to cold, so take action as soon as you start to feel cold. You will need to warm yourself up, whether that be via drying and a change of clothes or simply removing yourself from the situation if you can.
How Is NFCI Diagnosed?
Technically speaking, there is no objective single test to diagnose NFCI, so the diagnosis is made clinically. A medical professional makes the diagnosis based on a detailed medical record containing medical history and focused examination.
Some criteria used to assess NFCI include the affected area becoming cold enough to lose all sensation for at least an hour (often much longer). Assessments cover whether rewarming was painful for over 30 minutes, and analyse symptoms such as tingling, burning, pins and needles, and altered sensations persisting for more than 48 hours.
NFCI is excluded if the general sensation returns 48 hours after cold exposure.
Treatments Available
Treatments for non-freezing cold injury focus on preventing conditions from worsening and avoiding re-exposure. Techniques used to treat NFCI include:
- Prevention of further cooling
- Effective pain management
- Avoiding direct heat exposure in affected areas
- A slow rewarming process
- Air drying
- Elevation and rest
- Avoiding re-exposure to cold conditions
Contact Veterans For Veterans
If you have experienced NFCI as a result of serving in the armed forces, you may be entitled to compensation. Contact us today at Veterans For Veterans; we are a team of ex-military personnel who want to help fellow veterans get the compensation they deserve.