Assessing And Treating Cold-Related Injuries Among Athletes

By Mark Caselli, DPM

Skiers, ice-skaters, joggers, mountain climbers and outdoor enthusiasts are all prone to cold-related skin injuries. Local cold injuries occur when the core (consisting of internal structures such as the brain, heart, lungs and abdominal organs) temperature is maintained but the shell (skin, muscles and extremities) temperature dramatically decreases. The feet are among the most commonly affected body parts with these local cold injuries. Duration of the exposure, the temperature to which the skin has been exposed and the wind velocity are the three most important factors to consider when determining the severity of a local cold injury. The most common types of local cold injuries include frostnip, chilblains, trench (or immersion) foot and frostbite. Frostnip, the most common cold-induced skin disorder in athletes, is a slow-developing condition that results in blanching or whiteness of the skin. It is usually associated with the reversible formation of ice crystals on the skin’s surface. Frostnip usually develops painlessly and affects the tips of the ears, nose, cheeks, chin, fingertips and toes. It often occurs in conditions of high wind, extreme cold or both. The affected athlete often does not notice it and frequently a companion first perceives it. There is usually no permanent tissue damage and it can be treated effectively by the firm, steady pressure of a warm hand. The skin should not be rubbed with snow. This old folklore treatment can actually result in more damage to the tissue. As the tissue gradually warms and thaws out, the color returns and the athlete may experience tingling in that body part. The skin may continue to be red for several days after the tissue is warmed. There may also be some flaking and peeling of the skin. Recognizing And Treating Chilblains And Trench Foot Chilblains and trench (or immersion) foot are commonly grouped together. Trench foot usually refers to the lower extremity, while chilblains can affect either the hands or feet. The etiology of this condition is either the repeated exposure of skin to cold water or the presence of wet extremities for prolonged periods at a temperature near freezing. Initially, this condition damages the capillaries of the skin. With further progression of the injury, necrosis or gangrene of the skin, underlying muscles, nerves and other associated tissues occurs. This can lead to swollen, cold, pale, numb skin and progresses to mottled skin with a pale or grayish blue tint. The initial symptom is tingling or burning. The extremity may also feel cold and numb. Upon rewarming of the affected body part, there is a typical sequence of events. The skin first becomes red, swollen and hot. Areas of increased burning and itchy sensations develop. The skin may then blister or develop localized gangrene or both. Recurrence of this injury tends to happen in the same area of the body and there may be permanent hypersensitivity to cold and paresthesias in the affected skin. These sequelae are probably the result of permanent injury to the peripheral vascular and nervous system. The treatment for this condition is to remove the wet, cold clothing and footgear and gently re-warm the extremity, maintaining good local hygiene and applying a warm, dry covering. The re-warming should take place in an appropriate environment where there will not be re-exposure to the cold. There is no effective treatment once permanent skin injury has occurred. Therefore, all treatment should be geared to prevent initial occurrence and to protect the area once re-warming has occurred. How To Identify The Varying Degrees Of Frostbite Frostbite represents the worst of the local cold-related injuries and usually involves the hands and feet. It is caused by the actual freezing of the soft tissue. The danger of frostbite must be considered very strongly whenever there is exposure to extreme cold. Frostbite can be classified into four stages based on the degree of injury. First-degree frostbite produces white patches on the skin surface. It is often painless and there is numbness of the affected area. There is no tissue loss, but sometimes edema occurs if it is not treated immediately. Second-degree frostbite occurs when the white patch is not caught in time. Persistent cold, pale skin that does not blanch with pressure is a common sign. You may see vesiculation or blistering with surrounding edema and erythema. The blisters are usually clear.

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