When the Cold Takes Hold - The Devastating Progression of Severe Trench Foot

Trench foot, a non-freezing cold injury historically recognized in World War I, continues to affect vulnerable populations exposed to prolonged cold and wet environments. It is characterized by vascular and neuropathic damage that can progress to infection, necrosis, and amputation if not promptly addressed. Racial disparities have been reported, with Black and African-Caribbean individuals demonstrating a significantly higher risk of cold-related injuries in both military and civilian settings. We present a case of a 51-year-old African American male who developed bilateral trench foot after wearing wet socks and boots for several days and subsequently soaking his feet in warm water with salt. Despite early initiation of broad-spectrum antibiotics and wound care, his condition progressed rapidly, with necrosis and foul-smelling gangrene evident by day 9 of hospitalization. Imaging revealed soft tissue emphysema consistent with advanced infection, necessitating bilateral guillotine amputations to prevent systemic sepsis. This case highlights the unpredictable course of trench foot even under medical management and underscores the importance of early recognition, prevention, and timely surgical intervention. It also emphasizes the need for targeted public health strategies in high-risk populations, including individuals facing housing insecurity and racial groups disproportionately affected by cold injuries.