Cold injuries..frost bite?

[Dane]

I am doing an article (to eventually be posted here) on cold injuries and frost bite. More specifically how hydration, fitness and footwear play a part in the equation.

 

If you have had any type of cold injury, immersion foot,

or frost bite I'd like to hear about it and be able to quote your circumstances as a reference.

 

What you were wearing for boots and clothing, the kind of climb and temps when it happened and your level of physical well being all would be helpful.

 

The idea is to help others avoid a similar circumstance. TIA

 

[Dane]

For a graphic view of immersion foot take a look under "immersion foot" in goggle images.

 

"Immersion foot occurs when feet are cold and damp while wearing constricting footwear. Unlike frostbite, immersion foot does not require freezing temperatures and can occur in temperatures up to 60° Fahrenheit (about 16° Celsius). The condition can occur with as little as twelve hours' exposure."

 

FWIW I suspect mild immersion foot injuries (the ones with no visual injury) are very common in the winter climbing community but unreported and generally unrecognised for what they really are.

 

What is missed is immersion foot can easily lead to very serious reinjury and less resistance to cold injuries in general.

[Dane]

Turns out this is more appropriate topic than I would like it to have been.

 

One of our buddies severely froze some digits this week. After a trip to the ER and the Doc he is now bed ridden. Will be for at least several weeks and no climbing again for months.

 

Not his but the injury is similar..

 

If anyone has any experience or info to add please do.

 

 

[Le Piston]

Luckily I've never had frostbite, but when I climbed Monte Rosa my boots were wet and it was well below freezing. I had numbness and some pain in some of my toes for weeks after. I had the older (sans Gore-tex liner) La Sportiva Trangos. I'm pretty sure I had immersion foot.

[Dane]

24 hrs out climbing in the Enchantments...12/2/09

 

[kinnikinnick]

last week up at chair peak i was wearing two pairs of heavy socks in lasportiva nepals (not my usual practice, but i was sketched about the temperatures) and had very numb feet until i removed one pair of socks. fine balance between heel lift (climbing performance) and keeping feet warm. i had foot and hand warmers, dont think i'll ever climb again in the winter without them

[kinnikinnick]

dane what boots were you wearing when you suffered the frostbite in the above pic?

[denalidave]

24 hrs out climbing in the Enchantments...12/2/09

 

Yikes, I hope the toes have healed up?

[Choada_Boy]

24 hrs out climbing in the Enchantments...12/2/09

 

 

Ow. We need an "Injuries" gallery.

 

I've found that tying your boots is an art. I go for loose boots over cold feet. Tight laces across the top of your foot can reduce circulation.

[billbob]

I found that my basic Sportiva Makalu boots actually keep my feet warmer than my Nepal Evo's because they are not nearly as tight and constrictive. My feet are big and part of the problem has been finding a size 15, saving my pennies for the new Baruntse.

[denalidave]

I found that my basic Sportiva Makalu boots actually keep my feet warmer than my Nepal Evo's because they are not nearly as tight and constrictive. My feet are big and part of the problem has been finding a size 15, saving my pennies for the new Baruntse.

Size 15, holy crap... On the bright side, if what they say about shoe size is true, I bet your popular with the ladies...

[Bug]

No frostbite or immersion foot to report.

But here is what I do to keep my feet warm.

 

I have worn light hiking boots up Rainier several times.

Asolo's. They are much like these (http://www.rei.com/product/706762) only not gortex.

My feet stay warm under very cold temps. There are conditioning and gear tricks that I use. Conditioning tricks include lots of foot exercises. Ankle rotations (using theraband), toe lifts, and wearing light shoes in cold weather as often as I can to vascularize my feet.

Gear tricks have mostly been listed here already, don't get your boots too tight. Don't let your feet get wet. If your boots get wet, pull out plastic bread bags and put them over dry socks.

Standing on cold snow conducts heat out the soles. Have good insulation in your footbeds/soles.

 

[Dane]

Yikes, I hope the toes have healed up?

 

Good thing?...not my feet!

 

Bad thing? 4 to 6 weeks, more likely 6 totally off his feet in a wheel chair. By six weeks the dead tissue will have hopefully detached itself or at least shown itself enough to be cut away. Then 6 months or more before you get back into climbing boots let alone rock shoes. Serious sheeeet.

Edited December 15, 2009 by Dane

[G-spotter]

Couple of years ago on Night N Gale my partner had forgot his boots so I wore my plastics and he wore my leather boots (scarpa Freney 2000 model) which were a tight fit for him, about a half size smaller than his normal boot.

 

temps around -20C all day, about 7 hours CTC

 

My feet were fine, he got frostbite on big toe. Big black spot half under nail, later peeled off, lost a few mm (maybe a qurater of an inch) of skin. Kept the toe. He could walk around in sandals while the skin was coming off.

 

the big deal I think was the tight boot rather than the cold. Cold was obviously a contributing factor but in his own boot fitting well he should have been fine as evidenced by neither of us getting frostbite on eg. noses or fingers that day.

[ryanb]

Yikes, I hope the toes have healed up?

 

Good thing?...not my feet!

 

Bad thing? 4 to 6 weeks, more likely 6 totally off his feet in a wheel chair. By six weeks the dead tissue will have hopefully detached itself or at least shown itself enough to be cut away. Then 6 months or more before you get back into climbing boots let alone rock shoes. Serious sheeeet.

 

Yikes! But if those feet belong to who I think he will easily campus harder then most of us climb without ever needing to touch feet to rock.

[Dane]

Don't give him any ideas......at least for 4 or 5 more weeks!

[danhelmstadter]

i got pretty knarsty frostbite on my big toe - digging and analizing a snow pit at 12k on flattop mountain (rmnp co) in subzero temps and howling winds in feb 06. later affected skin fell off, and toenail came off - but i've been in a perpetual state of full toenail death and regroth the last few years due to frontpointing when i forget to buckle my boots etc...

 

i was wearing thrift store alpine ski boots - with their original liners -(burlier than most at stock liners)

 

my toes and fingers get numb all the time when i'm out and about in the winter months, but if my toes get numb again like that for long enough, i'd like to think i'd stop and try to warm em up somehow.

 

 

 

 

[kublaicon]

i was on denali's muldrow glacier this past summer with NOLS and another student ended up getting frostbite on one of his big toes. this was preceeded by him getting sick moving up to 15,000 feet which may have been attributed to dehydration, then ended up vomiting and not drinking much water during the ascent which deffinatly resulted in dehydration. im guessing dehydration was a major factor. he was wearing kolfach plastics with stock liners.

[Rad]

Dehydration, tight boots, lack of foot mobility all boil down to reduced circulation, which seems to lead to unpleasant outcomes. Thanks for the data points.

[Nick]

Years ago in New Hampshire's White Mountains, in January, we were on an overnight trip that got extended to three nights out on the mountain when a storm came in. It was as cold as 30 below zero at times and we became somewhat dehydrated. Everyone else had mild frost nip in the toes, but I ended up with second degree frostbite in all 10 toes, The difference was that I had soft felt-liner boots and old style strap-on snowshoes that cut off the circulation. I was in the hospital for a week. All the skin on all the toes was hard and black and came off in big toe-shaped chunks. After a week in the hospital on IV vasodilators and oxygen I was up on my feet and back to normal. A few weeks later at a dance all of my toenails came off leaving my toes smooth and alien looking, as if they had never had nails at all. Soon the toenails grew back and my feet have been fine ever since, though I am more careful with them. Once, caught by another storm, I had pretty bad immersion foot. It took about a week for my feet to stop hurting after that.

[Mtguide]

A wealth of info on causes, treament and prevention can be found by Googling it. Also, the late Bradford Washburn, famed Denali climber and cartographer, published an excellent treatise on frostbite while serving as director of the Museum of Science in Boston in 1963. It was first published in the American Alpine Journal in 1962, later as a pamphlet put out by the Museum. It's of course out-of date regarding equipment, but the basic principles of causes and prevention are every bit as relevant today as they were 45 years ago. It's called "Frostbite: What is is- How to prevent it; Emergency treatment". Copies and/or microfiche can be found in The Mazamas archives in Portland , or at The Mountaineers in Seattle.

 

Another good article is on p. 373 of the American Alpine Journal for 1965, " Avoiding Frozen Feet- Cold weather Footgear" by William E, Davis. This piece is more thorough on equipment and how to deal with the difficulties of drying footwear in extreme conditions, yet maintaining warmth. One of the most important basic conclusions it makes is that "A regular leather climbing boot simply will not protect against freezing in extreme cold".

 

Despite the advent of Thinsulate and other systems, the persistent popularity of leather climbing boots makes this a warning still worth heeding, simply due to the nature of leather itself. Although leather "breathes", and can aspirate moisture to the outside, it also permits moisture to enter, is easily frozen and extremely difficult to thaw in extreme conditions, and thus is an excellent conductor of cold. For full-on winter conditions, plastic, comfortable fitting, thermo-formed foam insulated boots and a well-thought out sock system are your best bet.

 

 

[billbob]

Word.

[Dane]

Dehydration, tight boots, lack of foot mobility all boil down to reduced circulation, which seems to lead to unpleasant outcomes. Thanks for the data points.

 

Rad pretty much summed it up.

 

The old data (leather boots and prevention) doesn't really address current philosophies, conditions and gear. Modern fabric boots that either aren't water resistant or are water proof and cause additional sweating and wet feet, most with a tight technical fit and many trying to do long days without enough hydration are a quick ride to immersion foot or worse frostbite. More often than not many winter climbers have already had immersion foot, didn't recognise it, and are even more likely to get frost bite in similar condions the second time around.

 

What you really need to be aware of is keeping your feet dry, and staying hydrated. Generally being inattentive of both will cause cold injuries. Staying hydrated in really cold condions is extremely important in keeping all 20 digits intact. Tight boots that work fine on road side crags are often not suitable for off the road cold weather alpine climbing. Over night cold weather trips involve keeping your boots unfrozen and hopefully dry. Same reason plastic dbl boots were such a hit. Double boots are still the key to long term use on cold weather trips. Additional help is the use of anti-perspirants on your feet, vbl sox if your inner boots are not foam and water proof. Using 2 layers of liner sox and no additional insulation soxs with the newst foam liners allow for extra soxs to be carried easier. Easier changed when damp..and dried easily against your skin in the bag or while climbing if required.

 

Another piece of gear that is now often replaced by the pant cuff, the knee gaiter, is an additional lay of insulation and wind barrier for the lower leg. Gaiters are easily over looked in the new "fashion" alpine pants. But they add more warmth and protection to the current bunch of fabric boots than you might first suspect and a quick way to add a few degrees to your boots, fabric, leatherr or double boots in any weather.

[groupb]

"Immersion foot .. can occur with as little as twelve hours' exposure."

 

Mine occured in only ~ 5 hours of restricted circulation in saturated boots continuously immersed in ~ 40 degree water.

 

Doc said tiny, numb nerve endings would grow back at 1 mm/week - 6 weeks later the feeling came back. Since then major portions of my feet go completely pale & numb when cold - but I have been relatively OK with old plastics down to around zero.

 

Bill

[Dane]

Good info Bill. I did mine in less than 2 hrs by stopping to rest. Feet had been wet (got wet crossing a creek but not soaked enough to think of changing soxes) but not cold for the previous 8 to 10 hrs.

 

I decided to take a nap and let the cold wake me up...done so many time before but never with really damp feet and tight boots.

I spent the next 9 months getting the feeling back in mine even with no visual damage. Much more succeptable to cold now. With some extra care I was able to climb the rest of the winter in the Cascades and Cnadian Rockies with no additional damage although complete healing may have been extended considerably.

 

I've had small bits of frost bite in the distant past and none have effected me as much as immersion foot has or for as long.

 

Many including myself might even pass it off simply as bruised toes and feet.