Paddy Foot: A Warm Water Immersion Foot Syndrome Variant. Part II. Field Experiments, Correlation.

摘要

Paddy foot is a unique form of reversible cutaneous injury involving the boot top area - the dorsum of the foot, ankle, and lower leg - following prolonged immersion in water over 20 C affecting American soldiers in the Mekong River delta. Field data revealed that 20% of soldiers constantly in warm water for 72 hours became incapacitated, while 80% of men wet for 120 hours became casualties. All races are susceptible. About 20% of men do not develop paddy foot, while 3% seem unusually susceptible to recurrent episodes. Pruritus under the boot top occurs first in 18-48 hours; then small vesicles and patchy or diffuse erythema appear on the dorsum of the feet. Purpura develops shortly in some vesicular bases, dull aching pain is felt in the dorsal metatarsal head area, and finally a hard, non-pitting edema appears. The soles are spared. About half the casualties develop femoral lymphadenopathy or a fever of 1-3 deg. Microscopically, the epidermis shows some areas of acanthosis and other areas of intraepidermal vesicles resulting from ballooning degeneration, while the dermis reveals telangiectasia, mild perivascular infiltrate, but no evidence of vascular damage. Extraneous matter, microorganisms, or chemicals in the water or mud are not significant causal factors. Four to 15 volunteers wearing boots and constantly exposed to clean drinking water developed paddy foot in 96 hours. Treatment consists of bed rest and elevating the feet for 48 hours. Prevention in combat consists of limiting operations to 48 hours in the paddy, then duty in a dry area for 24 hours.