Foot care is extremely important since feet are enclosed in some type of footwear and are constantly in action. Foot care measures include foot hygiene, care of minor foot ailments, foot care preventive measures and injury treatment, and proper fitting and care of footwear.
Before, During, and After a March
E-1. Foot care is an important ingredient in Soldier morale. Soldiers whose feet are dirty and unkempt do not function as well as Soldiers who have had an opportunity to bathe and put on clean, dry socks. During combat, unit leaders must stress the importance of foot care before, during, and after a march.
Foot Protection
E-2. In all types of footgear, feet sweat more and are generally less ventilated than other body parts. Moisture accumulates in socks, decreasing their insulating quality. Feet are susceptible to cold injury and in most cases are observed less frequently than the rest of the body. Protecting feet is vital to mission accomplishment. Leaders and Soldiers should—
- Bring several pairs of proper fitting socks.
- Have an extra pair of boots available, when possible, to change when wet or worn down.
- Keep socks clean and dry.
- Change wet or damp socks, as soon as possible.
- Apply foot powder on feet and inside of boots when changing socks.
- Wash feet daily, if possible.
- Avoid tight socks and boots and completely lace boots up as loosely as possible.
- Wear overshoes when appropriate and dependent on the mission variables of METT-TC (I), which stands for mission, enemy, terrain and weather, troops and support available, time available, civil considerations, and informational considerations.
Foot Conditioning
E-3. Conditioning is accomplished by progressively increasing distance marched from day to day. Marching is an excellent way to strengthen feet and legs. The arch, ankle, and calf can be conditioned by performing simple exercises such as—
- Rising high on toes.
- Placing feet on towels and using toes to roll the towel back under the arch.
Preventative Measures
E-4. Foot care preventive measures enable continuous operations. Commanders and subordinate leaders implement preventive measures before, during, and after the march to avoid painful foot problems.
E-5. Before the march, trim toenails on a regular basis. Cut toenails short and square, and straight across. (See figure E-1 on page 118.) Keep feet clean and dry and use foot powder. Wear clean, dry, proper fitting socks (preferably cushion soled) with seams and knots outside free from holes or other obvious signs of wear. Nylon or polypropylene sock liners can reduce friction and add protection.
Note. Carefully fit new boots. When getting used to new pairs of boots, alternate with another pair and tape known hot spots before wearing the new pair.
E-6. During halts, when conditions permit, Soldiers remove only one boot at a time to massage feet, apply foot powder, change socks, and medicate blisters. Soldiers cover open blisters, cuts, or abrasions with absorbent adhesive bandages. Unit medics or combat lifesavers (CLSs) can help. Obtain relief from swelling feet by slightly loosening bootlaces where laces cross the arch of the foot.
E-7. After the march, when conditions permit, repeat foot care methods, wash and dry socks, and dry boots. Medicate blisters, abrasions, corns, and calluses. Inspect painful feet for sprains and improper fitting of socks and boots. Red, swollen, tender skin, which could become blisters, can develop along sides of the feet from prolonged marching. If possible, give feet a daily foot cleaning. In field environments, cool water seems to reduce the sensation of heat and irritation. After washing, dry feet well.
Note. Unit medics and CLSs have proper equipment and training to care for Soldiers with foot problems before, during, and after foot marches.
Foot Injuries and Treatment
E-8. Care of minor foot ailments should be given the utmost attention. Many major conditions requiring hospitalization and disability have resulted from neglected or maltreated minor conditions. Conditions that can occur from foot marches include—
- Blisters and abrasions.
- Foot perspiration.
- Athlete’s foot.
- Foot frostbite.
- Trench foot.
- Immersion foot.
- Stress fractures.
Blisters and Abrasions
E-9. Foot blisters and abrasions are the most common Soldier load-related injury. Blisters result from friction between socks and skin. Blisters can cause extreme discomfort, may prevent Soldiers from completing planned actions, and can lead to many days of limited activity. Blisters may progress to serious problems like an infection. Common causes of blisters and abrasions are improperly conditioned feet, heavy Soldier load, ill-fitting footwear and socks, improperly maintained footwear, heat, and moisture. Blisters are normally caused by friction, pressure, and impact.
E-10. Heavy loads increase blister incidence, possibly by increasing pressure on the skin and causing movement of the foot inside the boot through higher propulsive and breaking forces. When loads are heavy (61 kilograms/134 pounds or more), the double pack method of load carriage has been shown to demonstrate lower blister incidence than the backpack method, suggesting better load distribution can reduce blisters.
E-11. Gel shoe insoles have been shown to reduce foot blister incidence, possibly because they absorb frictional forces in anteroposterior and mediolateral directions. Regular conditioning with load carriage induces skin adaptations reducing the probability of blisters. Thus, blisters can be less of an issue in units marching regularly; however, sudden increases in march intensity or distance probability make blisters likely, regardless of conditioning regularity.
E-12. Moist skin increases frictional forces and probably increases blister incidence. Acrylic socks decrease the number and size of blisters, possibly by conducting sweat away from the foot. Nylon socks worn inside wool socks reduce incidences of blisters for Soldiers who are foot marching. Polyester socks alone, or thin polyester sock worn inside thicker socks either wool-polypropylene or cotton-wool, reduce foot blister incidence as well. Antiperspirants reduce foot sweating and blisters.
E-13. Soldiers typically experience areas of friction known as hot spots. Subjective experience is a localized warm or burning sensation. This presumably pre-blister stage is characterized as a local red (erythema) and tender area. (See figure E-2 on page 120.) When hot spots are detected, blisters may be avoided by shielding the affected areas with low-friction skin coverings. Various skin coverings have been examined for their coefficients of friction, and lower values may be effective in reducing blister incidence.
Note. Soldiers may use moleskin to prevent blisters before movement or foot marching. Soldiers should consult with their unit medic for proper usage and placement of moleskin.
E-14. To clean blisters, wash gently around it with soap and water, being careful not to break the skin. (See figure E-3.) If unbroken, use a sterilized needle or knifepoint to prick lower edge of blister to remove fluid. (To sterilize a needle or knifepoint, hold it in a flame or immerse and wipe with alcohol.) Do not remove the skin; cover blister with an absorbent adhesive bandage or similar dressing, extending beyond edges of the blister. After applying the bandage, dust outside of the bandage and the entire foot with foot powder.
E-15. Use just enough foot powder since it can harden and become irritating. Foot powder lessens friction on the skin and prevents raw edges of bandage adhesive plaster from adhering to socks. Bandage adhesive plaster should be smooth so it can serve as a second skin. Check blister periodically for proper drying.
E-16. After blister has dried, remove the bandage adhesive plaster. Carefully inspect the foot for other problem areas that are red and tender needing protection of bandages adhesive plaster. Cover abrasions and cuts on foot with absorbent adhesive bandages for rapid healing. In an emergency, medical personnel can attend to the injury and aid in applying first aid. See table E-1 for signs, symptoms, prevention, and treatment of blisters.
Note. When mission variables permit, allow medics or CLSs to drain blisters.
Foot Perspiration
E-17. When feet perspire, secretion decomposes and causes a foul odor. Skin between toes usually becomes white and soft, rubs off easily, and is prone to abrasions. Treatment comprises of washing feet with soap and water, thoroughly drying feet, applying foot powder lightly, and changing socks.
Athlete’s Foot
E-18. Athlete’s foot usually occurs between toes, on soles of feet, and at points of contact between skin and footwear. Mild chronic cases of fungal infection may respond to daily foot powder applications. If fungicidal ointment is available, it can be used along with foot powder. Fungicidal ointment should be used as directed and while feet are at rest. If foot powder and fungicidal ointment do not heal the infection, consult with the unit medic or physician.
Frostbite
E-19. Frostbite is freezing of the foot or feet due to exposure to below freezing temperatures and it is classified as either superficial or deep. Frostbite is a constant hazard in operations performed at freezing temperatures, mainly when accompanied with strong winds. Normally, cold sensation occurs, followed by numbness and tingling, stinging, aching, or cramping pain. Skin first turns red and yellowish, pale gray or waxy white.
Prevention
E-20. Prevention of frostbite or stopping it in its early stages is easier than thawing and caring for frozen flesh. Proper-fitting clothing, foot gear, and properly worn equipment avoid interference with blood circulation, which could reduce amount of heat delivered to extremities. To prevent severe frostbite—
- Proper clothing must be worn for protection against cold and wind.
- The face must be protected during high winds and during exposure to aircraft propeller blast.
- Clothing, body, and extremities must be kept dry.
- To avoid sweating when performing heavy work in cold environments, Soldiers should remove their outer layers of clothing and replace them when work is finished.
- Socks should be changed when feet become moist.
- Cold metal should not be touched with bare skin in extremely low temperatures, because doing so could mean loss of skin.
- Constricting clothing or jewelry should be removed.
- Adequate clothing, equipment, and shelter must be provided during periods of inactivity.
- Face, fingers, toes, and ears should be exercised or massaged to keep them warm and to detect numb or hard areas.
- The buddy system or teamwork always should be used.
- Soldiers should find buddies and observe each other for signs of frostbite and for mutual aid if frostbite occurs.
- Small frozen spots should be thawed immediately, using bare hands or other sources of body heat.
Note. Always consult unit medics and leaders with issues about any kind of frostbite.
Levels
E-21. The two levels of frostbite are superficial and deep. Superficial frostbite involves the skin. Deep frostbite is a serious injury and requires immediate first aid and subsequent medical treatment to avoid or minimize amputation. If freezing extends below the skin, it demands involved treatment to avoid or lessen loss of the body part such as fingers, toes, hands, or feet. Often no pain occurs, so Soldiers must observe each other for signs. Since it is difficult to distinguish between superficial and deep frostbite, Soldiers should assume injuries are deep and serious. If numbness occurs for a short time, frostbite is probably superficial.
Treatment
E-22. For treatment of superficial frostbite, the following measures should be taken:
- Cover cheeks with warm hands until pain returns.
- Place uncovered frostbitten fingers under opposing armpits, inside clothing next to skin.
- Place bare frostbitten feet under clothing and against chest or belly area of a buddy.
- Do not rewarm area by such measures as cold-water soaks or rubbing with snow.
- Be prepared for pain when thawing occurs.
E-23. For treatment of deep frostbite (freezing injury), the following measures should be taken:
- Do not attempt to treat injury in field environments if freezing is considered deep.
- This causes increased pain and invites infection, greater damage, and gangrene.
- Quickly evacuate the injured frostbite victim to nearest medical facility.
- Protect frozen body parts from further injury, and do not try to thaw them by rubbing, bending, or massaging.
- Do not rub body parts with snow or place in cold or warm water.
- Do not expose body parts to hot air or open fires, and do not use ointments.
- Do not walk on feet after they have thawed.
- Though it is safer to walk on frozen feet, thawing may occur during transportation to a medical facility.
- This cannot be avoided since a Soldier’s entire body must be kept warm.
Note. Leaders and medics should know and monitor all Soldiers having previous cold weather injuries. Soldiers having sustained past cold weather injuries are more susceptible for reoccurrence.
Trench Foot
E-24. Trench foot is thermal injury caused by exposure to severe cold weather conditions or in damp or wet environments in temperatures between 32- and 50-degrees Fahrenheit. Causes include immobility of limbs due to sitting or standing, insufficient clothing, and constriction of body parts due to boots, socks, and other garments.
E-25. Trench foot is like gradual frostbite since the primary causes are the same-only difference is degree of cold. In early stages of trench foot, feet and toes are pale, and feel cold, numb, and stiff. Walking becomes labored. If preventive action is not taken at this stage, feet may swell and become painful. In extreme cases of trench foot, flesh dies, and amputation of the foot or leg may be needed. Since early stages of trench foot are not painful, Soldiers must be alert to prevent and treat trench foot.
Prevention
E-26. Socks and boots should be cleaned and dried daily, and feet should be dried soon after being wet. If Soldiers must wear wet boots and socks, their feet should be exercised by wiggling toes and bending ankles and should be warmed with hands. Foot powder should be applied, and dry, clean socks should be put on as often as possible.
Treatment
E-27. When treating trench foot, feet should be handled gently. Feet should not be rubbed or massaged. If needed, feet can be cleaned carefully with plain soap and water, dried, elevated, and left exposed. While it is best to warm the patient, feet always should be at room temperature. The patient should be carried and not allowed to walk on injured feet.
Immersion Foot
E-28. Immersion foot is an injury following prolonged immersion of feet in water not cold enough to cause freezing or frostbite. It can occur after exposure in subtropical waters. Clinically and pathologically, immersion foot is like trench foot since its cause is the same lowering temperature of the body part involved. Other important factors are—
- Body cooling due to wind.
- Total immersion.
- Inadequate protective clothing.
- Illness.
- Starvation.
Note. Prevention and treatment for immersion foot is the same as for trench foot.
Stress Fractures
E-29. Lower extremity stress fractures are common in Soldiers. Stress fractures are attributable to repetitive overloading of bones during activities, such as foot marching. The most common areas that stress fractures occur are the lower extremities, especially the tibia, tarsals, and metatarsals. Once stress fractures occur, Soldiers must allow them time to heal. The affected areas of a stress fracture must rest for several weeks until pain is gone, followed by a slow return to activity to avoid a recurring injury. Personnel who have had previous injuries are susceptible for injury reoccurrence.
Proper Fit and Care of Footwear
E-30. Poor-fitting boots can cause blisters, abrasions, calluses, and corns. Pressure is caused by boots being too small; friction is caused by boots being too large. If tops of toes are involved, the cap is too low or too stiff. If ends of the toes are affected, the boot is too short or too loosely laced. If sides of the big and little toes become irritated, the boot is too narrow. Heel irritation is caused by boots being too long, too loosely laced, or too wide of a heel space. This section addresses the proper fit and care of footwear.
Properly Fitted Boots
E-31. There are two important factors in fitting boots. First, the space between the end of the big toe and the toe of the boot should be the width of the thumb. Second, in the unlaced boot, Soldiers should have enough space under the lower edge of the boot tongue to insert an index finger.
Note. This technique may not work for everyone. Soldiers should do what is comfortable for them. Different manufactured boots may not always fit the same.
E-32. Figure E-4 illustrates how to test for a proper fit.
E-33. Figure E-5 illustrates fitting and sizing guidance for military boots.
Note. Boots must be dried after use to avoid losing proper fit and to prevent hardening of the material. To prevent moist material from freezing during winter, boots should be placed inside sleeping bags or somewhere warm to allow drying naturally to maintain proper fit.
Properly Laced Boots
E-34. Proper lacing of boots prevents blisters and prevents improper blood flow in the foot. Laces can assume a seesaw action, which can produce a blister across the instep. To prevent blistering, lacing over the instep can be avoided. If possible, broad laces should be used and an extra pair should be carried.
Properly Worn Socks
E-35. To check the fitting of socks, Soldiers should stand with their weight evenly distributed on both feet. If socks fit correctly, no tightness or fullness should exist (see table E-2). A wool cushion sole sock is best, as it offers good foot protection.
Note. This technique might not work for everyone. Different manufacturers may cause different fit and feel. Apply what is best and works. When Soldiers are allergic to wool, using other alternative material like nylon, acrylic, or polypropylene may be beneficial.
E-36. Soldiers should allow 3/8 inch for shrinkage of new socks. Socks that are too large will wrinkle inside boots, increase friction inside the boot leads to blisters and abrasions. Socks that are too small will wear quickly and may reduce blood flow in the foot. When wearing two pairs of socks, Soldiers should wear an outer pair at least a half size larger than usual. Socks must be changed daily. Dirty socks are conductors of heat and allow warmth to escape. Socks should be washed in lukewarm water to preserve the fibers, since hot water can cause the socks to shrink.
E-37. When socks become damp, they can be dried by placing them inside a shirt next to the body or tied to the outside of the rucksack. Socks should be completely dry before wearing. If it is not possible to wash them, socks should be changed. Dirty socks should be dried and kneaded by hands to remove dirt and hardness.
Next Page : Appendix F – Related Injury and Illness Awareness