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Medical Education Division |
Operational Medicine 2001
Field Medical Service School
Student Handbook
FOOT CARE IN THE FIELDFMST
0604 17
Dec 99
TERMINAL LEARNING OBJECTIVE: 1.
Given a combat environment (day and night) and necessary FMST supplies
and equipment, perform care of the feet per the references.
(FMST.06.04) ENABLING
LEARNING OBJECTIVE: 1. Without the aid of reference materials and given a list of
symptoms of foot disorders, select the correct prevention techniques, per the
student handbook. (FMST.06.04a) 2. Without the aid of reference materials and given a list of foot
disorder symptoms, select the appropriate treatment for the type of foot
disorder, per the student handbook. (FMST.06.04b) 3.
Without the aid of reference materials and given a list of boots, select
the appropriate boot for specific environmental conditions, per the student
handbook. (FMST.06.04c) 4.
Without the aid of reference materials and given a list of test protocols
for fitting boots, select the appropriate test protocol for determining proper
boot size, per the student handbook. (FMST.06.04d) 5.
When given a patient with foot blisters in a field environment and given
the FMST MOLLE Medic Bag, perform foot
blister care effectively, per the student handbook.
(FMST.06.04e) OUTLINE: A. TYPES OF BOOTS 1. MATTERHORN
MARINE INFANTRY COMBAT BOOT a.
Standard issue for Marines and Navy personnel assigned to the Fleet
Marine Force or graduating from Field Medical Service School. b.
Leather with black nylon fabric on each side. c.
Breathable, Gore-Tex Construction (waterproof) d.
Outsole is non-marking, jet fuel and oil resistant. 2. JUNGLE
BOOT a.
Standard issue for Marines and Navy personnel assigned to the Fleet Marine Force
or b.
Leather with green or black nylon fabric on each side c.
Holes for drainage d.
Steel insert in sole. 3. VAPOR
BARRIER BOOTS (“Mickey Mouse Boots”) a.
Issued to personnel stationed in extremely cold climates. b.
Black boots protect feet in wet cold up to -30 degrees F c.
White boots protect feet in dry cold up to -60 degrees F d.
Interior and exterior insulation 5. HOT
WEATHER TYPE III (DESERT BOOT) a.
Issued to personnel stationed in extremely cold climates. b.
Tan suede with tan nylon sides c.
Rubberized top and no eyelets (to keep sand out) d.
No steel shank which allows for cooler wear B.
PROPER FITTING OF FOOT WEAR 1.
FITTING OF BOOTS a.
Criteria #1 - Determine the fit under the arch. There should be no wrinkles
under the arch. b.
Criteria #2 - Ball of foot rests on the widest part of the sole. c.
Criteria #3 - Determine the width of the boot. No tightness or fullness of the
leather. d.
Criteria #4 - Determine the boot length. There should be 1/2 inch between
the end of the longest toe and the end of the boot. C.
FITTING OF SOCKS 1.
Proper fitting of socks is paramount to good foot care. 2.
Improper fitting can lead to: a.
Blisters b.
Abrasions – “Hot Spots” c.
Poor sweat absorption d.
Poor feet circulation 3.
Proper sock fitting guidelines: a.
Place socks on feet and stand with weight evenly distributed 1.
Socks should feel comfortable – i.e. No fullness and “not to tight” 2.
Socks should fit snugly on the foot without excess material over toes and
heel a.
Excess material may bunch up and cause pressure points on the foot b.
Allow 3/8” shrinkage with washing c.
If a person opts to wear two pairs of socks, the outer pair should be 1/2
size larger to comfortably fit over the inner sock. D.
COMMONLY OCCURRING PROBLEMS 1. BLISTERS
a. DEFINITION - A vesicle of
the skin, containing watery matter or serum.
b. CAUSES:
1. Wet socks
2. Improperly fitting boots
and/or socks
3. Frequent impacting on one
or more areas of the foot
4. Friction
c. SIGNS / SYMPTOMS OF
BLISTERS
1. Vesicle of skin flap
containing watery matter (serum)
2. Mild edema and erythema
3. Sloughing of tissue
exposing subdermal tissue layer
4. Localized discomfort and
pain
d. TREATMENT
1. Small blisters usually
need no treatment
a. Clean area with soap and
water
b. Watch for increase in
size and for signs and symptoms of
infection
2. Larger blisters that
effect the way a person walks or functions
a. Wash the area around the
blister with betadine solution or
alcohol pad
b. Insert a 20–25 gauge
needle near the margin of the blister
4-5 mm into the dome keeping the needle parallel to the skin,
then withdraw the needle
c. Then apply gentle
pressure to the blister dome, expressing the
clear blister fluid
d. Circumvent the affected
area with absorbent adhesive bandage
or adhesive tape (moleskin)
e. DO NOT PUT ANY ADHESIVE
DIRECTLY ON THE
BLISTER ROOF.
f. Dust entire foot with
foot powder to lessen friction and prevent
adhesive from adhering to the socks.
h. Check blister
periodically to ensure that it is drying properly. 2. SWEATY
FEET
a. DEFINITION - Excessive
perspiration called hyperhydrosis on the sole of the foot and
between the toes.
b. CAUSES:
1. In some cases it is
related to mental stress and nervousness, especially in
adolescents and young adults
2. Systemic diseases such as
anemia and hyperthyroidism may be associated with
hyperhydrosis
c. SIGNS / SYMPTOMS OF
SWEATY FEET
1. The skin between the toes
usually becomes white and macerated.
2. The skin rubs off easily
and the foot is prone to abrasions.
d. TREATMENT
1. Change socks frequently
2. Dry feet frequently
2. Apply an antiperspirant
preparation containing 15 - 25% aluminum chloride
3. Use an absorbent foot
powder 3.
ATHLETES FOOT (Tinea pedis)
a. DEFINITION – An
infection of the foot caused by a fungus which predisposes the
foot to sluffing of the skin.
b. CAUSES:
1. Sweaty feet and wet socks
2. Contact with contaminated
footwear and floors
3. Poor hygiene
c. SIGNS / SYMPTOMS OF
ATHLETES FOOT
1. Itching between the toes
2. Red, raw-looking skin,
which is often itchy
3. Skin that flakes, peels
or cracks
4. Sore, purulent, weeping
rash
d. TREATMENT
1. Change socks regularly
2. Never wear a pair of
boots for more than 24 hours in a row. This
will allow
the boots to dry.
3. Apply anti-fungal foot
powder daily for work hours (DAY) – i.e. Tolnaftate
4. Apply anti-fungal
ointment daily at rest hours (NIGHT) – i.e. Mycelex Cream
5. If the patient fails to
respond to treatment, refer patient to Medical Officer
4. INGROWN TOENAILS
a. DEFINITION - The nail
(often the big toe nail) grows into the skin, down the sides
of the nail, becoming embedded as the nail grows,
which can cause severe pain, bleeding, and a toenail infection.
b. CAUSES:
1. The most common cause is
cutting your toenails incorrectly. Nails cut too
short or down the sides may leave a sharp piece of nail which pierces the
groove as the nail grow.
2. Trauma to the nail plate
or toe
3. Improperly fitted
footwear – especially shoes too small
4. Abnormally shaped nail
plate
5 Other toenail
deformities (e.g. excessively thick nail plate)
c. SIGNS / SYMPTOMS OF
INGROWN TOENAILS
1. Pain along the margin(s)
of the toenail 2.
Aggravated by wearing shoes, particularly those with narrow toes 3.
May be sensitive to any pressure, even the weight of the bed clothes 4.
There may be signs of infection 5.
There may be drainage of pus, or a watery discharge tinged with blood
d. TREATMENT
1. Trim a small spicule of
nail to relieve the pressure. Callus (dead skin) may
have accumulated in the nail groove, which needs to be removed.
2. Elevate the end of the
nail plate to prevent impingement on the soft tissues.
3. Surgically correct a
chronic ingrown toenail at the BAS.
4. Completely remove a
deformed toenail so it will not grow back. 5.
CORNS, CALLUSES, AND BUNIONS
a. DEFINITION - A thickening
of the surface layer of the skin in response to pressure.
Usually form on the toes, where the bone is prominent and presses the
skin against the
shoe, ground, or other bones.
b. CAUSES:
1. Tight fitting shoes
2. Deformed and crooked toes
3. Tight socks
4. Seam or stitch inside the
shoe which rubs against the toe
5. Sometimes a shoe which is
too loose, with the foot sliding forward with each
step
6. Prolonged walking on a
downward slope
c. SIGNS / SYMPTOMS OF
CORNS, CALLUSES, AND BUNIONS
1. A hard growth on the skin
of the toes.
2. Pain on direct pressure
against the corn.
3. Sometimes redness and
swelling around the corn, with severe discomfort.
4. Increased discomfort in
tight fitting shoes.
5. More common in women than
men
d. TREATMENT
1. Carefully debride (pare
down) the corn and any deep seated core it may have.
It should be stressed that this provides only temporary relief, if the
pressure
continues after treatment.
2. Apply various pads and
devices to the toes to relieve pressure (mole skin)
3. Find the cause and
alleviate - i.e. fix improperly
fitted boots
4. In extreme case refer to
Medical Officer E. PROPHYLACTIC FOOT CARE 1.
BEFORE MARCHES
a. Educate troops about
proper foot care and wear b.
Keep feet clean and dry
c. Wear clean, dry,
un-mended, well fitting socks
d.
Use foot powder
e. Cut toenails on a regular
basis (every two or three weeks)
f. Early and immediate
attention to pain around toenails
2. DURING REST PERIODS
a. Lie with feet elevated at
rest points
b. If time permits, massage
the feet, apply powder, change to dry socks and treat blisters.
c. Relief from swelling feet
can be obtained by a slight loosening of the boot laces where
they cross the arch.
3. AFTER MARCHES
a. At all times EARLY
ATTENTION IS ESSENTIAL. As soon as any discomfort is felt,
take corrective action.
b. Treat blisters,
abrasions, corns, and calluses if they have occurred.
c. If red, swollen, tender
skin develops along the edges of the foot, the foot requires
aeration, elevation, rest, and as a rule, wider foot wear.
d. A daily foot bath is
important. In the field, cool water seems to relieve the sensation of
heat and irritation.
REFERENCE (S): 1.
Foot Care Direct 2.
Foot Talk Field Medical Service School
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