Friday, February 14, 2014

Trench Foot (exposure to prolonged cold and damp)

Soldiers on the move in the front line have little time to care for their feet. However George C Patton did recognise when soldiers wore good quality boots they fought like Trojans. Today’s makers of combat boots totally agree. Since the Gulf War of 1991, combat boots have changed drastically. Traditionally, combat boots were "stiff and heavy,” designed for durability more than performance. Technology now is helping make them "lightweight, and biomechanically correct. Bearing in mind the average soldier carries 120 –150 pounds of equipment and needs to be stable on rough and unfamiliar terrain. It is important their footwear promote good posture, has shock absorbing soles, and is made with breathable fabrics for climatic conditions. A long way from the barefoot wars of Alexander the Great. The new order of boots, are designed to cope with special operations and quick-strike missions, where speed and maneuverability are critical. However like the best laid schemes of mice and men – it doesn’t always work.

When two tribes go to war, how many people count the cost of keeping them in shoes. In the Great War it was estimated some 2,500,000 pairs of shoes were made for the Allied troops. Laid end to end this would mean the shoes would cover the complete coastline of Western Australia. An estimated 380,000 cattle were required to be slaughtered to provide the equivalent of 17.5 million square feet of leather or 400 acres to make the boots. The soul leather alone weighed 4,000 tons; metal for nails was 1,150 tons; with 55 tons of thread; and 78,000,000 eyelets. War has always meant big business to the shoe and textile industries. Sadly this has not always brought the best from friendly suppliers and it is estimated human greed can account for almost as many casualties as enemy fire in modern warfare. When soldiers’ boots are poor quality for the conditions of combat then their fighting ability is undermined. During the American Civil War, for example, the US cavalry were demoralised because of shoddy workmanship. Supplied with sub-standard cardboard, cowboy boots, their feet and legs were cut to ribbons. During the Second World War footwear supplies to the front were fatally delayed because vital supplies were misappropriated by Black Marketeers. It was quite common to find non-combat units wearing superior footwear intended for their colleagues at the front.

Trench foot was first described in the Great War and was attributed to the feet being immersed in very cold mud for long periods of time. The forces footwear was no match for the atrocious conditions of the trenches. Trench Foot results from prolonged exposure of the extremities to cold (non freezing) conditions. Both vascular and nerve injury arises and depending on the severity symptoms range from a feeling of coldness and par aesthesia (pins and needles). During the hyperaemic stage the extremity becomes hot and swollen often with bleeding under the skin. This may be complicated with lymphangitis, cellulitis and thrombophlebitis. The late vasospastic stage is very painful with excessive sweating and paresthesia. These symptoms may last for years. When foot ligaments gave way and the feet collapse and solders are left unable to move.

In the Second World War, trench foot was responsible for putting more Allied Forces out of action than the German 88 (artillery). In December 1944, northern Europe's witnessed it's coldest winter during which 45,000 men - the equivalent of three full infantry divisions, were pulled out of the front line because of trench foot. Three days before the Battle of the Bulge began so great were the casualties to trench foot, men unable to walk were carried from sheltered pillbox positions at night to firing positions in the day time. Behind the US Lines it was decreed any soldier suffering trench foot would be tried for court martial. Senior officers were suspicious some soldiers were hoping to avoid combat by actively encouraging symptoms of trench foot. One reason why trench foot was so common was soldiers slept with their boots on. During engagement they were recommended to dry and warm their feet as best they could, and sleep with their boots off. This was often impractical and most ignored the directive. Conditions in the Falklands War were extreme. The British soldiers were severely challenged by their inferior boots. The direct molded sole failed to keep their feet dry and water poured through the lace holes. The impermeable sole provided a perfect reservoir and feet was immersed in cold water for long periods. Trench foot was commonplace and a major concern to the assault forces. The Argentine boot, on the other hand, was superior in every way and provided ideal protection to the elements; hence it became a valued prize of war. The crossover trend from military wear to fashionable is not new and was seen during the Napoleonic Wars. The Wellington and Blucher boot were proudly worn as a tribute to the Great War heroes. Paradoxically of course although Napoleon lost the war his style of boots became the prototype of all modern cowboy boots. The Engineer boots was popular after the Second World War and was taken into civilian life primarily by those young men who now rode motor cycles. The high ankle protectors meant the skin was not burnt by the hot exhaust pipe and of course this gave the fashion for biker boots. "Its an ill wind that blows no-one, some good ". The misfortunes of a US boot making companies were transformed with the wars in Afghanistan and Iraq. Although 90% of US shoes are manufactured overseas there is a US federal law which states all military footwear should be made from cow hides of American cattle. War meant a new lease of life for ailing traditional industries. At first the mountainous terrain of Afghanistan was a major challenge to the boot designers. During the winter in the mountains the snows can be anything from waist height to over the head and since much of the campaign covert tell tale boot prints gave away the presence of strangers. Landmines were a major problem and despite the sophistication of design and material, no army boot has yet been able to prevent injury. Official US Government research indicates the spectrum of lower leg injuries is the same whether wearing sandals or standard army boots. At best the purpose of the army boot is to prevent below knee amputation for small charges and above the knee for large charges. Combat troops keen to avoid detection wore sandals made from old tyre treads.

A morbid and sordid fact of war, but often the boots of the dead were removed in order to continue combat. In the Falklands War there was a reoccurrence of Trench Foot because the boots of the British Forces' were unsuitable for the weather conditions. Some military experts have postulated had the Argentineans been prepared to prolong hostilities they would have won because of casualties to Trench Foot. A similar condition known as Immersion foot gives similar symptoms but is associated with prolonged exposure to warm and wet conditions. This was common in Vietnam, were fighting in the jungle swamp necessitated combatants remained in warm moist conditions for long periods of time.

Modern theatre of war takes place on diverse turf and boots need to cope with the rigors of desert, jungle, urban and country settings. Waterproofing is important but so too is aeration with many military disasters in the past to support the importance of the right boot for the right battlefield. Apparently US troops reported slipping in their chemical-protection boots and the rubber soles were no match for the dust. A sad sign of the times but necessity none the less the military boot of the future will protect the wearer against biochemical warfare. Unfortunately the prototypes used in Iraq presented more technical problems and the protective suit's black rubber boots which are worn like galoshes over the troops' normal combat boots, trap heat and block airflow. Trench foot or immersion foot again plagued the fighting forces. Some medical corpsmen ordered their troops to air their feet out for at least two hours each day. Despite a semi-permeable material designed to release heat and moisture, much like the Gore-Tex fabric used by campers and hikers, the MOPP suits failed to "breathe" as temperatures near Baghdad top 100 degrees in the afternoons. Back to the drawing board. Feeding and clothing an army is critical and a major task itself. Prior to hostilities some British troops trained for action in running shoes because of a shortage of combat boots. Problems with the supply due to “production difficulties” were the official line but even when they did arrive, the hot sun caused the boots to disintegrate. British soldiers scavenged for Iraqi army boots. No surprise the Iraqi boots were more suited to the conditions and hence a prized possession. Lessons learned from Afghanistan was the combat boots proved too inflexible for maneuvering in mountain terrain, and had soles that too easily wore out or were torn up by walking and climbing on rocks. Soldiers also said their feet were perpetually cold and wet because the insulated lining of the cold-weather boots made their feet sweat too much, and the boots could take days to dry out.

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