Winter Barefoot Frostbite
I joined some friends for Utica's Thanksgiving Run for Hunger 5k race. The run is very close to my parents' house where I would be feasting later in the day. I struggled to decide which footwear to run in. The temperature was 19 degrees with snow, ice, and road salt covering the ground and clouds blocking the sun. I am comfortable running barefoot in 20 degree sunny weather on pavement, and running for a bit through snow has not been a problem. So I decided to run barefoot despite the fact that it was a little outside of my comfort zone in several ways. The plan was to run the race in 20 minutes and scurry back to a warm place in case my feet got cold. How cold could my feet get in 20 minutes? As it turns out they could get pretty cold and freeze solid in just 20 minutes.
I took my shoes off and jogged in place for 3 or 4 minutes before the race started. We took our marks, got set, and went. A group of us in the front discussed where we were heading. "Up to The Eagle, just like the Boilermaker developmental runs". We headed into the golf course up the steep hill. The road was icy but plowed. After a right turn near the top of the hill the road was no longer plowed. Running along tire tracks was the only way to avoid running through several inches of chunky snow. It was quite a bit colder with a howling wind near The Eagle, the large statue looming over the top of Val Bialis Ski Resort. As I reached the turn-around point, a race official yelled, "slow down I gotta get a picture of this!".
On my way back down the long steep hill, I zig-zagged through crowds of people running up. In all my barefoot running I had never before heard comments like what I was hearing now. Nearly every comment included an f-bomb, so things like "omg wtf" were coming at me at regular intervals.
My adrenaline was pumping from the excitement of the race. My feet felt cold for a bit, then I suspect they went numb and so I didn't notice anything unusual. I was all alone as I approached the bottom of the hill. I noticed that the sound of my feet touching the road no longer had the usual barefoot soft and silent quality to it. Each footfall produced a sound like hard plastic hitting the pavement. There wasn't much I could do about it at this point besides finish the race, so I made a mental note and ran towards the finish line.
After finishing the race, I grabbed my shoes. I was distracted with conversation with other runners and family so it took me a while to notice that my feet were completely numb making it nearly impossible to put them into shoes. My dad walked up and made the comment, "looks like frostbite to me".
That's when the gravity of the situation hit me. I tuned everyone out and crammed my dead white rock solid toes into socks and shoes and ran indoors. I put my feet next to a heater (which apparently is a huge frostbite no-no, I should have soaked them in 105-degree water instead) and tried to warm them up. After a while with surprisingly little progress, I put my shoes back on and scurried to my parents house where I warmed them up some more by a heater. It took 30 minutes or so for them to warm and soften up, much longer than I expected. Once thawed, I felt a growing sensation of burning. This feeling continued to get worse and worse until I was writhing around in pain. My wife suggested going to Urgent Care. I quickly agreed. During the short car ride, I hit a solid 10 on the pain scale, crying and all:
Urgent care was closed for Thanksgiving, so we went to the emergency room. As soon as I entered the hospital, the pain went away and things were looking up. A doctor reamed me out pretty harshly after which a nurse told me the doctor was crazy and I was going to have a full recovery. I went home with a prescription for pain medications and antibiotics, but otherwise my feet had their color back and looked normal, so I expected everything was going to be fine.
We enjoyed a wonderful Thanksgiving meal and had lots to give thanks for. At the end of the evening I went to change my socks so I could put shoes on for the ride home. Upon removing my socks, I let out a huge gasp. I was not counting on the giant inner-tube blisters surrounding most of my toes. I quickly put them into socks and shoes and we drove home.
Here's what they looked like later that evening. Blisters yes, but the undersides of my feet looked perfectly fine:
The condition is slowly progressing. After a long day of sitting at a desk my toes feel dead, but after spinning on an exercise bike for 25 minutes they feel great. It seems like moving really brings circulation and life back.
The tops of all toes feel basically perfect except of course where the big blister is. The tips of all toes are a little numb but actually seem to have some direct sensitivity to light touch. The rest of the foot besides the toes is totally fine. The pinkie toes are a little dry and beat up but otherwise feel normal. The middle toes are slightly numb and tingly along the bottom with hardened toe pads, and the worst fourth toe is hard and most of the surface tissue has turned soft with with a ghostly white color. The big toe seems totally fine except for a bit of white flesh where the fourth toe was touching the big toe.
A woman with a condition similar to mine blogged about her experience with frostbite. It's hard to say but hers is probably worse because she had some dark blue areas on her big toe after her feet stayed frozen for several hours. I hope that following her story gives me sort of a worst-case scenario for myself (and her story really doesn't sound too bad):
After spending countless hours fruitlessly searching Google to try and find out if I was going to survive, I realized that I had no idea what I was looking at. The blisters on the tops of my toes didn't seem like a big deal, but I started panicking that the ghastly white zombie flesh on the bottoms of my toes was gangrenous necrotic flesh which sounded pretty scary. (Turns out they were pretty much just blisters, they looked different largely because the foot is tougher on the bottom). I made the trip to Urgent Care to talk to a Doctor. Doc pulled rubber gloves on his hands, reached out to inspect my feet, and just before touching them said, "uhhhhm this looks bad, I don't like this. We're going to get you set up with a surgeon to take a look, I don't want you losing toes on my watch. I've never seen frostbite this bad before." A few minutes later, I had a new appointment scheduled at a plastic surgery place for later that day.
At the plastic surgeon's I was placed in a small room. In it was a small table with a shot glass of disinfectant, a medical paper towel, small scissors, and tweezers. I was expecting a discussion to possibly schedule a time to take action. Instead the doctor immediately grabbed tools and got to work. She said she doesn't usually use any pain killers for this type of debridement. The assistant asked if I would be able to watch. I said, "I don't know." I can definitely be squeamish at times, but watching I felt no attachment to the awful dead stuff she was pulling, tearing, and snipping away. She might has well have been working in paper mache. Occasionally I'd let her know when something hurt a little because that meant she was getting close to healthy skin.
To her my condition might as well have been toenails that needed clipping. She said I'll recover fully. About a week for the skin to grow back, then another 2 weeks or so for most everything else to return to normal. The assistant bandaged me up and I headed home. I asked if it would be good if I removed the bandages while I slept to allow some airflow. She said no, right now what they need is to remain moist. The blisters were providing the moisture, and for now it will come from antibiotic ointment and bandages.
As soon as I got home I did some bandage readjustment to try and guarantee as much circulation as possible. It takes very little for them to feel like they have fallen asleep. While the bandages were off, I snapped a few pictures.
I haven't been getting out much at all. The slightest bit of pressure stops blood circulation in my toes after which they feel awful: asleep or dead. In shoes I walk around like I'm crippled. In socks I can walk around like perfectly normal. So I went on a mission to find a pair of shoes so I can walk outside again. I hobbled around 10 different stores getting increasingly frustrated until I finally tried on a pair of weird rag shoes. As soon as I put them on and started moving, I couldn't help but break into a run right there in the shoe store. They are perfect for loosely bandaged feet. When I got home I walked and ran around the block a few times and felt great. The next day it was more like 4 miles. I could get used to this.
While my toes have some feeling, there is still a fair amount of numbness. Keeping circulation going is tough. After sitting at a desk for 7 hours or so they feel dead. A few minutes of spinning on an exercise bike has worked well, and more recently going for a run with my new shoes in 40-degree weather helps get them warm and circulating. Some of the skin that I haven't lost, particularly on the tips of my toes is thick and half-dead. I expect to shed some of that skin slowly over the next few weeks. The skin under the blisters is healing really well.
Today almost all of the thick dead skin peeled away leaving behind fairly normal looking toes. This feels like a huge step towards full recovery. They still have a way to go before they will feel 100% normal, but at least they look ok.
I have been running for the past week. A week ago I managed to eke out 13 miles by going out on 3 separate runs throughout the day. I had to return to the house regularly to warm up my toes. It's not so much that they got too cold, but they have been very sensitive and I can't gauge how cold they are by feel. Also it has been a struggle to comfortably wear shoes. Apart from that running hasn't been problem. A few days ago my feet felt too cold while running in 20 degree weather, but today I was able to run 6 miles in 10 degrees with reasonably comfortable toes. Tomorrow I'm hoping to run 15. I prepared before-hand with a warm shower and some time on the exercise bike to get the blood flowing. Oh, and I wore regular shoes for several hours this evening which is a first. I still need to be careful, I'm keeping them moist with Vaseline twice a day, but they are improving every day and it's not much to deal with at this point. I feel incredibly lucky that within just two short weeks most of the damage has been reversed.
Both feet are back to 96%. Old dead skin continues to peel away and needs to be snipped away every few days. The tips of my toes have only remnants of numbness. They feel much more normal and are not significantly sensitive to the cold like they were. As of only very recently, wearing regular shoes is comfortable again.
Since my last post, my feet and toes have been almost perfectly normal except for a few minor things. My toes have often been unusually red. And as of the last week or two, my toenails have started falling off. 3 toenails down, and I expect at least one more to come off eventually. They also seem to get cold easily when they are completely exposed.