An interesting case recently came through the Intermountain Orem InstaCare, a case that illustrates the importance of seeking medical treatment as early as possible.

A young man went out to hike “Y” Mountain in Provo with a group of friends in the late afternoon on a fairly warm January day.  As the elevation got higher and nighttime fell, the snow starting getting deeper so the young man pleaded with his group to turn around since he was only wearing gym shorts and thin tennis shoes. He was “outvoted” by the group twice.

At one point, this young man lost a shoe without knowing it (due to numb feet) and hiked at least a half mile in his sock. He took his shoes off (with pliers) twice – once to rub his feet and once to warm by a fire. The socks were beaded with ice crystals the entire time. When he finally made it home, he rewarmed again in the shower, but both of his shins had lost an entire layer of skin from being scraped against frozen snow. After a fair amount of coercion, his friends took him to find a doctor, eventually ending up in the InstaCare only minutes before it closed.  

In addition to horrible-looking shin abrasions, the patient had early signs of frostbite – swelling of the toes with purple discoloration of the tips. In the left foot, this extended along the entire sole of his foot to the heel with no feeling in these areas. Having seen frostbite on multiple occasions, usually after the patient waited 24 hours or more when the damage is set, I was pleased he had come in early. We immediately started him on a blood thinning agent to help improve flow and initiated hyperbaric oxygen therapy. This is an investigational use for hyperbaric medicine. But with no better options for treatment, it was our best chance to try and save his toes.  

Frostbite starts with freezing of the skin and then progresses to deeper tissues like muscles and bone as it worsens. The blood vessels are damaged in the earliest stages, causing a diminished flow of oxygen to the affected area, thereby increasing damage from freezing. Lack of blood flow and oxygen also inhibits the body’s natural repair mechanisms, which utilizes oxygen. 

Since hyperbaric oxygen therapy has a well-documented, scientific evidence base for healing wounds affected by diminished blood flow, it makes sense that it will treat some of the damaging effects of frostbite and limit further tissue injury. Hyperbaric treatment delivers oxygen in such high concentrations it’s able to bypass the obstructed vessels to prevent further damage to deeper structures while promoting early repair mechanisms as long as the tissue destruction is not complete.

Although the young man lost a deep layer of skin from his shins, we were very successful in saving his toes from further frostbite damage. After five days of twice daily treatments, he began to recover feeling and color to the toes, ultimately without any skin loss.

In addition to possible treatment options for frostbite, there are several other lessons to be learned from this story:

1. Even with mild temperatures, it’s always unsafe to be caught outdoors without adequate winter clothing. More deaths from hypothermia occur in the 50-60 degree range than lower temperatures.
2. When doing activities in a group, decisions should be made in favor of protecting the most susceptible individual. Majority rules should not apply when one member is at risk. 
3. Early treatment is always better. If this young man had waited until Monday as his friends suggested, he would have lost at least one full toe, the tips of several others and likely the sole of his left foot.  The signs of frostbite are usually subtle in appearance in the early stages. When the toes turn dark or even black, it’s too late to save them.