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The expansion of water as it turns to ice is an impressive natural force. Frost action crumbles mountain ranges, cracks engine blocks, and heaves roads. When freezing occurs in your fingers and toes we call it frostbite, and the effects are no less impressive. This common injury must be taken seriously, both in prevention and in cure.

Frostbite is usually associated with extreme cold, but it can occur anytime temperatures are below freezing, especially if the wind is blowing. Skin will freeze just as fast at 20 degrees in a strong breeze as it will at 30 below zero in still air. That's what the wind chill charts are telling you.

Severe damage can result with prolonged or very deep freezing. Much of the damage occurs during and after re-warming. Re-warmed tissue is very sensitive to further injury, even from normal use. Re-freezing is devastating. .

The very early stage of freezing is called "frostnip", which is the loss of blood flow in the superficial layers of the skin. The area will appear white or gray (pink or red in dark skinned people) and feel cold and stiff to the touch. However, the area will remain pliable enough to allow movement over unfrozen deeper layers, joints, and tendons. The typical discomfort of early cooling will be replaced by numbness. Frostnip should be immediately re-warmed since it can easily progress to frostbite. The people who get into trouble with frostbite are the ones who ignore the first signs of frostnip.

Superficial Frostbite is next in line as the skin actually freezes. The area will appear white or light blue, or deep red in dark skinned people, and be completely numb. However, at this stage, the subcutaneous tissue is still soft and tendon and joint function is unimpaired. Superficial frostbite should be rewarmed immediately in spite of the moderately annoying pain that comes with it. Once rewarmed, superficial frostbite may leave red and swollen skin and shallow blisters. It is vital to protect the damaged area from further trauma and reduce the probability of infection. Walking or skiing on re-warmed feet can make the injury much more severe.

Deep Frostbite occurs when the skin and underlying tissues and bone are frozen solid. The area is white or blueish and firm to touch. Skin does not move over joints or underlying tissues. Ice crystals are usually visible on the skin surface. There is a complete loss of sensation. The digit or extremity feels like a club. Re-warming is extremely painful and can cause further damage if not done properly. Deep frostbite is best transferred for re-warming under controlled conditions in a hospital. Pain will be severe, and the chances of further damage from trauma and infection are high. Surgery is often required to remove dead tissue. Healing will take months.

People who experience frostbite for the first time generally take it too lightly, especially when it interferes with great skiing, training schedules, and races. Unfortunately, frostbite can be a crippling injury with life-long consequences. It is well worth avoiding.

Jeff Isaac, PA-C

12 Snowmass Rd, Mt. Crested Butte, CO 81225

Clinic: 970-349-0321

Hospital: 970-641-1456