Copyright 2007 American Academy of Orthopaedic Surgeons
Frostbite

It's fine if Jack Frost nips at your nose this winter, but be careful that you don't leave your fingers or toes exposed too long to wintry blasts.

It takes only minutes for exposed skin to become frostbitten if the temperature is below 20 F and the wind is blowing at 20 mph or more.

How Does Frostbite Occur?

When you're out in the cold, your body's first priority is to maintain its core temperature. To do that, it shifts blood away from the extremities and toward the central organs of the heart and lungs. This increases the risk of local cold injury such as frostbite to your arms and legs.

Body tissues actually freeze when they are frostbitten. Ice crystals form in the cell, causing physical damage and permanent changes in cell chemistry. When the ice thaws, additional changes occur and may result in cell death.

If just the skin surface is affected, it's known as superficial frostbite; deep frostbite affects underlying tissues.

Prevention

Who is at Risk?

  • Anyone who is not dressed properly for the weather, is out in the cold for too long, or gets wet as well as cold. The elderly and the young are particularly susceptible.
  • People with circulation problems, including diabetics and people with atherosclerosis.
  • Anyone who has had a previous injury caused by cold.
  • People who take certain drugs such as alcohol, nicotine, or beta-blockers, which decrease the flow of blood to the skin.
Avoiding Frostbite

It is easier to prevent frostbite than to treat it. If you must go out in bitter cold, be prepared.

Here are five common sense precautions to ensure that your winter outings end safely.

  1. Dress appropriately.
    Light, loose, layered clothing provides both ventilation and insulation. Top your outfit with a water-repellent (not waterproof) fabric.
  2. Protect your head, hands and feet.
    Substantial heat loss occurs through the scalp, so head coverings are vital. Mittens are warmer than gloves, and two pair of socks (wool over lightweight cotton) will help keep your feet warm.
  3. Don't drink or smoke before going out into the cold.
    If you plan on being out in the cold for a prolonged period, don't drink or smoke. Alcohol, caffeine and nicotine leave the skin more prone to thermal injury.
  4. If you get wet, get inside!
    Remove wet clothing as quickly as possible.
  5. Check yourself every half-hour or so for signs of frostbite. If your toes, fingers, ears or other body parts feel numb, get inside.
Symptoms
  • The affected area becomes numb; the individual may complain of a loss of feeling.
  • The skin may feel frozen, but deeper tissues are soft (superficial frostbite) or the entire affected area feels solid, hard, and frozen (deep frostbite).
  • Skin appears waxy, white, or grayish.
Treatment

Frostbite can be a very serious cold injury. Seek medical care promptly if you suspect frostbite has occurred. In addition, people with frostbite also frequently develop hypothermia, which requires emergency medical assistance. If medical care is not readily available, follow these "do's and don'ts" for first aid for frostbite:

The "DOs"

  • DO get the person into a warm room as soon as possible.
  • Call for medical assistance. You can also give the person warm drinks, such as broth or tea.
  • DO rest the injured areas
  • Avoid walking on frostbitten feet, for example, and elevate them slightly.
  • DO take off any wet or restrictive clothing.
  • DO warm the area
  • Immerse the area in warm water (NOT HOT water) for at least 30 to 45 minutes, or until the affected part feels warm and sensation returns. During warming, the patient may complain of severe pain and the injured area may swell and change color.

The "DO NOTs"

  • DO NOT do anything that will further injure the tissue.
  • Leave blisters intact, and cover them with a sterile or clean cloth.
  • DO NOT rub the area with your hands, with snow, or with anything else.
  • DO NOT start to warm the affected area if there is any chance that it will be exposed to the cold again.
  • DO NOT use dry heat, such as from a heating pad, sunlamp, fire, or radiator, to try to warm the area.
  • Because the skin is numb and will not feel the heat, it can easily be burned by dry heat.
Last reviewed: July 2007

Reviewed by members of POSNA (Pediatric Orthopaedic Society of North America)

AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS "Find an Orthopaedist" program on this website.
Copyright 2007 American Academy of Orthopaedic Surgeons
OrthoInfo
The American Academy of Orthopaedic Surgeons
6300 N. River Road
Rosemont, IL 60018
Phone: 847.823.7186
Email: orthoinfo@aaos.org

Was this article helpful?

HELP US IMPROVE OUR WEBSITE. PLEASE FILL OUT THIS quick survey