What is it?
Frostbite is an injury that can occur after prolonged exposure to below freezing temperatures (< 0° C or 32° F). The most commonly affected body parts are the fingers and toes, although the tips of the nose, ears, and cheeks can be affected as well.

Symptoms
Symptoms of frostbite depend on the severity of the injury. The most common symptoms of frostbite are “burning” pain or numbness of the affected body part, pale appearing skin, and possibly blistering of the skin.

Sports Medicine Evaluation
An evaluation for frostbite begins with an examination of the affected area. This should be done in a location protected from the cold, which would preferably be in a clinic. Cold or wet clothing should be removed immediately once protected. The physician will take note of the appearance of the overlying affected skin, as well as assess for blood flow and sensation in the affected location.

Sports Medicine Treatment
There are different types of frostbite, which are determined by how deep the freezing has occurred, and will affect the level of treatment needed. Superficial frostbite involves the outermost layers of the skin, and it may be treated by local thawing of the affected area by direct contact with a warmer part of the body or more preferably by immersion in warm water. This should be followed by keeping the affected area dry and warm with towels or blankets. This may take up to hour. Rubbing the affected area is not advised as it can cause sloughing, or a loss of outer layers of skin. More severe frostbite involving the deeper layers of the skin, underlying muscle, or bone requires more rapid re-warming, and it may require admission to a hospital to be best treated. Rapid re-warming is best accomplished by putting the affected area in a hot water bath (39-41° C or 102-106 ° F). It is often painful and it may require pain medications during the process. Re-warming by heat from a fire or radiator is not recommended as skin burns can occur. If blisters are present, the physician may debride (scrape) the blisters or leave them alone. Anti-inflammatory medications and aloe, as well as a tetanus shot, may be recommended. Intravenous medications may be used for severe deep frostbite.

Injury Prevention
Frostbite injuries are preventable. Adequate planning for outdoor activity in the cold is the most important step in injury prevention. Well-fitted, layered clothing, including insulated inner layers and protective outer layers (providing protection from the wind, rain, and snow) is recommended. Extremities, such as the head, face, and hands should be covered. Wool or synthetic socks are preferred to cotton. Vaseline and other topical creams do not prevent frostbite and should not be used in this manner.

Return to Play
Return to play should be overseen by a sports medicine physician and may take several weeks or months depending on the severity of the injury. A player should not return to play the same day after thawing, especially if there is a chance of re-freezing.

AMSSM Member Authors
Mark Kasmer, MD, Matt Gammons, MD

References
Brukner P, Khan K. Brukner & Khan’s Clinical Sports Medicine. 4th Edition. Australia: McGraw-Hill Education; 2012.

Zafren K. Frostbite: prevention and initial management. High Alt Med Biol [Internet]. 2013 Mar [cited 2014 Dec 31];14(1):9–12. Available from
http://www.ncbi.nlm.nih.gov/pubmed/23537254