January 11, 2019

Bundle Up: Don’t Get Frostbite – Keep Your Body Warm during Winter Activities

bundle up - stay warm during winter activities frostbiteBy Aaron Vaughan, MD

Winter is here with the temperatures to prove it. Whether you’re an athlete and have a fitness regimen to keep up, you’re walking the dog or going ice skating, take note of important precautions to take when going outside for periods of time. Athletes need to be especially aware of the risks and benefits of exercising in the cold, and the potential for frostbite.

The body attempts to maintain its temperature in a variety of ways to permit exercise, despite the freezing temperatures. If the body loses its ability to maintain its peripheral and core body temperature, it can lead to frostbite.

Frostbite is an injury that can occur following prolonged exposure to temperatures below freezing (below 0 degrees C or 32 degrees F). Cold-related injuries can fall on the spectrum of mild, to severe and deep injuries with a range of symptoms and treatments for each.

Common signs and symptoms of a mild cold-related injury are:

  • “Burning pain” or numbness of the effected body part
  • Pale-appearing skin
  • Blistering of skin

Moderate to severe cold-related injury signs and symptoms are:

  • Dry gangrene, which is the death of body tissue due to either a lack of blood flow or a serious bacterial infection
  • Mental status changes such as confusion, lack of coordination or irritability

Cold illness treatments are determined by how deep the freezing has occurred.

Superficial frostbite involves the outer layers of the skin and can be treated by local thawing and reacclimation of tissues. Affected areas should be gradually exposed to warmer parts of the body, like the chest or abdominal areas, or immersed in warm water for about one hour. Following warm water immersion, the affected areas should be kept dry and warm with towels or blankets. Rubbing affected areas may cause loss of outer layers of skin so avoid

Severe frostbite involves deeper layers of the skin, muscle or bone. Consider the following for treating severe, deep cold injuries:

  • When in doubt, consider rapid rewarming in a hospital setting
  • Pain medications
  • Treat wounds/blisters; consider aloe for skin hydration
  • Avoid rewarming by a fire or radiator as skin burns may occur
  • Update tetanus immunization
  • IV medications may be needed for deep frostbite

Due to the severity of damage, rapid rewarming is essential and may require hospitalization. Rapid rewarming is best accomplished by putting the affected area in a hot bath (39-41 degrees C or 102-106 degrees F). If blisters are present, consider removing blisters or treating superficial wounds.

The key to frostbite and cold injuries is prevention.

Don’t forget that it’s not unsafe to play or exercise in cold weather, but know the risks and make sure to prepare! Keep in mind:

  • Well-fitted and layered clothing including insulated base (in contact with skin) and protective outer layers (wind and moisture) are important.
  • Extremities including the head, face and hands should be covered at all times.
  • Wear wool or synthetic socks (compared to cotton), which help control excess moisture and sweat accumulation.
  • Vaseline and other topical lubricants facilitate cold and should not be considered protective.

The most commonly affected body parts and those with greatest exposure are the tips of the nose, ears and cheeks. Individuals are at more risk for cold-related injury if they use tobacco (smoke), have underlying cardiovascular disease (specifically peripheral vascular disease), a history of prior cold-related illnesses, diabetes and respiratory issues including asthma, COPD/emphysema or chronic bronchitis.

You’re at higher risk for reinjury in the weeks and months following your cold-related injury. Consult your medical provider when attempting to return to sport or activity.


Aaron Vaughan, MD, is the Director of Primary Care Sports with Mission Orthopedics and a nonoperative physician with Asheville Orthopaedics Associates. 

Athletes and weekend warriors can take advantage of the Mission Orthopedic & Sports Medicine same-day clinic located at 310 Long Shoals Rd., Suite 200, in Arden, Monday-Friday, 7:30 am – 4:30 pm, and the Concussion Clinic on Friday afternoons. To schedule an appointment, call 828-782-9330. For more information on our orthopedic services and office locations, visit missionhealth.org/orthopedics.