From Willow Bark to War Trenches: The Story of Wet Feet Disease

Wet feet disease, better known as trench foot or immersion foot, is a painful reminder of how brutally the environment can damage the human body. It is also part of a longer medical story that begins not in modern war, but on the riverbanks of Europe, where people first learned to use willow bark to relieve pain and inflammation. Over time, this humble tree led to the discovery of salicylates and eventually to modern drugs that still play a role in managing pain and inflammation in conditions like trench foot.

For centuries, healers in regions such as Brittany prepared teas and poultices from white willow (Salix alba) bark to treat fever, joint pain, and irritated skin. They did not know about salicin or biochemical pathways, but they observed that willow reduced pain and soothed inflamed tissues. People who worked in cold, wet environments—fishermen, farmers, and sailors—often came home with swollen, painful, water‑logged feet. When available, warm willow decoctions and compresses were applied to these damaged feet to relieve pain and support healing, long before there was any formal concept of “wet feet disease.”

The scientific turning point came when salicin was isolated from willow bark and recognized as the active principle responsible for its effects. This discovery paved the way for the development of salicylic acid and, later, acetylsalicylic acid (aspirin). These compounds became widely used analgesic and anti‑inflammatory drugs. Thus, a traditional Breton remedy for sore, cold‑damaged feet quietly evolved into standardized medicines that form part of the broader toolkit for treating painful inflammatory conditions, including those caused by prolonged exposure to cold and moisture.

Trench foot itself emerged as a clearly defined medical entity during World War I. Soldiers standing for days and weeks in cold, muddy trenches developed pale or mottled feet, numbness, severe pain, swelling, blisters, and sometimes open sores. The condition occurred above freezing temperatures, so it was not classic frostbite, but the damage could be just as severe. Doctors gradually understood that constant moisture, cold, pressure, and poor circulation were the key factors. Treatment focused on removing soldiers from wet trenches, drying and gently rewarming their feet, providing rest and elevation, and managing pain—often with salicylate‑based drugs that traced their origins back to willow bark.

As medical science advanced, the principles of management became clearer. The first step was always environmental: take off wet boots and socks, carefully dry the feet, and avoid rapid rewarming in very hot water, which could worsen tissue damage. Then came gradual rewarming in a dry, warm space, protection from further pressure, and close monitoring for infection. Pain control relied on modern analgesics, including non‑steroidal anti‑inflammatory drugs that share a direct chemical lineage with the old willow remedies. In more severe cases, antibiotics and even surgery were needed to manage complications such as deep infection or gangrene.

Tragically, wet feet disease is not only a historical curiosity. The modern Russian‑Ukrainian war has revived prolonged trench warfare under harsh conditions. Soldiers on both sides, and especially Ukrainian defenders in long, static trench lines, have had to endure weeks or even longer in wet, cold, muddy positions. In these “modern trenches,” the same combination of standing water, freezing mud, stress, and limited opportunities to change socks or boots has created an ideal environment for the resurgence of trench foot. This brutal continuity shows how quickly an ancient and early‑twentieth‑century problem can return when basic protective conditions are lost.

Today, we understand both the pathophysiology of wet feet disease and the chemistry of the medicines used to ease its symptoms far better than our predecessors. Yet the core lessons remain remarkably simple and old: keep feet dry and warm, allow rest, relieve pain, and prevent infection. The story, from willow bark along Breton rivers to salicylate tablets in field hospitals and the muddy trenches of modern Eastern Europe, reminds us that even high‑tech warfare cannot erase the basic biological needs of the human body—or the enduring value of insights first drawn from a tree growing beside cold, wet water.

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