Each year numerous frostbite threads appear on BYC where individuals seek information and advice. In most cases the frostbite is to the comb, the injury is minor to moderate, and the bird heals without any special treatment or extra care. At worst, a straight comb with severe frostbite will become swollen and turn grayish white in color, before eventually turning black and possibly entirely losing its points, as happened to this poor guy.

20210322_143739~3.jpg


Even though his comb had severe frostbite, there was low risk of infection since his comb wasn't exposed to the soil. Other than possible damage to his pride if he could see himself in a mirror, his comb healed with no treatment and no lasting issues.

Frostbite to the toes and feet can potentially be much more serious, leaving a bird more susceptible to infection after injury and more likely to be permanently handicapped. Some choose to euthanize when they find a bird in this condition. But with a little extra attention and care, even a bird that loses both feet to frostbite can recover to live a quality life.

WHAT IS FROSTBITE?
Frostbite occurs when fluids in skin and tissue freeze and form ice crystals, causing the cells to die. In addition, frostbite causes damage to the blood vessels themselves. Blood flow is constricted and clots form. This leads to inflammation that causes further tissue damage. Frostbite injury includes both the initial freezing and rewarming as well as the resulting vascular damage.(1)

HOW DOES FROSTBITE PROGRESS?
During prolonged cold exposure, the body sends signals to the blood vessels in the extremities telling them to constrict. By slowing blood flow to the extremities, the body is able to send more blood to the heart and other vital organs. As this process continues and the extremities farthest from the heart become colder and colder, a condition called the hunting reflex is initiated. (2) The body's blood vessels are dilated for a period and then constricted. Periods of dilation and constriction are cycled to preserve as much blood supply to the extremities as possible. However, when the brain senses that the bird is in danger of hypothermia, it permanently constricts blood vessels in order to prevent them from returning cold blood to the heart.

STAGES OF FROSTBITE
1st Degree: Irritates the skin surface and causes temporary pain and numbness.
2nd Degree: Involves all skin layers. In addition to pain and numbness, blisters filled with clear fluid may form on the skin, but underlying tissue is unaffected.
3rd Degree: Involves all layers of the skin and causes permanent tissue damage. Swelling and blood-filled blisters appear. Skin color turns white or yellowish before turning purplish-blue. Skin becomes waxy in appearance. Tissue damage is permanent.
4th Degree: Skin, tissues, muscles, bones, and tendons freeze. Damage is permanent. (3)

FROSTBITE PREVENTION
Take steps to prevent frostbite rather than treating it after it occurs. The two situations that most commonly result in frostbite are drafts and moisture when the air temperature is below freezing.

Some common preventative measures include:
1) Make sure birds are not directly exposed to drafts in the coop but do ensure that a coop has adequate ventilation above the roosts. Moisture and humidity can build up quickly in a non-ventilated coop, and when the droplets adhere to non-feathered body parts, frostbite can occur.
2) Provide roosting bars wide enough that birds can cover their feet with their feathers. Two-by-fours with the four-inch side up are ideal.
3) Remove water from containers that birds can step in when the air temperature is below freezing. However, it is important to make sure birds always have access to warmed drinking water, as dehydration can make frostbite worse.
4) Provide ample dry bedding on the floor of the coop. Some options include wood shavings, wood chips, hay, straw, and dry leaves.

But sometimes despite one's best efforts, a problem occurs and a bird gets frostbite. Many times frostbite damage goes unnoticed until much later after the injury. By then it is too late to offer anything other than supportive care as the damage heals. If the injured area is too damaged to heal, the body begins a process called autoamputation.(4) This means that the body naturally separates necrotic skin, tissue, and bone from living skin, tissue, and bone with no surgery required. The process can take weeks or even months to complete.

TREATING FROSTBITE
If a bird is discovered while the body part is still frozen, the affected area should be rewarmed in warm (not hot) water. If the comb or wattles are frozen, a warm moist towel may be gently pressed onto the affected area. If the injury is to the toes or feet, a shallow pan should be provided for the bird to stand in until the area has thawed. Do Not use anything else such as a blow dryer, heating pad, etc. to rewarm the affected area, as doing so may result in further damage. (5) Also, do not rub or massage the injury, as this may also cause further damage. The thawing process will take approximately 20-30 minutes.

After the frozen area is thawed, place the bird in warm housing on clean, dry bedding such as paper towels, puppy pads, shavings, etc. The bird should not be put back out into freezing weather until the frostbite has fully healed, as doing so will likely result in further injury. (6) Offer food and water. Unflavored Pedialyte will help counteract dehydration and boost electrolytes. Alternatively, Sav-a-Chick electrolytes may be mixed into the water. The medication pentoxifylline improves blood flow, enhances tissue survival, and may prevent permanent damage. (7) Pentoxifylline must be prescribed by a veterinarian within 24-48 hours of initial frostbite injury in order to be effective. Aloe vera gently applied topically to damaged skin has a soothing and healing effect, and baby aspirin also improves vascular flow and provides pain relief.

The chicken featured in this article experienced a combination of factors that resulted in severe frostbite on her feet.
1) The air temperature was in the single digits Fahrenheit at the time of her mishap.
2) She flew up onto an unused metal broody cage to get off the snow-covered ground. Since metal is an efficient temperature conductor, the metal cage felt even colder than the air temperature.
3) When she jumped back off the cage, her spur got caught in a narrow gap, causing her to hang suspended upside down until I discovered her predicament. This was almost certainly the reason for her severe frostbite.

The remainder of this article documents the hen's severe frostbite injuries and recovery. Included are graphic photos showing the visible progression of severe frostbite damage, as well as how to treat and ways to make a bird more comfortable while healing. I knew very little about frostbite when her accident occurred. I hope this article helps others know how to treat frostbite, and I also hope that even if severe frostbite occurs, a bird keeper will be confident that the bird can be saved and eventually return to its natural activities.

Her name is Matilda. Immediately after I discovered her hanging upside down, I brought her inside and thawed her frozen feet. At this point, I had no idea if she would survive. My concern at that time was not frostbite, but fear that being suspended upside down in freezing temperatures had caused too much stress to her internal organs including her heart and lungs. But survive she did, and soon after her feet were rewarmed would have been the ideal time to take her to a vet for further treatment. The vet might have prescribed pentoxifylline, and may also have administered sub-cutaneous fluids since frostbite causes dehydration. Pain medication such as meloxicam would also have likely been prescribed because rewarmed frostbitten tissue is very painful. But if a vet is not an option, helping a bird recover from severe frostbite at home is fairly easy to do.

After rewarming her feet, I placed Matilda on clean dry shavings inside my house and offered her food and water. Her appetite was very poor for the first few days, and all she willingly ate was live mealworms. If a bird refuses to eat or drink anything at all, tube feeding may be needed the first few days after the initial frostbite.

original_01f3c35d-40b3-4ab7-925a-4d16fd9b5b84_20210227_152624~3.jpg


TWO DAYS AFTER FROSTBITE
Swelling and red blisters appeared. Blood-filled red blisters signify more severe frostbite than blisters filled with clear fluid. Blisters should never be popped as they help protect damaged tissue, and popping them may expose the tissue to infection. At this early stage, there was little skin discoloration other than the red blisters. Beneficial therapeutic home treatments include warm Epsom salt soaks to provide pain relief and draw out any infection. Aloe vera gel gently applied to the skin and baby aspirin also provide pain relief and help frostbitten skin heal. The chance of infection is low as long as the area is kept clean and dry, but triple antibiotic ointment without painkiller, Vetericyn antimicrobial spray, or other topical antibacterials may be gently applied to the affected area. I made sure to keep Matilda's bedding clean and dry but left her injured feet uncovered and unwrapped for the next several weeks.

20210222_125434.jpg


EIGHT DAYS AFTER FROSTBITE
Her toes were very swollen, and her skin color turned shades of yellow and purplish-blue, signifying severe frostbite. Continue with therapeutic warm Epsom salts soaks, topical aloe vera gel and antibacterial medication, and baby aspirin.

original_904c8b04-64e9-4a95-bab7-b8953ff04a23_20210227_150857~2.jpg


TEN DAYS AFTER FROSTBITE
Her skin was now very waxy in appearance. Waxy-appearing skin is an additional sign of severe frostbite injury. Continue with therapeutic treatments.

original_85ee0ea9-30d8-4e86-858d-a1a0e881d0de_20210301_170645.jpg


By this point, if not before, it is helpful to provide a sling for a bird to comfortably rest in for a few hours each day, especially if the bird is mostly sedentary. This will help prevent pressure sores from developing, as well as ease boredom by giving the bird a different view in a more normal upright position.

20210402_100227.jpg


TWO WEEKS AFTER FROSTBITE
The left foot was showing severe damage. The toes on the right foot were swollen and darkened, but I had hoped her right foot would heal. I continued with daily therapeutic treatments.

original_b28edda6-5857-4d7a-8f15-a28e3dc16709_20210308_124958.jpg


If outside temperatures are well above freezing and the ground is dry, a bird recovering from severe frostbite will benefit from being outside to soak up some sun and have supervised interaction with other flock members.

original_af0a7bfe-be7a-45bc-b258-27d7fa2cdeb0_20210517_180056.jpg


If the bird has a calm and trusting temperament, interaction with its human caregiver may be the best therapy of all. Here Matilda has comfortably fallen asleep in my lap.

20210407_112544.jpg


THREE WEEKS AFTER FROSTBITE
Around this time is often when a bird owner first notices severe frostbite damage. Matilda's left foot was now rigid, blackened, and dead. The line of demarcation (necrotic blackened tissue separated by healthy living tissue) was now visibly obvious. Necrotic tissue protects the remaining viable tissue, but it is still important to keep injured areas clean and dry. A topical antibacterial should be applied at the line of demarcation to protect viable tissue from infection risk.

20210313_105958~2.jpg


I continued with daily therapeutic treatments including warm Epsom salt soaks because I still had hope the right foot could heal. To clarify, it is ok for the frostbitten areas to get wet while soaking in medicated water. Just make sure the area is clean, dry, and topically medicated before placing the bird back into its housing.

20210416_112310.jpg


FOUR WEEKS AFTER FROSTBITE
As shown from underneath, the left foot pad was completely necrotic.

original_492548eb-fda7-48b6-94ee-58c53c4714c6_20210321_105629~2.jpg


While the right foot pad showed a hint of healthy pink skin.

original_6afcc549-5303-4966-a210-60df6d4c6ae7_20210321_105640.jpg


FIVE WEEKS AFTER FROSTBITE
The swelling was now visible at the line of demarcation on the left foot, signifying that the autoamputation process was nearing completion and preparing to separate.

original_51cb3f20-581f-4269-8ab3-846c532ac445_20210327_125557~2.jpg


SIX WEEKS AFTER FROSTBITE
Swelling on the left foot at the line of demarcation was even more pronounced.

20210402_093933~4.jpg


Meanwhile, the right foot pad continued to heal.

20210402_104204.jpg


TWO DAYS LATER
The necrotic left foot autoamputated from living tissue. This very graphic photo shows the exact moment the dead foot began to separate. Separation is not usually this bloody, but in this case, an inner core of viable tissue remained after surrounding necrotic tissue and bones had internally autoamputated.

original_6fd3a94e-15af-4df5-aa04-8a46e8efa0da_20210404_094107.jpg


Autoamputation was completed ten minutes later. Here is the inside of the separated left foot.

20210404_112201~2.jpg


At that time I generously medicated the remaining stump with triple antibiotic ointment and Vetericyn spray, then covered it with non-stick gauze. I then very loosely secured the gauze with Vetwrap to keep it in place.

TWO DAYS AFTER THE LEFT FOOT AUTOAMPUTATED
As gory as the remaining viable tissue appeared at the moment of separation, less than 48 hours later the stump was well on its way to healing. From this point on I left the stump uncovered while it healed, making sure to keep it clean, dry, and topically medicated. I also continued with baby aspirin and Epsom salt soaks.

20210406_165656.jpg


Meanwhile, as Matilda's left stump healed, her right foot stubbornly held on. Fragile pink smooth skin remained on the top of her foot after frostbitten scales sloughed off, giving me hope that more of her right foot would also heal.

original_67a139d9-ae99-414f-845c-272b1e1afb8d_20210417_175454.jpg


The length of time involved in the autoamputation process varies according to each individual frostbite injury, sometimes extremely so. Matilda's left foot completed autoamputation six weeks after frostbite. But her right foot was in no hurry to leave.

TWO AND A HALF WEEKS AFTER THE LEFT FOOT AUTOAMPUTATED
Matilda's right foot pad swelled up so much that the necrotic toes no longer made contact with the ground.

20210420_205903~3.jpg

20210421_124304~2.jpg

20210420_210422~2.jpg


At the time I thought the immense swelling meant that her right foot would soon autoamputate too. Especially since an obvious line of demarcation soon appeared separating the healthy foot pad from necrotic toes and the top of the foot.

20210429_155102~2.jpg


THREE WEEKS AFTER THE LEFT FOOT AUTOAMPUTATED
The left stump continued to heal. The part that extends out forward from the rest of her shank is the tissue that was so bloody at the time of separation. The darker part on her inner shank is her receding spur. Both spurs extended from viable tissue, and neither was necrotic. Yet both began to slowly "absorb" her frostbite injuries until they were almost completely gone. It was very peculiar, and I haven't found an answer as to why they did that.

20210429_155027~2.jpg


Here is a front view of her healing left stump showing the disappearing spur.

original_d86a6e02-567d-422d-bb0b-7c949f097f1b_20210502_121649~2.jpg


FIVE WEEKS AFTER THE LEFT FOOT AUTOAMPUTATED
The stump continued to heal.

original_a7ea2380-59d2-4e75-b51a-57c380bfb6a8_20210509_140431.jpg


But still, the right foot held on. By this time I seriously began to question if it would ever come off. Matilda seemed long past ready to be rid of the useless appendage too.

original_e2bb59bb-20c9-4fad-bada-3323fd3fb416_20210517_174943.jpg


SEVEN WEEKS AFTER THE LEFT FOOT AUTOAMPUTATED
Finally, thirteen weeks after Matilda's mishap led to severe frostbite injuries, the top of her right foot began to visibly change. The necrotic surface began to slough off, revealing more necrotic tissue underneath.

original_4a40a5b3-7252-41a3-bde5-de63a64c69e6_20210523_133216.jpg


The next day the top of the right foot began to rotate and separate from live tissue.

original_a3bb8d1e-9e2a-4897-beaf-2417ed1f89c1_20210524_135432.jpg


And the day after that, the right foot finally came off. Here was the exact moment of separation.

20210525_140417.jpg


There was no blood this time, but the remaining stump as viewed from above looked oddly hollow. And the necrotic foot smelled horrible. At first I feared the live tissue had become infected and was the reason for the foul odor. (There was no odor until the foot came off. Before then, any foul odor would have signified serious and potentially deadly gangrene infection.) Dead body parts are obviously not meant to hang on for thirteen weeks. But the frostbite injury on Matilda's right foot was very unusual, and so it took much longer to complete the autoamputation process.

I generously coated the remaining right stump with triple antibiotic ointment and Vetericyn spray, then covered it with non-stick gauze and loosely wrapped it with Vetwrap. The remaining exposed surface area on her right stump was much larger than the left stump had been, so I kept the right stump loosely covered for about two weeks after the foot came off. I also continued with Epsom salt soaks since I didn't want to risk any chance of infection.

20210528_192358.jpg


Almost immediately after the right foot detached, Matilda became more active than she had been since her frostbite occurred. She literally stood and walked within an hour after the foot was gone. I was then advised not to let her become active until the wound had a few days to heal. And it did begin to heal quickly.

FIVE DAYS AFTER THE RIGHT FOOT AUTOAMPUTATED
Five days later, the right stump looked like this.

original_e32c43d5-5389-4798-8266-2bde3bdcf78a_20210530_121806.jpg


TWO WEEKS AFTER RIGHT FOOT AUTOAMPUTATED
Matilda resumed laying eggs. She laid three eggs in four days and showed signs of going broody. I contemplated letting her hatch and raise chicks, since she had been a supreme broody hen before her accident. I thought raising chicks would give her something to focus on, and also mean that she was truly recovering from her injuries. But her stumps still needed time to heal, so I removed each egg soon after she laid it.
20210610_132757.jpg


FOUR WEEKS AFTER THE RIGHT FOOT AUTOAMPUTATED
Matilda had healed enough to resume dust-bathing. I wrapped both stumps beforehand so they would stay clean, then unwrapped and medicated each stump afterward while they continued to heal.

original_3fddd337-d161-474b-b09f-4e73be20e7e3_20210620_092647.jpg

original_baf883ce-3483-41e1-9114-c10fc3cd5503_20210705_110207~2.jpg


Matilda also resumed enjoying fresh vegetables from the garden.

original_c95cda58-6345-4e31-a2a9-60b9d8158e78_20210731_103325.jpg


And in general spending time with her flock.

original_9201cd8a-10c0-4c83-ba9b-0148cae687a1_20210704_124456~2.jpg


TWENTY-FIVE WEEKS AFTER FROSTBITE
Her stumps looked like this.

Left
original_733b0ace-34fb-4193-8a85-e14e4fd2eae1_20210812_100724.jpg


Right
original_ae230ba3-cd74-4a00-add8-5301424ecaf5_20210812_100813.jpg


Both stumps were now essentially healed, though the fleshy tissue protrusion on the left stump and the new skin covering her right foot pad were still fragile. I now kept both stumps permanently padded and wrapped, except for once weekly unwrapping, examining, medicating, and re-wrapping them. Matilda was now spending most days outside with her flock. I continued bringing her inside each night, mainly because we had both grown accustomed to her being inside my house.

A few months later, Matilda had a temporary setback that was minor but could have become more serious if I had not noticed the problem. Though I examined her stumps weekly and they always looked fine, I was only viewing them from the top and side views. One day I happened to see them from underneath while holding Matilda and facing a mirror. I saw that both stumps had developed pressure sores on the areas of each stump where she bore her weight when she stood and walked. The left stump actually had a small plug I extracted, exactly the same as when performing bumblefoot surgery.

20220102_140232~4.jpg


This taught me to always examine her stumps from every angle, and there have been no more issues. I also realized her stumps weren't padded enough, which caused the pressure sores in the first place. I continued to pad and wrap them exactly the same as while they were healing. But after they healed and Matilda became more active, both stumps needed more cushion and padding. I asked for ideas for better padding on Matilda's thread and received many helpful suggestions. Though I didn't need to use them all for Matilda, I believe that all the ideas can be of use to other birds that need more padding and cushion.

Matilda's frostbite led to severe injuries that left her permanently handicapped. But she recovered, and she is not the only bird that has successfully done so. Along with her thread link, here are some other threads where birds lost their feet but recovered to resume the activities and lives of a normal chicken.
https://www.backyardchickens.com/threads/matilda-is-going-to-lose-her-feet.1454933/

https://www.backyardchickens.com/threads/help-i-don’t-want-her-to-lose-her-leg.1513145/#post-25456540

https://www.backyardchickens.com/threads/frostbite-lost-both-feet-my-hens-story.1343701/

As for Matilda, I now consider her my chicken with benefits. Most days she spends time outside with other chickens, while at night she sleeps comfortably inside my house. For the care I provided her, Matilda has repaid me in full. She has become every bit as cuddly as a sweet puppy or kitten, cozying up next to me whenever I read, rest, and relax in my chair.

20220122_140503~2.jpg


ACKNOWLEDGMENT
My heartfelt thank you to all who offered words of helpful advice and emotional support on Matilda's thread. You helped me to better care for her as she healed, and I feel certain that if Matilda knew how many supported her during her journey, she would gratefully thank you all too.

REFERENCES
1. Stoppler, MD, Melissa Conrad. Frostbite. 7/29/2022
2. Wellehan DVM MS, James. Frostbite in birds: pathophysiology and treatment. October 2003
3. Bassit H, Wallen TJ, Dudley C. Frostbite. June 27, 2022
4. Kaushik, Robin. Spontaneous auto-amputation of the foot in case of diabetes, atherosclerosis, and gangrene. September 2002
5. Jacobs, Dr. Jacquie. Frostbite in chickens. Poultry Extension
6. Frostbite. Poultry DVM
7. Miller, MD MB, KoltaI, MD RJ. Treatment of experimental frostbite with pentoxifylline and aloe vera cream. June 1995