Chilblains: The Cold Weather Red Toes

As anyone who has ever made the mistake of walking outside without shoes on a cold winter day well knows — cold toes are no fun. However, for some people, the cold can be far more than just a little uncomfortable for their toes and feet.

Chilblains (sometimes called “pernio” or “perniosis”) is an unpleasant reaction of the toes (and sometimes, fingers, tips of ears, or cheeks) to sudden exposure to cold temperatures.

This phenomenon is characterized by uncomfortable swelling, red and blue discoloration, puffiness, and often aching or itching in the affected area.

What are Chilblains

As we mentioned above, chilblains are characterized by extra uncomfortable swelling and agitation of your digits during cold weather.

This abnormal response to cold, damp weather should not be confused with frostbite, an injury that occurs when the skin and surrounding tissues freeze, which is an entirely different ailment brought about by extremely cold temperatures.

Chilblains are caused by the blood vessels in the affected region (in this case – the toes) mishandling the sensation of cold and humidity even if those temperatures are significantly below freezing.

When exposed to cold, the blood vessels in your toes are naturally inclined to constrict. However, in the case of chilblains, these toe blood vessels may constrict to the point of damaging themselves.

If these constricted vessels are warmed too quickly, they may leak blood into the tissues surrounding them and cause the redness and swelling of chilblains.

Both the damaged blood vessels and the leaked blood contribute to that itchy, achy, swollen sensation associated with chilblains.

In certain severe cases of chilblains, the toes may even blister, bleed, or become infected. As you may well imagine, this makes chilblains an uncomfortable condition to overcome on the feet, especially as wearing shoes may further agitate the area.

This condition is a more centralized version of a condition known as vasculitis (inflammation of the blood vessels).

Because it is directly associated with the blood vessels, people who have underlying conditions involving the vascular system are more likely to experience chilblains.

Conditions that May Cause Chilblains

For reasons that doctors and scientists are still not sure of, chilblains are more likely to occur in women in and in children regardless of underlying health issues.

This means that it is especially important for parents to keep their children’s feet well bundled up in the cold weather months.

Certain medical conditions not associated with age or gender contribute to the likelihood of chilblains as well. Conditions primarily associated with blood vessel abnormalities like Raynaud’s Syndrome, diabetes, or certain heart conditions are most likely to result in associated chilblains outbreaks on the toes or fingers.

Raynaud’s Syndrome is an especially likely culprit because it is a disease that affects the blood vessels by essentially causing people to experience chilblains as a result of cold or even stressful situations.

People who suffer from diabetes generally have a likelihood of poor circulation as a result of higher-than-normal glucose levels. This can make diabetics notably susceptible to chilblains and may make their recovery from severe bouts of chilblains much slower than other non-diabetic folks.

Other lifestyle factors may contribute to the likelihood of wintertime chilblains as well. Those who smoke are likely to have blood circulation abnormalities that increase the probability of chilblains.

People who are anorexic (or even those who just generally have a lower BMI) are at more of a risk for the cold weather ailment as well.

Oddly enough, if you find that you do not have Raynaud’s or a history of frequent chilblains and are coming down with chilblain-like markers even when it may not be cold out, you will want to consult a doctor about being tested for COVID-19.

"COVID toe" is a phenomenon that has been widely reported in patients who have tested positive for COVID-19 where chilblain-like swelling occurs in the toes as a result of the virus attacking the blood vessels in these digits.

COVID toes can appear before, after, or during active infection by the coronavirus, and it is not clear whether or not those who have come down with COVID toes will all produce antibodies for the virus.

This bizarre symptom of the coronavirus is often present in very mild forms of the illness, so it is imperative that you seek out the advice of a doctor if you are concerned that your chilblains may be symptomatic of COVID-19.

How to Prevent Chilblains

The best thing you can do to avoid chilblains on your toes is to make sure that your feet are properly swaddled when going out in the cold — especially if you know that you are someone who is more susceptible to the condition.

This means layering up with thick socks and well-insulated shoes in the cold weather months. You may even want to throw your socks in the dryer before putting them on or invest in a boot warmer, or some toe warmers to keep in your shoes while you are out in the cold.

Be sure if you choose to use chemical toe warmers that you follow all safety procedures outlined on their packaging or else you may run the risk of giving yourself a chemical burn.

No matter how you manage it, keeping those toes warm will prevent their blood vessels from being damaged by the cold and by any sudden warming.

If you do happen to get your toes cold to the point of chilblains, be sure that you warm them gradually. Do not go sticking those nobby little icicles right up by the heater at the first chance. Warming your toes too rapidly will likely result in more significant swelling and aching.

You should also avoid rubbing or massaging your toes after coming in from the cold. This is especially true if you experience lesions in association with your chilblains. If these lesions are agitated they may result in ulcers.

Not only will rapidly heating your toes and rubbing at them result in a worsening of your chilblains, but they are also not going to be comfortable sensations. If you are warming your chilblains too quickly, you may feel the affected area start to burn, sting, or tingle uncomfortably.

Exercise is also an important part of helping to ward off chilblains of the toes. Though this is not a foolproof cure for chilblains, living an active lifestyle can help your body circulate blood more effectively.

Additionally, being active when you find yourself out in the cold can help to prevent your blood vessels from squeezing up and causing chilblains.

So if you find your toes are cold, get them to wiggling!

People who find themselves routinely coming down with chilblains should also avoid partaking in habits that do further damage to their circulatory system such as smoking or excessive alcohol consumption, as this can worsen the condition.

How to Treat Chilblains

If you do happen to get a bout of chilblains, the first signs and symptoms of their unpleasant effects should be present within twelve to twenty-four hours after exposure to the damp or cold.

Nevertheless, rest assured that the condition usually rights itself within a couple of weeks and your toes should go back to normal afterward (unless of course, you have scratched them to the point of infection).

However, you can do a few simple things to help your toes on their way to recovery and to ease the discomfort of chilblains while they are running their course.

Perhaps the most important thing you can do is to avoid scratching at or rubbing the affected area. Though it may be tempting, scratching at these swollen areas or rubbing against something may cause the sensitive skin to break.

If the skin breaks, and you continue to scratch with dirty nails or go barefoot, you greatly increase your risk of introducing an infection into your already suffering toes.

An infection in this already damaged area will take significantly longer to clear up because of the already weakened blood vessels and will undoubtedly make matters much more uncomfortable than the itchiness from before.

If you find that you cannot ignore the itch and ache, a topical cortisone cream may be a useful solution for taking the edge off and reducing redness as well.

While your toes are healing be sure to keep those puppies as warm and dry as possible! Protect your feet against anymore unpleasant temperature changes with cozy socks, slippers, and warm blankets.

However, do not get your toes too warm as this may result in sweating which could cause the condition to worsen.

If you find that your chilblains are not going away on their own, are continuing to worsen in condition, or have developed into open wounds or pustules, you will need to consult a qualified medical podiatrist or general care doctor.

Certain extreme cases of chilblains require the application of prescription medications or topical ointments to prevent more severe issues from occurring. These cases may also be emblematic of an underlying blood vessel disorder that should be investigated by a doctor.

Unfortunately for those who suffer from regular chilblains, there are not a lot of definitively effective medications that put a complete stop to the issue. Most medicines simply reduce the symptoms of chilblains.

For an evaluation at Triad Foot & Ankle Center, click here to make an appointment or call 336-375-6990.