Cold injuries of the toes and feet usually occur in winter when the cold temperature combines with slightly moist skin to create injury. Cold weather injuries may consist of Frostbite or the less severe but still painful Chilblains.
Chilblains is actually an abnormal reaction by the very small blood vessels in the skin, commonly in the toes but also in the hands or legs. An extended period of time outside , which results in chilling of the skin, causes the small blood vessels to constrict. In the case of feet, when the toes and feet are then warmed, the small vessels do not relax quickly enough for the influx of blood from larger warmed and thus vasodilated vessels and instead of the blood flowing into the small blood vessels, it leaks into the skin. It may take several hours for the skin changes to be observed and often the changes appear as a deep blister. Later, it may become darkened with blood. Usually there are small patches of dark red, purplish skin on swollen toes which may have intense itching or burning associated with them. These damaged patches of skin sometimes ulcerate creating the additional concern for possible infection.
This condition is more commonly seen in slim young, woman and in certain at risk populations including:
-Smokers (due to nicotine induced vasoconstriction)
-Persons with peripheral arterial disease (diminished blood flow to extremities)
-Persons with a family history of Chilblains
-Persons with certain autoimmune diseases including Lupus
-Persons with Raynaud’s disease or phenomenon
- Persons with diabetes (due to peripheral neuropathy causing inability to feel the cold and /or PAD)
Treatment of Chilblains may consist of topical steroid creams, oral medicines (for persons with chronic Chilblains) which help to vasodilate the small blood vessels, and antibiotic ointment for any areas of skin which become open.
The goal is to prevent cold injury by keeping the extremities warm and dry using mittens, socks and appropriately fitting water resistant foot gear. Avoiding Chilblains is the best treatment!