blue feet and toes

by Brian D.
(San Diego, CA)

Hello and thank you in advance for taking the time to listen.

I am going to try and be as specific and brief as possible. This is for my wife, whose feet have been extremely blue and purple around the sides of and on the bottoms of her feet. Her toes are also purple all over even underneath her nail beds. We have been to our PCP, a vascular surgeon and even the ER. No one as of yet has been able to give us a definitive answer.
We discovered the discoloration 5 days ago and at the time, there was no pain involved. On the third night, the pinky toe on her left foot started causing her minor pain. Since then, that same toe has become excruciatingly painful to the point where 1000mg of Vicodin (prescribed by a Dr.) barely helps. The pain is intermittent and occurs up to 2 times/hour and lasts up to 4-7 minutes.
Background: My wife is 28 years old 2 and 1/2 months post-partum with our first child. She spiked a fever during labor and was given antibiotics, other than that there were no other complications. 2 weeks ago she was diagnosed with ulcerative colitis and was prescribed 3600 mg of Asacol daily. She took this medication for a week and a half but it seemed to make her feel worse (nausea, vomiting...) She stopped taking the Asacol and the problems with her feet started 2 days later. She went back for a check up and they did blood work to check her WBC count and discovered it hasn't really gone down and her potassium was low. They tested her urine and discovered a UTI and prescribed her Ciproflaxin and Potassium CL.
Our most recent trip to the ER early yesterday morning yielded almost no results, we spoke to a vascular surgeon there and he says we may have vasculitis and a nurse there at the ER says it could also be Raynaud's phenom. Anyway, the Vascular surgeon prescribed her Nifedipine a calcium blocker. My wife also went to the vascualr surgeons office the day before and they simply took her pulses and said everything was okay.
My wife and I are very worried since there has been no real diagnosis and the pain becomes more frequent and the discoloration won't seem to go away. We have tried warming them with a electric blanket and hopefully the calcium blocker will show results. The color really bothers me, but the vascular surgeon and the Dr.'s say that the color doesn't bother them at all, but the pain is what they are concerned about. According to them, they say that the pulses are good and the feet and toes are blanching, so circulation is fine.
Hopefully you may be able to provide some insight for us. I can provide more information if needed. Again, thank you for taking the time I really do appreciate it. My wife is scared of losing her toe, I keep telling her that will not happen. It breaks my heart to see my wife in so much pain and I can't really tell her whats going on.

Staying positive,
Brian D.

Hi Brian,
Discoloration like you describe is NOT normal, particularly if it never existed before, particularly in a 28 y.o. woman. Just because you can palpate her pulses doesn't tell the whole story; there may be an issue with the blood returning to her heart. I find this particularly troubling because she just gave birth and my first thought would be a blockage of some sort at the level of her pelvis, preventing blood from returning to the heart; this would discolor her feet.
In addition she may have thrown a small embolism which will discolor her feet, but not always be blocking the blood flow into her feet , so when the vascular surgeon palpated her pulses, they were present.
This discoloration may have also been a result of some of the medication she was on; I am not familiar with some of them, but medicine can cause discoloration in the feet.

This is just some things that come to mind without having the luxury of being able to visually examine your wife's feet.

Have you discussed this with her obstetrician? If not, a phone call to that office might shed some light on the problem, or at least rule out her pregnancy as being the source of the problem.

Also, do not use heat in an effort to warm up her feet; if she is suffering from a circulatory disorder you are only going to make it worse.
Good luck.
Marc Mitnick DPM