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The response to the question below was authored by Marc Mitnick DPM

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

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Mar 31, 2011
I am having the same thing!
by: Anonymous

I am having the same thing! What did they find out for your wife? Did you get an answer? I'm in the hospital but no one can help me.

Feb 22, 2011
Red toes/blue toes...
by: Baillie

My red, swollen, painful toes were ultimately linked to two illnesses. The first was idiopathic (and unclassifiable) cardiomyopathy w/heart failure; the second is Sjogren's Syndrome, an autoimmune disease with vascular elements.

Plavix took care of the the toes for about six years. Symptoms are slowly returning, so probably need another echo to see if my heart is still holding its own.

I suspect that the Sjogren's is behind the heart failure, too, if not the cardiomyopathy. I had no thromboembolism to account for the foot problem.

I also look as if I've broiled myself in the sunshine all day: bright splotchy red all over. I suspect this is the Sjogren's since it affects the vascular system, as mentioned above.

I was on the Plavix when I had a pulmonary embolism (blood clot in lung). Plavix works for arteries: the embolism was in a vein, so I had to go on warfarin for that. I did not have a thromboembolism then, either - it's the usual cause because a small clot breaks off the larger one in a major leg artery and heads straight for the lungs.

I had a heart catheterization and my heart had no coronary disease. But I'm staying on both kinds of "blood thinners" because the clotting is unexplained and I don't want to live with the likelihood of suddenly drowning on my own lung fluids. I take medication for the heart failure also.

If your feet are turning red/purple/blue for no reason, demand an echocardiogram from your doctor. That's the best place to start.

I was only in my mid-forties when this all started, 48 when the heart failure was discovered and am now 54. But the symptoms go way back further than that, so don't think that youth is a protective against heart problems.

So get that echo!

Feb 09, 2011
Any updates?
by: Anonymous

Hi, and I'm sorry to hear about your wife's problems. I was wondering if there have been any updates, because I have been experiencing similar problems lately ... I'm also 28, female, and my symptoms started out with extreme joint pain, redness, and swelling. I saw a rheumatologist who said that he thought it was autoimmune but still hasn't figured out exactly what's going on (this started about a month ago). In the past week, the symptoms have gotten much worse ... my feet no longer get red but now purple (almost brown even) and there's intense pain in my little toe, my hands are always swollen and the joints red and painful, extreme abdominal pain and swelling followed by loose stool (this morning I think I figured out that it happens more after I eat), skin rashes, and blood in the urine.

Dec 25, 2010
I have the same problem
by: Anonymous

About 6 mos ago I started experiencing extreme cramping in both of my feet. I have Rheumatoid Arthritis so I thought this was a result of it. About 1 mos ago, I started experiencing extreme burning in my heels and toes, particularly at night. It happens every night. My heels, the sides of my feet, and my pinky toe are now turning purple. I noticed this morning that my pinky toe was almost black in some spots. This is really scary for me. I will be going to the hospital tomorrow.

Nov 08, 2010
My 13 yr old daughter has this! sooo worried
by: Eva T in Detroit

My 13 year old daughter has the same symptoms. She is being treated by an Orthopedic Surgeon who says he cannot explain the pain. She has had an MRI, Vascular testing, blood work, bone scan and other test with no diagnosis to date. This has been happening to her for 4 weeks! I am so worried. What do I do? The pain is so intense she cries for hours on end. She cannot put her foot on the ground, her toes are blackening and she cannot be touched anywhere near her feet! Please help!

Oct 27, 2010
by: Tressa Clippinger

Have you considered RSD? Check out the web pages on it and see if any of her eyetems match. The discoloration and pain do so also since it happened so colose to her giving birth... Worth a look...

May 14, 2009
by: Anonymous

You should also test her blood sugar for possible diabetes. It is common during and after pregnancy.

Alison Burns,RN

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Wonderful advice

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