discoloration, itching, burning in ALL toes

(Illinois)

Hello everyone,

I am a 25 year old graduate student finishing my doctorate in physical therapy this May. I live in Illinois, where it is most definitely cold in the winter. Last February/March, I noticed my toes starting to become discolored, itchy, and extremely painful, say if someone stepped on my foot. I gave it about a month and continued my running and exercising, changed my shoes, only to note an increase in symptoms and tingling on the bottom distal portion of my foot. I also noticed that if I took a hot shower, the swollen areas on my toes turned blue almost every time. I've always had cold hands and feet. After a month it became so annoying I went to the doc. They sent me for a full blood workup testing for RA, which runs in my family, lupus, gout, and other things. It all came back negative. So they put me on prednisone and sent me to a rheumatologist, who felt it was something systemic but wanted to watch it before giving a definite diagnosis. Two weeks on a mild dose of prednisone seemed to effect the toes positively, and as it got warmer, I would occasionally get mild irritation but NOTHING like it had been. Fast forward...in the past few months I was diagnosed with Chiari malformation in my CNS and am having surgery next week. I was thinking maybe this was all related...but it appears not. Last week I had a sore, scratchy throat with canker sores in my mouth and throat. This lasted about 5-7 days, it's cold outside, my hands and feet are always cold, and lo and behold, my toes are swelling again. It appears it is only from the IP to the tip of the toe, and does not extend to the base of the toes, but it's definitely BOTH feet, and started in 1 foot and is now in both. It seems to be exacerbated by wearing shoes that are even the slightest bit constricting. My toes are warm, itchy, swollen, red, and annoying. I have tried cryotherapy to vasoconstrict and it seems to help the inflammatory process. Seems to work, but I am not sure if this is the correct or healthy conservative approach. I hesitate to take prednisone before my brain surgery next week. I have attached pictures. What do you think? Is it related to viral infection, cellulitis, or something goofy?

Thank you,

Christina

Hi Christina,
Based on your description it sounds like superficial frost bite where there is vasoconstriction of the arteries going into the toes as a result of exposure to the cold weather. Read my section on circulation. You should be examined by a podiatrist or vascular specialist to confirm this. One option besides the obvious of protecting your feet from cold exposure would be to consider taking Trental in an effort to improve the circulation to your toes. Unfortonately it may be too late this year as you need to start it three months before the onset of cold weather. Good luck with your upcoming surgery.
Marc Mitnick DPM