Toes randomly go numb and turn purplish in color

(Rochester, NY)

On 8/18/2005 I was hit by a local ambulance company. I fractured the second and third metatarsal in my right foot from slamming on the break so hard. They ended up being at fault but the impact was in the front of my car, both vehicles were totaled. Since the accident I have notice numbness in my right foot. The numbness is felt in the 3rd (middle) toe, gets slightly worse in the 4th toe, and the 5th toe is goes completely numb. When I notice the numbness it starts in the 5th toe and works its way to the 3rd toe. My 5th toe will be numb to temperature and any touch. The outside of my right foot (along the 5th toe) is just as numb as the toe itself, all along the 5th metatarsal. I will walk funny when the toes are numb and the majority of my right foot feels almost useless. After I notice the numbness I can watch my toes start to turn a light purple or blueish. I live in NY state and have noticed this in any temperature/ weather condition (90 degrees to below 0). I can be doing anything or just sitting/ laying on the couch/ bed, wearing shoes or no shoes, socks or barefoot, my foot just goes numb, it's the same numbness every time.

While skiing my toes have become so numb that I was in the worst pain trying to take off my boots. Pain is extremely uncommon in my foot in general, let alone while my toes are numb. Some times, I would notice that they were feeling cold and had about 5 min to get inside and get my boots off before it was unbearable. Last season I didn't feel any burning pain like the previous ski season. I am an expert level skier and I ski for a living. I have purchased boot heaters, custom foot beds, and new boots, boot heaters help a little on freezing cold days. The numbness may last for hours so I now just put my boots back on after a warmer-upper and continue skiing, with my foot feeling half dead with numbness.

What do you think could be going on with this and what else can I do to improve it? I'm open to any recommendations or ideas.
Thank you


RESPONSE

Hi,
Not that it is absolutely important but I am curious if you are male or female as it sounds like you are having what is known as a vasospastic disorder where the arteries in your toes clamp down when subject to temperature changes particularly excessive cold. This tends to happen more in females but it would seem to me that there is some cause and effect from the automobile accident you suffered a six years ago as these symptoms began occurring right after the accident.
To complicate matters more, some of your symptoms are also suggestive of Morton's neuroma which is basically a pinched nerve just behind the toes where the toes meet the metatarsal bone. Because the impact was severe enough to fracture your metatarsal bone, it would not be far fetched to think that it could have also adversely affected the adjacent nerve.
I would be curious to know if the the metatarsal fracture healed properly or if there is any residual issues with that as that could also impact your neuroma symptoms.
In the overall scheme of things there is the possibility that nerve damage to the forefoot is causing all your symptoms.
Unfortunately, I cannot give you any definitive advice regarding a diagnosis because the trauma complicates the issue as does the fact that I know nothing about you in regards to sex, age, weight, medical history etc.
What I can suggest is that you first consult with a vascular specialist to determine the extent of vascular compromise you are experiencing to see if there potentially a serious issue here.
Once that is appropriately assessed, your next visit should be to a foot specialist for evaluation of the healed fracture and neuroma like symptoms. It would not surprise me if in addition to an x-ray, an MRI is performed to get a better idea of any soft tissue damage resulting from the automobile accident.

Marc Mitnick DPM
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