Cold toes

When considering the problem of cold toes, we will immediately leave out of the review the usual freezing of feet in the cold season. We are interested in the medical aspect, since cold toes can be not only one of the characteristic manifestations of a person's constitutional features, in particular, his autonomic nervous system, but are also a symptom of peripheral circulatory disorders, angiopathies, autoimmune and endocrine diseases.

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Causes cold toes

The main cause of cold toes is circulatory problems in the legs. Since the toes of the lower extremities are literally their periphery, there are many problems with their blood supply. Blood flows to the toes through the arteries furthest from the heart - the femoral, popliteal, anterior tibial - and enters through the dorsal artery of the foot (a. dorsalis pedis). At the base of the metatarsal bones of the foot, this artery branches to form an arcuate artery (a. arcuata), from which even thinner blood vessels go - the metatarsal arteries (aa. digitales plantares), reaching the toes with branches aa. digitales plantares propriae (dorsal arteries of the toes). At the same time, individual anatomical "variations" in the structure of individual vessels are often noted, for example, they can be of a smaller diameter or have additional branches. And this certainly affects blood circulation, especially capillary circulation, leading to cold toes.

It should also be borne in mind that the diameter of the capillaries is 100-200 times smaller than the diameter of small arteries and arterioles, the speed of capillary blood flow is more than 100 times lower than in branching arteries, and the resistance in the capillary system is 25x10 ⁴ times higher than in larger vessels of the systemic circulation. In addition, in the absence of active movement, approximately 65-75% of the capillaries do not function (especially since there are no muscle fibers in their walls). All this is a fairly serious prerequisite for the development of a physiological condition described as cold toes.

And if even in the middle of a hot summer your fingers and toes are cold, as with Raynaud's disease or systemic lupus erythematosus, then the reason for this is the narrowing or spasm of blood vessels and insufficient capillary blood flow, because it is the capillaries that deliver oxygen and nutrients to the tissues, ensuring normal tissue metabolism. See also - Angiopathy of the extremities.

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Pathogenesis

The pathogenesis of this condition may be a consequence of the side effects of certain medications, such as beta blockers, which are prescribed to reduce high blood pressure in hypertension, angina and heart failure. Circulatory problems in the legs are aggravated by excess body weight and a sedentary lifestyle: your toes will definitely become cold if you sit in front of a computer for hours.

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Symptoms cold toes

Very often the first signs of vascular pathology – chronic arterial insufficiency (ischemia) of the lower extremities – are manifested by cold toes. In clinical angiology, the pathogenesis of chronic arterial insufficiency of the lower extremities is associated with atherosclerosis – the deposition of atherosclerotic plaques on the walls of blood vessels (primarily the abdominal aorta and iliac arteries), narrowing the lumen. And vascular ischemic syndrome in arteriosclerosis is caused by the loss of elasticity of the vascular walls due to their compaction. As doctors note, the symptoms of chronic arterial insufficiency at the very beginning are expressed in patient complaints of cold toes and that the big toe is cold and often numb.

Cold toes can signal the development of a very dangerous autoimmune disease - obliterating endarteritis, which is accompanied by leg cramps, intermittent claudication and intense pain when walking.

Complications and consequences

Complications of this disease lead to tissue necrosis and so-called spontaneous gangrene, the consequences of which are sometimes inevitable amputation of the affected limb.

Cold toes may also be due to poor blood supply due to anemia and decreased hemoglobin levels in the blood; neurocirculatory (vegetative-vascular) dystonia; diabetes mellitus with frequently developing diabetic angiopathy.

Endocrinologists always check the thyroid hormone levels in patients with cold toes, since when their production is reduced (hypothyroidism), cardiac output, blood flow, and heat transfer are reduced.

And hematologists note that hematocrit (blood viscosity) plays an important role in ensuring normal blood flow – the proportion of the blood’s formed elements and liquid part (plasma). It is known that blood that is too thick slows down the blood flow through the vessels. This happens with dehydration (insufficient fluid intake), smoking, lack of iron and vitamin B12, multiple kidney cysts, ascites, chronic obstructive pulmonary disease (COPD), diabetes, bone marrow cell hyperplasia (polycythemia), and leukemia.

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Diagnostics cold toes

Cold toes are diagnosed not only on the basis of patient complaints and anamnesis.

Blood tests are prescribed: general, for inflammation markers, for cholesterol, sugar and thyroid hormone levels.

Instrumental diagnostics includes:

• angiography (X-ray of arteries with contrast);
• determination of the brachial-ankle index (BAI) by measuring systolic pressure in the brachial and ankle arteries;
• rheovasography (measurement of blood flow velocity);
• ultrasound Dopplerography (tissues are examined for pathological changes);
• duplex color scanning of blood vessels;
• capillaroscopy;
• thermography (determination of local skin temperature).

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Differential diagnosis

Considering the multivariant pathogenesis of cold toes, differential diagnostics are performed using: multispiral CT of the lower extremities, MRI of the leg vessels, scintigraphy, intravascular ultrasound, laser Dopplerography for transcutaneous determination of oxygen tension in the tissues between the toes (which characterizes blood microcirculation).

Treatment cold toes

Since this symptom occurs in a number of pathologies, the treatment of cold toes will depend on the specific diagnosis of each patient.

In case of autonomic dysfunction syndrome, vegetative-vascular dystonia should be treated.

If atherosclerotic plaques are deposited on the walls of blood vessels, narrowing the lumen and making it difficult for blood to pass through, you need to combat excess cholesterol - see Tablets for high cholesterol.

There are methods that treat obliterating endarteritis; there are drugs that treat primary hypothyroidism, etc.

In complex drug therapy for cold toes, medications can be used to improve blood circulation in the capillaries.

In particular, Trental (Pentoxifylline Agapurin, Vazonit, Pentilin) is prescribed to reduce blood viscosity - two to three tablets 2-3 times a day (after meals). It should not be used by patients with a tendency to bleeding, hemorrhagic stroke and retinal hemorrhage, as well as pregnant and lactating women. Trental can cause side effects such as nausea, vomiting, redness and itching of the skin of the face and chest, stomach and headaches, sleep disorders and heart rhythm.

To improve peripheral circulation, Alprostan (Alprostadil, Vasaprostan) may be prescribed, which is administered intravenously by infusion once a day (0.05-0.2 mg) for 1-2 weeks. The drug is contraindicated for use in patients under 18 and over 75 years of age, as well as in severe angina, bronchitis with pulmonary obstruction, liver failure, stomach ulcers and during pregnancy. The use of Alprostan may cause side effects: headache, nausea, decreased blood pressure, tachycardia, blood in the urine. Treatment should not last longer than a month.

The angioprotective drug Curantil (Dipyridamole, Anginal, Antistenocardin, Parsedil and other trade names) in the form of 25 mg dragees is recommended to be taken only as prescribed by the attending physician, since its contraindications include widespread atherosclerosis of the coronary arteries. The standard dosage is one dragee three times a day; treatment can last for several months. At the same time, such side effects as facial hyperemia, allergic rashes and increased heart rate are not excluded.

The medicine Xanthinol nicotinate (Theonikol, Complamin, Angioamin, etc.) helps to expand peripheral blood vessels in case of cold toes: 0.15 g tablets should be taken after meals (1 tablet) three times a day (for 2-3 months). This medicine has contraindications: severe heart failure, decreased liver function, bleeding or pathologies associated with the occurrence of bleeding. And side effects are expressed by dizziness and a feeling of heat in the head, neck and chest.

Also, if you have cold toes, you need to take vitamins of group B, PP (nicotinic acid), P (rutin) and antioxidant vitamins – C and E.

To get rid of the feeling of cold in the toes, physiotherapy treatment can be used: thermal procedures (warm and hot foot baths, ozokerite foot wraps), massage, baromassage (with a change in external pressure), diathermy, diadynamic currents.

In case of arterial insufficiency of the lower extremities with vascular obliteration, surgical treatment is performed according to indications, including bypass of the damaged section of the vessel or vascular prosthetics.

Folk remedies

In some cases (except for chronic arterial ischemia of the leg vessels and problems with the endocrine system), folk remedies for cold finger syndrome help.

But it helps, naturally, temporarily, since it does not affect the cause of the pathology.

It is recommended to do the same hot foot baths (with a decoction of pine needles or mustard powder). And, of course, wear warm socks. And for "training" the vascular system of the feet, contrast baths or dousing the feet are suitable - alternating hot and cool water.

The feeling of cold disappears for a while after rubbing the toes and the entire foot with vodka (with the addition of 3-4 drops of turpentine or cypress essential oil), camphor alcohol, or hawthorn alcohol tincture.

Herbal treatment is also used. Thus, for atherosclerosis, it is recommended to take an infusion of dried dill (a teaspoon per 250 ml of boiling water) with honey (a tablespoon) orally. This remedy should be drunk half an hour before meals - 50-60 ml three times a day. In the same way, you can use decoctions and infusions of sweet clover, ivy-leaved bugleweed, stinging nettle, white willow bark or dried dandelion roots.

Tincture of horse chestnut flowers tones small blood vessels. To prepare it, fill a half-liter jar two-thirds with flowers, pour in vodka, close tightly and keep in the dark for a month. Then strain and take 20 drops before meals for a month.

For anemia , herbs that increase hemoglobin are used.

It is useful to eat beets, cabbage, apples, it is necessary to eat fresh garlic and add pepper to food, and ginger to tea. And how to treat atherosclerosis with food, see - Diet for atherosclerosis.

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Prevention

Prevention of poor blood circulation in the toes begins with quitting smoking, drinking enough fluids (1.5-2 liters during the day) and moving more, for example, walking.

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Forecast

The prognosis depends on the reason for your cold toes.