Cold toes

Considering the problem of cold toes on the legs, we immediately leave behind the frame of the usual freezing of the legs during the cold season. We are interested in the medical aspect, since cold toes can be not only one of the characteristic features of the constitutional features of man, in particular, of his autonomic nervous system, but also a symptom of violations of peripheral circulation, angiopathy, autoimmune and endocrine diseases.

[1], [2]

Causes of the cold toes

The key cause of cold toes is a violation of the circulation of the legs. Since the fingers of the lower extremities, in the literal sense of the word, are their periphery, then with its blood supply there are many problems. In the fingers blood passes through the farthest from the heart arteries - the femoral, popliteal, anterior tibial - and gets through the back artery of the foot (a. Dorsalis pedis). At the bases of the metatarsal bones of the foot, this artery branched to form an arcuate artery (a. Arcuata), from which come even thinner blood vessels - a meta-digitales plantares, reaching to the fingers with aa branches. Digitales plаntares propriae (back arteries of fingers). In this case, individual anatomical "variations" in the structure of individual vessels are often noted, for example, they may be of smaller diameter or have additional branches. And this, of course, affects the circulation, especially the capillary, leading to the fact that you have 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 rate of capillary blood flow is more than 100 times lower than in the branching arteries, and the resistance in the capillary system is 25x10 ⁴ times higher than in the more large vessels of the great circle of blood 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 these are quite serious prerequisites for the development of a physiological condition, described as cold toes.

And if you have cold fingers and toes, like Raynaud's disease or systemic lupus erythematosus, even in the hot summer, then this is due to the narrowing or spasm of blood vessels and the lack of capillary blood flow, because it's the capillaries that deliver oxygen and nutrients to the tissues, providing normal tissue metabolism. See also - Angiopathy of the extremities.

[3], [4], [5]

Pathogenesis

The pathogenesis of this condition can be a consequence of the side effects of certain drugs, for example, beta-blockers, which are prescribed to reduce high blood pressure in hypertension, angina and heart failure. The problems of blood circulation in the legs are aggravated by excessive body weight and a sedentary way of life: the toes necessarily become cold if you spend hours in front of the computer.

[6], [7], [8], [9],

Symptoms of the cold toes

Very often the first signs of the pathology of the vascular system - 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 limbs is associated with atherosclerosis - the deposition of atherosclerotic plaques narrowing the lumen on the walls of the vessels (primarily the abdominal aorta and iliac arteries). A vascular ischemic syndrome with arteriosclerosis is caused by loss of elasticity of the vascular walls due to their compaction. As doctors say, the symptoms of chronic arterial insufficiency are expressed at the outset in patients' complaints about cold toes and the fact 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 cramps in the legs, intermittent claudication and intense pain while walking.

Complications and consequences

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

There may also be cold toes due to poor blood supply against anemia and a decrease in hemoglobin levels in the blood; with neurocirculatory (vegetative-vascular) dystonia; diabetes mellitus with frequently developing diabetic angiopathy

Endocrinologists must check the level of thyroid hormones in a patient with cold toes, so if their output is reduced (hypothyroidism), cardiac output, volumetric blood flow and heat transfer decrease.

And hematologists note that an important role in ensuring normal blood flow plays a hematocrit (blood viscosity) - the proportion of blood in the blood of the element and the liquid part (plasma). It is known that too thick blood slows the flow of blood through the vessels. This happens with dehydration (lack of fluid entering the body), smoking, lack of iron and vitamin B12, multiple cysts in the kidneys, ascites, chronic obstructive pulmonary disease (COPD), diabetes mellitus, bone marrow cell (polycetymia), leukemia.

[10], [11], [12], [13], [14]

Diagnostics of the cold toes

Diagnosis of cold toes is carried out not only on the basis of patient complaints and anamnesis.

Assign blood tests: a general, on the markers of inflammation, on the levels of cholesterol, sugar and thyroid hormones.

Instrumental diagnostics include:

• angiography (x-ray of arteries with contrasting);
• the definition of FPI (shoulder-ankle index by measuring systolic pressure in the shoulder and ankle arteries);
• rheovasography (measurement of blood flow velocity);
• ultrasound dopplerography (tissue is studied for pathological changes);
• duplex color scanning of blood vessels;
• capillaroscopy;
• thermography (determination of the local temperature of the skin).

[15], [16], [17], [18], [19]

Differential diagnosis

Given the multivariate pathogenesis of cold toes, differential diagnosis is performed using: multispiral CT of the lower extremities, MRI of the vessels of the legs, scintigraphy, intravascular ultrasound, laser dopplerography for percutaneous determination of oxygen tension in the tissues between the fingers (which characterizes microcirculation).

Treatment of the cold toes

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

In the syndrome of vegetative dysfunction vegetative-vascular dystonia should be treated .

If the walls of the vessels are deposited atherosclerotic plaques, narrowing the lumen and obstructing the passage of blood, you need to deal with excess cholesterol - see Tablets from high cholesterol.

There are methods by which to treat obliterating endarteritis; there are means by which primary hypothyroidism is treated , etc.

In the complex medication of cold toes, drugs can be used to improve the circulation of blood in the capillaries.

In particular, to reduce the viscosity of the blood Trental (Pentoxifylline Agapurin, Vasonitis, Pentilin) is prescribed - two or three tablets 2-3 times a day (after eating). It can not be used in patients with a tendency to bleeding, hemorrhagic stroke and hemorrhage in the retina, as well as pregnant and lactating women. Trental can give side effects in the form of nausea, vomiting, redness and itching of the skin of the face and chest, gastric and headaches, sleep disorders and heartbeat rhythm.

To improve peripheral circulation, Alprostan (Alprostadil, Vazaprostan) can be prescribed, which is infused into the vein once a day (0.05-0.2 mg each) for 1-2 weeks. The drug is contraindicated in patients under the age of 18 and older than 75 years, as well as with severe angina, bronchitis with obstruction of the lungs, liver failure, stomach ulcer and during pregnancy. The use of Alprostan can cause side effects: headache, nausea, decreased blood pressure, tachycardia, an admixture of blood in the urine. Treatment should not be longer than a month.

Angioprotective drug Curantil (Dipiridamol, Anginale, Antisthenocardine, Parsedil and other trade names) in the form of a 25 mg tablet is recommended to be taken only for the purpose of the attending physician, since among its contraindications there is a widespread atherosclerosis of the coronary arteries. Standard dosage - one dragee three times a day; treatment can last several months. In this case, such side effects as facial hyperemia, allergic rashes and increased heart rate are not excluded.

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

Also, with cold toes on the legs, it is necessary to take vitamins of group B, PP (nicotinic acid), P (rutin) and vitamins-antioxidants - C and E.

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

With arterial insufficiency of the lower extremities with obliteration of the vessels - according to the indications - surgical treatment is carried out, including shunting of the damaged part of the vessel or prosthetics of the vessel.

Alternative treatment

In some cases (with the exception of chronic arterial ischemia of the leg vessels and problems with the endocrine system), alternative treatment of cold finger syndrome is helpful.

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

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

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

Herbs are also used. So, when atherosclerosis is advised to take in the water infusion of dried dill (a teaspoon of 250 ml boiling water) with honey (tablespoon). This drug should be drunk for 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, buds of ivy, nettle, burning, willow bark of white or dried dandelion roots.

Tones fine blood vessels tincture from flowers of horse chestnut. For its preparation, a half-liter jar is filled with two-thirds flowers, poured with vodka, tightly closed and the month is kept in the dark. After that, filter and take within a month for 20 drops before eating.

When anemia is used herbs that increase hemoglobin.

It is useful to eat beets, cabbage, apples, it is mandatory to consume garlic in fresh form and add to the food - pepper, and in tea - ginger. And how to be treated with food for atherosclerosis, see - Diet with atherosclerosis.

[20],

Prevention

Prevention of inadequate circulation in the toes begins with the fact that you need to quit smoking, take enough fluids (1.5-2 liters during the day) and move more, for example, walking.

[21]

Forecast

The prognosis depends on why you have cold toes.