Jan 11 2008
Raynaud’s: Red, White & Blue Toes
The red, white and blue toe phenomenon, called Raynaud’s, is due to a transient decrease in blood flow to the toes. The fingers can also be affected, and less commonly the nose, ears and lips. The toes will initially become white, then become bluish and eventually red, which is the triphasic color change classically associated with Raynaud’s. When this disorder occurs without a cause, it is called Raynaud’s disease, or primary Raynaud’s. When the disorder is a result of another condition, like rheumatoid arthritis, scleroderma, or lupus, it is called Raynaud’s phenomenon or secondary Raynaud’s.
Cold temperatures, stress or anxiety can trigger attacks. Raynaud’s attacks are more common in the winter months. Cold weather or stress causes a temporary narrowing of the small arteries that supply the toes and this can result in pain, numbness, tingling or burning.
- White toes: The toes turn white as a direct result from a loss of blood flow due to narrowing of the small arteries. This is called the ischemic phase and can be associated with pain and numbness.
- Blue toes: The next phase is called the cyanotic phase. Although blue is the common color used for the second phase, the toes are generally described as deep bluish-purple. The bluish-purple color is caused by the remaining blood in the toes changing color as the blood transfers the oxygen to the tissues.
- Red toes: The final phase is called the hyperemic phase and the toes turn red as the vessels open and blood rushes into the toes. This phase can be associated with tingling and pins and needles sensations.
An attack can affect all the toes or only a couple of the toes. Although all the toes affected can change color at the same time, the toes may also change color at different rates. This can result in red, white and blue toes, all at the same time.
In severe Raynauds, tissue damage can occur and when preventative steps fail, it’s best to take a trip to your doctor and ask about medications. Medications prescribed for Raynaud’s open up or relax the blood vessels and can decrease the frequency of attacks. Some topical medications are also available.
Medications which may aggravate Raynaud’s include birth control pills and some types of high blood pressure medications, like metoprolol, and over the counter cold medications which contain pseudoephedrine.
Tips for Prevention
1. Avoid cotton socks. Stick with wicking socks (more on sock materials). Don’t walk barefoot and wear slippers with a thick lining in the house.
2. Don’t wear tight socks. Tight socks can cramp toes together and constrict circulation, make sure your toes have wiggle room in the socks.
3. Make sure your shoes fit. Shoes you wear in the summer may be too tight when you put on your thick winter socks. This can constrict the circulation to your toes, causing them to be even colder and increasing the risk of an attack.
4. Don’t’ Smoke! Nicotine causes the blood vessels to constrict, decreasing circulation and increasing your chances of an attack.
5. Avoid Caffeine. Caffeine also causes the blood vessels to constrict, reducing blood flow and may worsen an attack.
6. Lessen Stress. Stress, anxiety and high emotions are known triggers and although they are impossible to avoid, it’s best to attempt to avoid situations that could lead to stressful events.
I believe I may have this condition. So far, no doctor, specialist or podiatrist has brought Raynaud’s up as a possible explanation. The symptoms you describe seem to fit perfectly. Would appreciate any more advice you can give re: treatment and therapy.
There are limited over the counter treatments for Raynaud’s and prescription treatment depends on the severity. You may want to approach your doctor with this diagnosis or consider taking pictures of your feet or hands when they become severe, so he or she may have a better idea of the how to approach or treat the condition.