cold feet

Cold feet (and hands) is a fairly common complaint amongst patients. This discussion will be limited to people who suffer from cold hands and feet as there is usually a common denominator causing the problem in all extremities.

This section is devoted to the symptoms of cold feet that are not due to a blood vessel blockage. If you are suffering from feet that are cold and appear discolored, may be painful when at rest or when trying to walk a short distance or perhaps burn or tingle, this may be a sign of poor circulation and immediate medical attention is required. Click here for more information on peripheral circulation.

In most instances cold extremities can be weather related. Cold temperatures have a constricting affect on blood vessels, which will decrease the flow of blood to the hands and feet. However, there are other factors that will cause these symptoms, these include:

• a poor functioning thyroid
• anemia
• Raynauds disease
• rheumatoid arthritis
• lupus
• high blood pressure

People who have chronically cold hands and cold feet should have a complete work-up to rule out the above-mentioned conditions. Assuming your tests come back normal here is a list of things you can try to improve the situation.

1.Wear warm clothing. Seems like an obvious statement but one of the problems many people do not realize is that cold weather constricts your peripheral circulation thereby increasing blood flow (and heat) to your torso. By wearing very warm coats and protecting your “body heat” this counteracts the peripheral constricting process. Additionally, wearing warm covering on your legs and feet reduces the exposure to cold on your extremities further negating the effects of cold weather on your system. If you do a lot of walking outdoors in order to get to work, carry your work or dress shoes in a bag and wear warm socks and boots to and from work.

2.Do not smoke. I know this is easier said than done, but smoking causes vasoconstriction on your circulation. Just like exposure to cold, tobacco clamps down your arteries decreasing blood flow to the feet. Worse than exposure to cold, tobacco use over the long haul also increases arteriosclerosis (hardening of the arteries) in your feet and legs, as well as elsewhere.

3.Eat warm food. It is not so much that warm food “warms” you up; it is more that warm food requires less body energy than cold food in order to be digested. This leaves more body energy to help keep you warm.

4.Avoid coffee; drink tea. Caffeinated coffee constricts blood vessels as does all caffeinated drinks, but green and black tea contain flavonoids which help support blood vessel health.

5.Nutritional supplements. Magnesium 1000mg per day relaxes blood vessels and helps promote blood flow. Too much magnesium may cause diarrhea. Hawthorn berry and resveratrol supplements helps maintain the integrity of your blood vessels.

6.Aerobic exercise. Regular exercise such as walking, preferably indoors in cold weather, is a great way to promote better circulation to your feet.

Here in the northeast where we tend to have cold damp winters there are two conditions that I see a lot of related to this discussion.

Superficial frostbite, also known as chilblains or pernio. Most people think of frostbite as a condition that occurs when you are abandoned in the Canadian Rockies for a few days. Believe it or not you can develop superficial frostbite doing nothing more than walking four blocks to work everyday wearing nylons and dress shoes in the middle of winter. I have also seen it in people who work outdoors all day such as construction workers or deliverymen.

Depending on the quality of circulation to the feet to begin with, exposure to cold damp weather will further constrict the blood vessels that go primarily into the toes. This diminishes the blood flow to the skin which starves the skin of oxygen and nutrients. The patient will present complaining of pain in some or all of the toes. There may also be itching. There is usually a blue to red discoloration in the toes. In the slightly more severe case the toes may begin to ulcerate and thereby run the risk of becoming infected.

Below is a picture of superficial frostbite.

Treatment obviously is to avoid exposure to cold and to habits that potentiate vasoconstriction of the vessels, eg: smoking. In those individuals who suffer from this repeatedly and have tried all the “easy” solutions I will occasionally put patients on Trental about three months before the winter months in an effort to improve blood flow to the foot. They can stop the medication at the end of winter.

Raynauds disease This is a condition with idiopathic origins. Raynauds phenomenon is the same condition but which is secondary to an underlying disease such as arteriosclerosis, systemic lupus, scleroderma, Buergers disease among others.

Raynauds typically affects females much more so than males. It generally occurs in women in their 20’s and 30’s. Historically, it is seen in women who tend to be anxious and nervous thus suggesting a neurological origin.

The condition is not limited to the feet and hands; it may also be seen on the ears and nose.

Upon exposure to cold stimulus the affected area will undergo a series of color changes. First the affected part will turn pale (white), this represents a vasoconstriction of the small arteries in the area.

Below is a picture of a hand. Notice the how white some of the fingers are.

After a while the affected area will then turn cyanotic (blue). This represents the constriction of the small veins in the area in an effort to keep blood in the area. Finally the area will turn red which will occur when the small arteries in the area relax and blood rushes back into the affected area.

Along with the changes in color, the patient may also complain of burning, tingling, itching, numbness and pain.

Like superficial frostbite the patient is instructed to avoid exposure of their extremities to cold. The difference is that Raynauds can occur in less cold situations than superficial frostbite, so it can occur more often and for longer time periods during the year.

The best way to terminate an attack is to immediately return indoors and place the exposed digits in luke-warm water (109 degrees Fahrenheit). Never use HOT water.

Simple measures as explained above should suffice for infrequent and mild attacks. More severe attacks which lead to skin changes and perhaps ulceration may require oral medication to stem the attacks.

The most commonly prescribed drug is Nifedipine (Procardia, Adalat) which is a calcium channel blocker used to treat high blood pressure and angina. This medicine must be taken under the supervision of your doctor.

Pentozifylline (Trental) is another drug that has been used with success. This medicine is generally used for poor circulation and works by making the red blood cells more pliable so they can "squeeze" through the narrow arteries. This medication needs to be started approximately three months before the onset of winter.

REFERENCES

eMedicine Health

Harvard Health

Cleveland Clinic

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