Chilblains, also known as pernio, occurs when the small blood vessels of the toes go into spasm. This disease process results in redness, swelling, itching, and sometimes blistering of the involved toes. This is most commonly seen in cold, wet environments. For this reason, we have recently been seeing numerous cases in our offices.
Chilblains has more recently been associated COVID-19 when some patients, especially children, began to develop red, blistered toes after contracting coronavirus. This new condition is now referred to as “COVID toes”, but the exact correlation between coronavirus and chilblains is not well understood. Initially, it was thought to be the result of blood clotting disorders brought on by the virus. More recently, however, scientists have hypothesized that it is because patients who contract COVID-19 tend to isolate in cool, damp areas such as the basement of a home, and it is thought that these environmental factors may cause chilblains. Although chilblains can sometimes be associated with coronavirus, development of red toes with sores is not an indication to get tested for COVID if you are otherwise asymptomatic.
Diagnosis of chilblains is made clinically by taking a thorough patient history and performing a thorough physical exam. Because chilblains is a vascular condition, it may be more common in patients with a history of peripheral vascular disease or Raynaud’s phenomenon. When examining a patient with chilblains, the toes may be cool to touch, red or blue in color, and may sometimes have superficial sores or blisters.
First line treatment for chilblains is to avoid the environmental factors that cause it to occur. Avoid cool and wet climates, change socks frequently, and apply dry heat to the toes. For example, place a towel in the dryer then wrap is around the affect foot. If the toes are itchy or blistered, topical steroid cream may be prescribed to relieve symptoms. Topical vasodilators may also be prescribed to bring more blood flow to the affected toes.
Fortunately, with spring around the corner, these cases will decline. With warmer, dryer weather, these cases become self-limiting. In the meantime, however, do not hesitate to come in to be evaluated by one of the doctors of Advanced Podiatry.