Blue Toe Syndrome

What is Blue Toe Syndrome?

Arterial embolic disorder, otherwise known as “Blue Toe Syndrome” or “Trash Foot,” is a disorder characterized by the blockage of blood vessels leading to the toes. The most common scenario suggests that a tiny bit of an arterial plaque, usually from the abdominal aorta-iliac-femoral arterial system in the abdominal/groin area, breaks off and travels through the circulatory system before getting stuck in the small blood vessels of the foot.

This circulatory restriction results in the blue discoloration of one or more toes.

What causes Blue Toe Syndrome?

Blue Toe Syndrome occurs when blood flow is cut off to a toe or toes, usually because of a dislodged arterial plaque or crystallizing cholesterol in a blood vessel feeding into the feet. The toe/toes can’t receive fresh, oxygenated oxygen or the nutrients needed to survive, so local tissue can start to die off. Blue Toe Syndrome is usually a sign of underlying problems in the circulatory system as a whole. Risk factors include:

  • Diabetes
  • Heart disease
  • Atrial fibrillation
  • Invasive vascular procedures (ex. angiography)
  • Hypertension
  • Blood vessel trauma
  • Kidney impairment
  • Smoking cigarettes
  • High cholesterol
  • Foot surgery
  • Anti-coagulant treatment (blood thinners)
  • Thrombolytic treatment (treatment to break up large blood clots)
  • High levels of white blood cells, platelets, immunoglobulins resulting in thick, viscous blood
  • Old age
  • Atherosclerosis, Scleroderma
  • Toxic or illegal drug use (ex. cocaine, amphetamines)
  • Obesity
  • High fat diet
  • Aneurysm
  • Stroke
  • Anticoagulants/blood-thinning medications (ex. Warfarin)

What are the symptoms of Blue Toe Syndrome?

The characteristic symptom of Blue Toe Syndrome is, as the name suggests, sudden blue/purple discoloration in one or more toes. The color will not change in response to foot-position or temperature, and a pulse is still present in the foot. The following symptoms may be present as well:

  • Livedo reticularis (mottled, purple, netlike pattern on the skin)
  • Pain in the toes, feet, legs, or another area if the clot is a result of a circulatory problem there
  • Purpura (AKA blood spots: permanent red or purple spots on the skin)
  • Gangrene, in severe cases

What are the treatment options for Blue Toe Syndrome?

A healthcare professional will likely utilize angio-CT or Ultrasound scanning to determine the source of the blockage and to rule out other conditions. Surgery is not necessarily required for Blue Toe Syndrome; there are several non-surgical options to consider beforehand:

  • Compression stockings or socks that increase circulation in the feet
  • Soaking feet in warm water to increase circulation
  • Exercise to increase circulation throughout the body
  • Elevate feet above heart level to keep blood from pooling in the lower extremities
  • Eat a diet low in saturated fat; eat a nutritious, well-balanced diet in general
  • Quit smoking cigarettes to improve circulation
  • Medications that help to prevent the formation of blood clots in the body (ex. Dipyridamole, Aspirin)
  • Antigoagulants (ex. Warfarin) though these can also cause Blue Toe Syndrome so they should only be used as a short term solution

Compression socks help blue toe syndrome

If conservative treatments are ineffective, surgical options may include:

  • Thromboendartectomy (removing the blood clot and clearing out the obstructed artery)
  • Blood vessel stenting to keep the problematic vessel open
  • Bypass surgery to direct blood flow around the affected area
  • Amputation if gangrene has emerged in severe cases

Sources Cited