"My toe hurts" Part II

When last I visited the world of painful, old toes, I mentioned that my mother's big toe was suffering from arterial insufficiency--bright red when she was upright and gravity pulled oxygenated blood in, and pale, waxy white when she propped it up on a footstool.

This mid-sixties year old lady had a really painful toe. Not only painful but an alarming shade of purplish-black at its tip. Same story last year, she related. Then, as now, it was winter, and walking barefoot on tile floors caused the tip of another toe to become ugly and painful.

Chilblains, I declared, with the smugness of an internist who's seen this sort of thing once before. Particularly common in persons with poor circulation, and this woman had known hypertension and high cholesterol, chilblains are caused by constriction followed by inflammation in the small arteries of toes and occasionally fingers in response to cold. They are typically red or purple, itchy or painful, and particularly ugly if they ulcerate. I started this patient on a medication that promotes dilation of blood vessels and advised her to wear warm footwear, even indoors.

Pride goeth before the wrong diagnosis, and she returned shortly thereafter with the toe worse than ever and another one toe starting to turn a worrisome shade of black. I called Dr. Alan Synn, one of those marvelous send-'em-right-over kind of specialists, who ultimately discovered that our patient was throwing off little clumps of cholesterol/clot gunk from her diseased leg arteries. These bad actors then coursed down the vessels into the much tinier ones in the toes where they lodged, cut off blood flow, and caused the skin at toe tip to die from lack of oxygen.

He subsequently put a stent in the offending, atherosclerotic artery. She continued on the dilating medication, took a trip to Mexico where the warm air to toe connection hastened healing, and she's doing just fine now.