Raynaud’s Phenomenon- Red, White, and Blue Toes

Over the course of the last month, I have had several patients present with a cold-weather-related condition called “Raynaud’s phenomenon”, or sometimes called, “Raynaud’s disease”.  With this condition, the small blood vessels in the fingers and toes (and sometimes other peripheral body parts) constrict in response to a decrease in temperature, leading to an initial white coloration, with a temporary numb feeling and stiffness.

As this decrease in circulation persists, the toes then get a mottled blue color to them from the lack of oxygen.  When the area is warmed, the vessels dilate, and the return of proper blood flow causes a red coloration to the toes, as well as tingling and a “pins and needles” sensation.  Thus, the classic “white, blue, red” sequence.

Genetics are thought to be one causative factor with Raynaud’s.  Most commonly, the condition exists by itself, without other associated symptoms.  In this case, it is referred to as “primary Raynaud’s phenomenon”.  It can affect up to 5% of the general population.  Less often the condition is secondary to another more systemic disease such as lupus, in which case it is called, “secondary Raynaud’s phenomenon”.

Taking a good history of the symptoms as well as potentially getting some blood tests can help your physician determine whether you have primary or secondary Raynaud’s.  Your podiatrist may suggest a visit with your primary care physician to be sure that a thorough medical workup has been performed.

Treatment often focuses on avoiding environmental triggers.  Keeping your hands and feet warm in cold weather is critical.  Caffeine, smoking, vibrations, and stress are also known to play a role.  Occasionally, a prescription medication which dilates the blood vessels may be utilized as well.