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What chilblain cream do we use?

Chilblains are a relatively common vasospam of the small blood vessels in the toes that create a reddish or bluish lesion that can be itchy and painful. They typically occur in the cooler climates and that chilblain season is coming up. There are a number of things that can be done to prevent and treat chilblains. This include protecting the feet from the cold, not warming them too quickly after they become cold, and using creams that can help to stimulate and the circulation as well as sooth them when they occur.

There are a number of different creams, lotion, potions and ointments on the market that can be used for chilblains and every single one of them can probably produce some pretty convincing anecdotes and testimonials about how good they are. For us as clinicians it can be a bit of a problem to know which one to recommend in the context of them all claiming to be the best and each one of them having some support. There is no research that has been done to show which one is the best chilblain cream to use. We have some experience with some of them and that results of that experience is a bit mixed. The problem is that one cream that works for one person may not necessarily work for the next person. So any recommendation for a cream to use for chilblains is going to have to be for one that is more likely to affect a lot of people and be a good place to start. One thing I did notice is that when you see questions asked of a group of podiatrists, there will be a number of different recommendations given, but also the name “Akileine Akilwinter Chilblain Cream” does keep coming up and recommended more often than others, so that is now the one that we typically use first.

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What to do about toe jam?

‘Toe Jam‘ is not a medical term and is a lay term for that yucky ‘stuff’ that accumulates between the toes. It is really a collection of things such as sock lint, dead skin cells and sweat that have nowhere to go in the tight cramped spaces between the toes. At the best of times this can be unpleasant, even have a cheese-like consistency to it and can emit a foul odour. It is likely to be worse if you wear closed in shoes, your feet sweat a lot and your foot hygiene is not as good as it should be.

The best way to deal with toe jam is to practice good foot hygiene. You need to carefully clean and then dry between the toes.

Toe jam can only become serious if a fissure or split develops between the toe and an infection can get in; or if a secondary bacterial or fungal infection develops in the unhygienic environment created by the accumulation of the toe jam.

Toe jam is unpleasant and yucky and can be the butt of jokes, but please take it seriously and practice good foot hygiene habits to get rid of it. If any of the complications of it develop then come in and see us.

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Covid Toes

Around April 2020 when the COVID-19 pandemic was at its peak in Europe there were increasing reports of what appeared to be chilblains on the feet appearing with a very high frequency in those infected with the novel coronavirus. The mass media caught on to these reports and a lot of attention has been paid to these so-called COVID toes.

Chilblains are reasonably common in the colder climates anyway, and it was not clear what the significance of them appearing so often in those with COVID-19 was as it was winter in the northern hemisphere when these media reports started to appear. Since those initial reports, there have now been a number of published studies on COVID toes and chilblains. That has not necessarily led to an increased understanding of the problem with mixed results and commentary in the medical literature. The reason for this is that it could be due to one (or both) of two possible explanations:

  • the chilblains could be part of the pathophysiology of the coronavirus infection. Chilblains are well known as a problem with the small blood vessels and how they react to the cold, so the inflammatory process of the infection could affect the way the blood vessels react, causing the chilblain. COVID-19 has been well documented as affecting the vascular system, so the chilblains could be due to this mechanism
  • the higher incidence of the chilblains may actually not be directly related to the COVID-19, but may be due to lifestyle changes that happened during the lockdown associated with the pandemic and it was those lifestyle changes that predisposed to the chilblains. Spending more time in centrally heated houses rather than outdoors in the colder climates could be a factor in the increased prevalence of chilblains.

While it’s not clear if its both or either of the above, COVID toes are definitely a thing. If you have chilblains and you do not normally get them or if you have them and there is something out of the ordinary with them, then it might pay to get that investigated further. Regardless of the cause of the chilblains, the management is the same and the feet need to be protected from the cold and the application of creams to stimulate the circulation in the small blood vessels is important.

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Chilblains Season is Here

As the weather has started to cool for winter we have started to see some chilblains as it is that time of the year. That can also be a bit misleading as chilblains are not technically due to the cold weather, but are due to how the small blood vessels in the foot respond to the changes in temperature from cold to being warmed up.

Chilblains are typically red painful and itchy spots on the toes and other areas of the foot (though they can less commonly also affect the hands, ears and nose). They only appear in the colder climates and are pretty much unheard of in warmer climates. They typically occur when the foot has been cold and is warmed up too quickly for the small blood vessels to react to that change in temperature. This releases chemicals that cause the itch and creates an inflammatory reaction leading to the chilblain. They can become quite painful and break down which might lead to an infection. Repeated exposure to the cold may lead to the chilblain becoming chronic.

The best way to deal with chilblains is to prevent them from happening in the first place. This means making sure the foot does not get cold, so keep on warm socks and closed in shoes. If the foot does get cold, then make sure it is warmed up slowly. Do not put a very cold foot in front of a heat source – warm it up slowly.

If a chilblain does occur, then protect it. Keep it warm. Use some gentle rubbing of it with a cream to stimulate the circulation. Please give us a call and come and see us if you are troubled with chilblains. There is plenty we can do and plenty of advice that we can give.

You can read all the latest research on chilblains at Podiatry Arena, Craigs blog post on beetroot and chilblains as well as an episode of PodChatLive on chilblains.

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