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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.

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.