Blue Toe Syndrome – Why You Need To Treat It Immediately? | Pain Care

Blue Toe Syndrome – Why You Need To Treat It Immediately?

When arteries or small capillaries that provide blood to foot gets blocked, blood flow to fingers and other part of foot get diminished and ischemia sets in.

This leads to cyanosis of fingers which looks bluish in color.

Blue toe syndrome is caused by reduced blood flow to the fingers due to blockage in the vessels that provides blood to the foot. It is also know as purple toe syndrome and trash foot.

Atherosclerosis, aneurysm can be the leading cause of this syndrome.

Usually onset of this condition is sudden and may cause sever pain. Either multiple toes or a single toe may be affected in this condition and it turns blue in color.

This blue color arises due to reduced amount of oxygen in the toes and if not treated promptly this condition may lead to gangrene. If gangrene start to appear, amputation of gangrenous part is the only available treatment.

So, it is important that blue toe syndrome must be treated promptly before gangrene sets.


This condition have sudden onset and must be treated immediately to avoid complications.

Usually it limited to one leg but if any systemic cause is involved then it may affect another leg .

Most common symptoms of puprle toe syndrome are


Sever pain is the characteristic of this syndrome. As blood flow reduces, pain starts and become worse as condition aggravates.

Blue colored toes

Due to reduced blood flow, oxygen level of toes start to drops and toes look blue in color.

Livedo Reticularis

Purple discoloration of skin around affected area is known as Livedo reticularis.

Foot pulse

Trash foot mostly have palpable peripheral foot pulses which may misguide physician to rule out the vascular pathology.


This condition usually affects during the old age and more common in the people over the age of fifty.


Spontaneous breakage of small arterial plaque can lead to this condition. This plaque blocks pedal arteries and causes ischemia.

Breakage of small plaque from aorta-illiac-femoral arteries

Plaque is formed with fatty acids, cholesterol, calcium and platelet aggregation and it attaches to the inner wall of arteries. Sometimes, these plaque breaks off and start to move along the artery, this condition is known as embolism.

This embolism may travel to another place in body and can blocks artery. In blue toe syndrome blood vessels near the groin and abdomen are more prone to create a plaque.

Surgical procedures

Major surgical procedures may lead to thrombo-embolism that causes trash foot. Usually vascular surgery leads to embolism.


Blood vessel trauma may lead to embolism leading to purple toe syndrome.

Hypercoagulable blood

Thick blood may tend to coagulate faster like in case of polycythemia vera can cause this condition.


Uncontrolled diabetes may cause foot ulcers and this condition.


Patient who are taking anti-coagulant for some other reason are prone to develop this condition easily.

Anti-coagulant also known as blood thinners can break down the large blood clots and thrombo-embolism results into blue toe syndrome.


Diagnosing the trash foot is a difficult task.

Usually arterial blockage in foot leads to loss of pulsation of pedal arteries, but in this case pulsation does not vanish and make it difficult for any doctor to diagnose it.

However, with the help of past history and present symptoms clinical diagnosis can be made.

To make final diagnosis vascular testing can be done but one has to understand that performing peripheral angiogram test can make the condition worse.


Once the final diagnosis of purple toe syndrome is confirmed and doctor able to identify the cause then treatment become easy.


Stenting is the most common method that can be used to treat trash foot.

Stenting is done to reduce & prevent blockage of artery. A tube with mesh is introduced within artery and hold it open to help keep blood flow continue.

Bypass surgery

Bypass surgery helps to establish new way for blood flow. Bypassing a blocked part of major arteries a new blood vessel is attached to both end of affected part.


Anti-coagulant or anti-platelet aggregation medicine can be started.

This condition demand immediate treatment otherwise gangrene can develop. Gangrene is nothing but a condition where soft tissues of body start to die due to lack of blood supply and oxygen.

Dr. Sachin

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Brenda Sharp - January 2, 2017

My husband has had femoral stents and an atherectomy of left calf artery. He is on an a type of super-aspirin type anti-coagulant rather than plavix because of a past reaction to plavix. Since the Atherectomy, he has developed blue toes in the one foot and cannot sleep more than a few minutes to a half hour at a time because of the pain he is in. This has been getting worse all month. My questions are:
1. What should he do? You mentioned that the anticoagulant can lead to Blue Toes. Is there some other way to avoid this?
2. Can he take a pain medication so that he can sleep? Will it make his circulation worse? What is best to take. tylenol has no effect.
3. Should he have MRI or new assessment for new blockages? Then what? more atherectomy? a bypass? Supervised Walking? (in spite of the tremendous pain)
4. It seems that he can’t have a shower or soak his foot without this bringing on a lot more pain. Why is this?
5. He has developed a blister sore on the side of the most affected toe, as well as a blackish line on the toe. What does this mean?
6. How can we save his toes? his foot? Please help and advise. His doctor is out of town another week, and we were hoping for some direction so we could perhaps help guide the nurse if we call in tomorrow.

    Dr. Sachin - January 3, 2017

    Hello Brenda,

    First of all, it is very difficult to provide you advice without examining the patient. It will be better if you take advice of physician (in case of your husband you should take an advice of a surgeon).

    1. We do not mention that anticoagulant leads to blue toe syndrome, using anticoagulant is one of the part of its treatment.
    2. He can take the pain medications recommended by his doctor to relieve pain.
    3. Yes, further investigations are required in his case so clear picture of disease prognosis comes out. As per the description that you have provided, it seems like he has new blockage in leg which might be leading to gangrenous state of leg.
    4. Yes, pain is primary indicator of blockage of artery.
    5. Blackish line might be demarcation line that develops in case of gangrene sets in.
    6. First thing you should do is to rush hospital for further investigations and surgeons advice. Please note that as early he start his treatment, it is better for his health.

    I hope you got some answers to your queries. (Please note that this is just my simple opinion and should not be taken as medical advice, please visit your nearest doctor to get treatment started)

diane - March 3, 2017

my husband’s toe turned blue. Went to podiatrist suggested vascular doc took tests blood flow fine suggested aspirin went to md suggested back x ray said degenerative disc disease suggested pain management doc toe still blue

Lucia - July 17, 2017

Hello My name is Lucia
I wanted information in regards to what would be proper procedure after this has been diagnosed? my father is diabetic he clipped his nail and got infected with mrsa. his wound hasn’t healed now his whole toe is purple and his whole foot is red and swollen. he was treated for mrsa and released form the hospital 4 days after. the arteries connected to his foot are clogged they did an angiogram and after the procedure his foot has worsen and is in a lot of pain. we bring him in to see his dr and they tell us they cant do anything else about it but amputate. the podiatris is on vacation and they are making my father wait. he has been having this pain and issues wth his foot since the beginning of june. and yet they haven’t done anything about it. we need help we want to help him with his pain but meds that have bee prescribed are not helping and his foot gets worse daily.

    Dr. Sachin - July 18, 2017

    Is he diabetic too? MRSA is difficult to treat and in the case of your father amputation is the primary line of treatment. And yes, many time pain in such conditions are unbearable and does not subside easily.

    Karen Uhl - August 10, 2017

    I have read that colloidal silver and essential oils have cured mrsa. To improve healing, sugars and carbs except nonstarchy veggies need to be eliminated from diet. teaches about ketosis diets. Dr. Axe teaches more on nutrition. My prayers will be will your family.

Aaron - August 14, 2017

What are your thoughts on taking Niacin(OTC) to help increase cardiovascular blood flow to the cyanotic toes effected by “blue toe” syndrome?

    Dr. Sachin - November 11, 2017

    Niacin can help but you have to treat the underlying cause that blocking the arteries.

Michelle - January 15, 2018

My toes turn blue when cold, or unelevated. It comes and goes, but is starting to happen almost daily now. What should I do? Do I need to see a foot doctor or a cardiologist?

    Dr. Sachin - January 15, 2018

    Does any other part of extremities become blue? You need to see a cardiologist first then also have an opinion of a podiatrist.


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