“Does anyone else have a foot or toes that turn bluish-purple? The foot gets ice cold when it does that. If I massage the foot, the normal color returns. My right side is the weakest, and it’s the right foot that does this,” wrote one MyMSTeam member. Many other MyMSTeam members shared that they too have experienced this symptom. This uncomfortable and often unsettling condition is called peripheral cyanosis.

Many people with multiple sclerosis (MS) find that their toes and fingers will occasionally turn blue or purple, especially after exposure to cold temperatures. This sudden and confusing color change often comes with an uncomfortable icy sensation. Most of the time, the toes return to normal after a little while, but they sometimes get discolored and feel like they’re being pricked by pins and needles.

What Causes Blue or Purple Toes?

Freshly oxygenated blood in your arteries is normally bright red. As the oxygen in your blood is delivered to the tissues, the blood turns dark bluish-red. Peripheral cyanosis occurs when your hands and feet aren’t receiving a steady flow of red, oxygen-rich blood.

Low blood oxygen levels can cause this issue, but if your skin color is only changing in your fingers and toes, it may be a blood circulation issue.

Raynaud’s Phenomenon

Raynaud’s phenomenon is a common cause of peripheral cyanosis in people with MS. In addition to Raynaud’s phenomenon, there are several other possible causes of blue toes.

Blood vessels expand and contract naturally as a way to regulate blood pressure and control blood flow to specific parts of the body. For example, the blood vessels in your skeletal muscles expand when you exercise to increase blood flow and deliver more oxygen. When you are cold, the blood vessels in your skin contract to help reduce heat loss and keep your vital organs warm.

Raynaud’s phenomenon occurs when the blood vessels in your extremities constrict inappropriately, generally in response to cold weather or stress. There are two kinds of Raynaud’s phenomenon — primary and secondary:

• Primary Raynaud’s phenomenon is when the condition occurs in a person with no known health problems related to the disorder. This is also called Raynaud’s disease.
• Secondary Raynaud’s phenomenon is when the affected person has a medical condition such as MS that is associated with the disorder.

People with autoimmune diseases like MS are at higher risk for Raynaud’s phenomenon. According to Mayo Clinic, women tend to develop the condition more often than men, and it’s more common in places with colder temperatures.

Raynaud’s phenomenon can also occur as an occupational injury or a side effect of some medications, including interferon-beta, a medication used to treat relapsing-remitting MS.

Chilblains

Patches of dark blue skin may form on the feet due to chilblains. Chilblains are small, swollen, itchy areas on the toes, fingers, ears, or nose. They may develop as a result of cold temperatures and often go away within a few weeks. You should avoid scratching chilblains, as you can easily break open the skin and increase your risk of infection.

Some members of MyMSTeam have discussed dealing with chilblains. “My toes are so sore,” wrote one member. “They keep getting chilblains, and they’re not going away.”

Another member commented, “I had terrible chilblains on my feet as a child, and as an adult have had them on my fingers, ears, and nose! I have poor circulation and now have Raynaud’s.”

Diabetes

Another ongoing condition that causes blue or purple toes is diabetes, which leads to a reduction of blood flow to the feet. Diabetes can also cause a similar kind of tingling, prickly pain that people might feel during a Raynaud’s attack.

Other Causes

Diseases affecting the blood vessels, like atherosclerosis, which is the buildup of plaque in the arteries, or vasculitis, which is inflammation of the blood vessels, are common causes of blue toes. Peripheral cyanosis, another cause of blue toes, can occur due to changes in blood pressure or conditions like shock, which reduce oxygen in the blood.

Blue toes can also be a sign of deep vein thrombosis (blood clot in the veins of your legs) — a life-threatening condition that requires immediate medical attention. Likewise, this symptom can be a sign of some blood diseases that cause the blood to thicken.

Should You Be Worried if Your Toes Are Blue or Purple?

Having your toes or fingers turn blue can be as scary as it is uncomfortable. Fortunately, most of the time, it’s not a medical emergency.

You should, however, keep track of how often this symptom occurs and how long it usually lasts so your health care team can check for other health conditions.

When Should You Seek Medical Care?

Blue toes alone are not a cause for panic, but if you have other symptoms of deep vein thrombosis or serious cardiovascular events, you should seek emergency medical care. Symptoms that may warrant urgent medical treatment include:

• Leg swelling
• Pain in the affected leg
• A warm feeling in the leg
• Other notable skin discoloration

If you experience peripheral cyanosis so often that it impairs your day-to-day life, also reach out to your health care team. Your primary care physician or neurologist may have you come in for a physical examination and may ask to perform blood tests to rule out certain blood conditions.

What Should You Do if You Have Blue Toes?

Blue and purple toes are one of the many inconveniences of living with MS. However, there are ways to manage this symptom with the help of health care professionals and tips from your fellow MyMSTeam members. If your toes have turned blue from Raynaud’s, you can try several approaches to treat or prevent this symptom.

Warm Up

When you have blue toes, the first step is to warm your feet back up. Be very careful, and only use mild heating sources to avoid burning your feet. Try soaking them in warm water, but test the temperature with the back of your hand first. “I regularly soak my feet in warm water and have cream massaged in,” wrote one MyMSTeam member who experiences blue toes.

Keep warm when it’s cold out, too. Cold temperatures are a primary trigger for blue toes, so bundle up and try wearing two pairs of socks when you go out. Likewise, wear socks when you go to bed or keep your feet warm with an extra blanket. However, be careful not to get too hot, as overheating may trigger your MS symptoms.

Massage Your Feet

Massaging the affected foot is a great way to get the circulation back to normal. Another MyMSTeam member said, “Try lymphatic massage and elevating your feet above your heart for 20-minute intervals throughout the day.”

Talk to Your Doctor

If you have persistent circulation problems, your doctor may recommend other treatments. For example, several different types of therapies can help manage Raynaud’s phenomenon, including:

• Medications that boost blood flow, such as calcium channel blockers or vasodilators
• Injections to help block affected nerves
• Surgery to get rid of damaged nerves

Reduce Your Risk

Finally, try to reduce your intake of factors that can worsen Raynaud’s attacks. Smoking and vaping are associated with Raynaud’s symptoms, as is stress. Physical activity can also improve circulation and reduce the frequency of blue toes.

Talk With Others Who Understand

On MyMSTeam, the social network for people with multiple sclerosis and their loved ones, more than 215,000 members come together to ask questions, give advice, and share their stories with others who understand life with multiple sclerosis.

Have you had blue or purple toes along with MS? Share your experience in the comments below, or start a conversation by posting on your Activities page.