“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 others in the MyMSTeam community have described similar experiences. This uncomfortable and sometimes alarming symptom may be a sign that the toes aren’t getting enough oxygen-rich blood. Healthcare providers often describe this bluish or purplish discoloration as peripheral cyanosis.

Peripheral cyanosis isn’t a disease. It’s a term for when parts of the body like the toes or fingers turn blue or purple due to reduced blood flow or oxygen delivery. While exposure to cold temperatures is a common cause, this symptom can also signal underlying health conditions, including those that affect the nerves or blood vessels.

For people living with multiple sclerosis (MS), the condition itself doesn’t directly cause poor circulation, but it can contribute to circulation problems — such as cyanosis — by affecting the autonomic nervous system, which helps regulate blood vessel function.

Some people notice their toes or fingers take on a bluish tint, especially after being in the cold. This color change often comes with a cold, painful sensation. In most cases, the skin returns to its usual color after warming up, but it may also be followed by a “pins-and-needles” feeling, also known as paresthesia.

What Causes Blue or Purple Toes?

Blue or purple toes usually happen when the toes or fingers don’t get enough oxygen-rich blood. This may be due to a problem with blood circulation, a response to cold or stress, or a sign of an underlying medical condition.

One medical term for this color change is peripheral cyanosis, which simply means the skin turns bluish or purplish due to reduced oxygen in the blood reaching the extremities. While this can sometimes be caused by low oxygen levels throughout the body, it’s more often due to reduced local blood flow — especially if the color change only affects the fingers or toes.

Many factors can contribute to reduced blood flow in the feet, including narrowed blood vessels, nerve damage, autoimmune activity, or side effects of certain medications. In people with MS, these issues may overlap.

The following sections explore some of the more common causes of blue or purple toes, including Raynaud’s phenomenon, chilblains, diabetes, and other blood vessel conditions.

Raynaud’s Phenomenon

Raynaud’s phenomenon is a common cause of blue toes in people with MS.

Blood vessels naturally dilate (expand) and contract (narrow) 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’re 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 tighten too much, usually in response to cold or stress.

There are two types of Raynaud’s:

• Primary Raynaud’s phenomenon (also called Raynaud’s disease) occurs in people with no underlying medical condition.
• Secondary Raynaud’s phenomenon is linked to autoimmune conditions like MS, lupus, or rheumatoid arthritis.

People with autoimmune diseases, including MS, are at higher risk for developing 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, one of the disease-modifying therapies for relapsing forms of 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

Diabetes is another ongoing condition that causes blue or purple toes. Over time, high blood glucose (sugar) levels can damage blood vessels and reduce circulation to the feet. Diabetes can also affect the nerves, leading to tingling, prickly pain that may feel similar to what some people experience during a Raynaud’s flare-up.

Other Causes

Diseases affecting the blood vessels are common causes of blue toes. These include atherosclerosis, which is the buildup of plaque in the arteries, and vasculitis, which is inflammation of the blood vessels.

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 healthcare 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 healthcare 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 From Raynaud’s?

Blue or purple toes can be one of the frustrating symptoms of living with MS. However, there are ways to manage this symptom with the help of healthcare professionals and tips from your fellow MyMSTeam members.

If your toes have turned blue from Raynaud’s, there are steps you can take to help reduce or prevent flare-ups.

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

Certain habits and lifestyle choices may make Raynaud’s symptoms worse. To help reduce the frequency of blue or purple toes, consider the following steps:

• Avoid smoking and vaping — Both can narrow blood vessels and worsen circulation, making Raynaud’s attacks more likely.
• Manage stress — Stress is a known trigger for Raynaud’s. Practices like meditation, breathing exercises, or talking with a mental health professional may help.
• Stay physically active — Regular movement can boost circulation and help prevent episodes of poor blood flow to your feet and toes.

Talk with your doctor before making any changes to your routine, especially if you’re living with other health conditions.

Find Your Team

On MyMSTeam, the social network for people with multiple sclerosis and their loved ones, 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.