<s>[INST] My 27-year-old daughter, who has Down Syndrome, has puffy toes with purple areas on the tips and top surface. They are also cracked. I don t think she has this in warm weather. She says she feels no discomfort. Last winter, her doctor had her feet scanned for circulation problems and found none. Is this recurring condition anything to worry about? [/INST] Hi, It could be small hemorrhage from the veins. Can happen in certain diseases like Renauld's disease (a type of peripheral vascular disease). I suggest a consultation with a surgeon ASAP. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. Gopal Goel, Orthopedic Surgeon </s>