Keep Frosty the Snowman on your Front Yard and Not on Your Toes!

The snowy, wet weather and chilly temperatures we have experienced in Columbus the last few weeks can lead to a variety of conditions. The extremities, and especially the feet are at risk for cold injury due to the lesser blood circulation compared to the trunk of the body.

Cold injury occurs from a combination of cell damage and decreased blood supply to the tissues. Ice crystals form in cells and the cold itself causes a disruption of the cell machinery that maintains life. Blood thickens and clogs small vessels reducing the flow of vital nutrients to tissue. Body parts with small blood vessels, usually beginning with the toes, can then develop gangrene if the condition is allowed to progress without treatment.

Some cold injuries are caused solely by the body being exposed for to an extremely low temperature for a time period longer than the body can withstand. These injuries include frost bite and types of eczema. In the above freezing temperatures around Columbus lately, frost bite is less likely to occur, but other cold injuries can develop after a previously undiagnosed disease process is exacerbated by the cooler temperatures. One condition known as pernio or chilblains looks very similar to first degree frost bite, in that the toes, feet and legs will develop bluish red patches after being chronically exposed to a cool damp environment. Cold rainy climates are where this condition is most commonly found in winter. Pernio only occurs in individuals with inherently high tone in the walls of their blood vessels in the extremities, leading to poor circulation in the feet. In individuals with normal vascular tone, pernio or chilblains would not develop. Chilblains initially presents in an acute form in which skin findings are typically only present for one week before resolving, sometimes leaving a residual area of darkened skin behind. Over time, if these acute episodes of the disease are allowed to occur repeatedly by continued cold exposure, a chronic form of chilblains can occur with swelling, ulcers and bleeding. Feet may also itch or burn in this chronic state.

The best treatment of pernio, frost bite or any other cold injury is prevention. Warm clothing with moisture wicking fabric and staying out of cold environments are the best way to avoid pernio development. Moisturizing creams or ointments can be helpful in keeping cells hydrated. If the chronic form of pernio develops with ulcers, avoiding infection and gaining skin closure of the wound will be paramount and involve regular visits with your podiatrist.



By Dr. Animesh (Andy) Bhatia