When A Patient Presents With A Painful Red Toe

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M. Joel Morse, DPM

   A body part that suffers frostbite seldom recovers completely. Some degree of cold sensitivity and hyperhidrosis are common. Patients can experience neuropathies (including burning and tingling), decreased nail and hair growth, lymphedema, ulcerations and persistent Raynaud’s phenomenon in the affected part. Permanent tissue damage, such as subcutaneous tissue atrophy, bony defects on X-ray examination and abnormal epiphyseal growth, may occur. Patients should not smoke as this causes vasoconstriction and slows healing.

Key Pointers On Treatment

   When it comes to frostnip, patients want to flex their feet and toes to help circulate blood in them. Sometimes movement is enough to reverse frostnip. It is also imperative to get out of the cold.

   Remove wet clothing and tight items. Wet clothing greatly encourages the onset and worsening of frostbite. Patients should remove tight clothing, shoes and socks as they inhibit circulation. The outcome of a frostbite injury cannot be predicted in the first few days. For that reason, use the same treatment with all patients. Treatment involves re-warming the affected area at a temperature of 104° to 108°F (40° to 42°C). Treat the injury with aloe vera and splint, wrap and elevate the area.

   One may give injections of tetanus vaccine and penicillin. These injections protect the patient against infection. One may also give an antiinflammatory drug, such as aspirin or ibuprofen. In some cases, narcotics may be necessary to treat the severe pain that occurs with deep frostbite.

   If the frostbite is superficial, as was the case in my three patients, new pink skin will form underneath the discolored skin. The area will usually recover within six months although some people have permanent problems such as numbness, pain and stiffness in the affected area. In all patients, emphasize elevatation of the affected part to reduce swelling. Have patients drink warm, non-alcoholic, non-caffeinated fluids.

   When severe (deep) frostbite occurs, anti-clotting drugs are recommended within 24 hours of injury and within 24 hours of re-warming. Blood clot-dissolving therapy helps reduce the injury caused when frozen skin is warmed again. Inflammation during thawing typically stimulates clotting that blocks small blood vessels, leading to cell death. Since the therapy reverses this clotting, this restores blood flow before permanent damage happens.

Dr. Morse is the President of the American Society of Podiatric Dermatology. He is a Fellow of the American College of Foot and Ankle Surgeons, and the American College of Foot and Ankle Orthopedics and Medicine. Dr. Morse is board certified in foot surgery.

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