Red, White and Blue!!

April 15, 2011
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As we continue our journey this month through some of the more uncommon podiatric injuries, pathologies and diagnoses, I’d like to discuss Raynauds Disease. Raynauds is defined as an abnormal or overly aggressive constriction of the small arteries in the toes and fingers precipitated by exposure to cold temperatures. When the small arteries constrict, circulation to the toes and fingers becomes limited and the perception on behalf of the patient is that those areas of the body are numb.

Raynauds, also known as the “red, white and blue syndrome” secondary to its clinical presentation, is most common in women and is often undiagnosed. Patients disregard symptoms as normal or non-important during cold winter months when fingers and toes are typically cold, and thus their symptoms go unreported to physicians. The signs and symptoms are related to the severity of the disease, but as mentioned typically present as cold or numb toes and fingers (digits). As the pathology progresses, the digits become red in color, followed by white, followed by blue, signaling the most severe stage of the disease and living up to its nickname!

Patients suffering from raynauds do not experience a constant feeling of cold, tingling or numbness in their digits, but rather the symptoms appear during raynaud “attacks.” It can, on some level be related to an asthma attack whereby exposure to aggravating factors induces symptoms. These attacks can target just one or two toes or fingers or may affect all toes and fingers simultaneously. Symptoms appear secondary to exposure to cold temperatures (most commonly) and may appear during times of physical or emotion stress. Hormones produced during times of stress change balances within the body and may lead to attacks and presentation of symptoms. However, the underlying etiology of Raynauds Disease and why some individuals suffer from it, and not others, is largely unknown.

What we do know is that a secondary form of raynauds exists, where symptoms present as a side effect of other disease states such as: Scleroderma, Lupus, Rheumatoid Arthritis, Sjogren’s syndrome, trauma, and smoking to name a few. When associated with such pathologies, raynauds is referred to as “Raynauds Phenomenon” (as opposed to raynauds disease) and tends to induce slightly more serious attacks.

To determine the presence of raynauds and to separate the disease from the phenomenon, clinical presentation in addition to a complete medical history taken by your Podiatrist is necessary. A cold-stimulation test, where the toes are placed in cool water to trigger an attack can be used to help aid in diagnosis, but is rarely performed or necessary. Blood work may be drawn to help rule out any of the underlying diseases specific to the phenomenon, versus primary raynauds where there is no associated disease.

Besides enduring symptoms between attacks and holding out for summer when the winter weather fades and the temperatures rise, patients rarely experience debilitating consequences. However, if severe cases do occur, complications arise from permanent constriction of one of the small arteries within the toes or fingers, compromising blood flow to the area. Permanent constriction can lead to ulcerations with the inability of these ulcerations to heal and in the worst-case scenario, loss of the involved digits.

Prevention of attacks is the best attitude to take with raynauds. Keeping the severity and numbers of attacks to a minimal helps prevent tissue damage and permanent constriction. Therefore, keeping your hands and feet warm with heavy gloves and socks is a must, especially during winter! In addition, daily checks of fingers and toes can help catch early signs of ulceration, so that further skin damage and breakdown don’t occur. Bi-annual checkups by your Podiatrists are also recommended, especially for patients with associated disease states or difficulty visualizing their own feet. Medications can be used, but are reserved for severe cases and most patients will never need to take medications for treatment of their raynauds. Such agents are aimed at dilating blood vessels to promote circulation and decrease the risk of constriction.

Check back next week as we tackle yet another uncommon podiatric diagnosis!

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