Chilblains

Most of us will have experienced that ‘defrosting’ feeling when we move from being outside in the cold where our toes (or fingers) feel a little numb and stiff, and then we move indoors to warmer temperatures. It almost feels like a rush of blood as our extremities start to warm up, leading to them suddenly feeling tingly, uncomfortable and even painful. This feeling is very similar to chilblains, except that with chilblains, the sudden warmth causes the blood to leak out of the vessels, turning our toes red and leaving them feeling sore and tender. The resulting damage and symptoms can last weeks.

Signs and symptoms of chilblains include:

• Pain and throbbing at the toes (and fingers)
• Red or purple discolouration in patches 
• Inflammation and swelling
• Itchiness and sensitivity around the toes
• Changes in skin texture, with the skin becoming dry, scaly or hardened
• Severe chilblains may blister, become eroded, or may even ulcerate

When callus builds up excessively on the heels of the feet and then dries out, it can also cause cracked heels (fissuring), a frustrating and often painful condition. The risk with cracked heels is that it’s not just the dry callus that cracks, but the healthy skin beneath the callus can crack open too, leading to bleeding and putting you at risk of infection if bacteria enters the cracks and takes hold.

To best understand chilblains, we must understand that the blood vessels in our feet regularly expand (dilate) and narrow (constrict) depending on several circumstances, with one of them being our environment and whether we’re being exposed to hot or cold temperatures. When it’s hot, our blood vessels dilate, letting more blood flow through the vessels in an effort to get rid of any extra warmth and keep our core body temperature regulated. When our feet are exposed to cold temperatures, our body naturally wants to limit the loss of heat to prevent our body temperature from dropping excessively. So our vessels narrow and constrict, meaning a smaller volume of blood will be passing through the vessels.

With chilblains, it is the rapid change from vasoconstriction (narrow vessels) to vasodilation, where the blood starts rushing through, this can cause damage to the vessels and result in blood leaking to the surrounding tissues - so the affected area (often the toes) becomes inflamed, red and tender. Your toes may also throb and itch - but you must be careful not to scratch them as your skin may be more vulnerable to breaking at this stage.

Examples of scenarios that may trigger this response include going from the snow straight into a hot shower, and putting very cold feet directly in front of a fire or heat source. 

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Chilblains are a self-limiting condition, meaning that mild cases will typically resolve within a few weeks. During this time, you can support your healing and progress by:

• Keep the affected areas warm by wearing good warm socks and warm shoes when outdoors, while avoiding exposing your feet to cold temperatures where possible.
• Rewarming the affected areas slowly if they do become cold again, as sudden exposure to heat can worsen symptoms. An example includes starting off with a slightly warm water applied to your feet in the shower, instead of going straight to hot water.
• Using over-the-counter creams or ointments that contain ingredients like calamine, aloe vera, or witch hazel may naturally help soothe itching and reduce inflammation without further damaging the skin.
• Elevating your feet can help reduce swelling and promote blood circulation and healing.
• Avoiding tight footwear that presses on the toes, instead opting for comfortable footwear with plenty of room in the toe box.
• Avoiding scratching the affected areas, which can otherwise further irritate the skin and put you at risk of infection. If your feet are feeling very itchy, try anti-itch creams to help.
• Engaging in gentle exercises or movements, such as walking or wiggling the toes and going for gentle walks can help promote blood circulation and reduce your discomfort.

Here at Matt Raden Podiatry, our trusted and experienced podiatrists listen to the concerns, goals and needs of our patients with chilblains and utilise evidence-based treatment methods to help you get the best outcome. 

While in the case of chilblains, the damage has already been done and you’ll need to focus on caring for your feet at home and preventing another episode of chilblains in the future, for many of our patients, they may have underlying problems that either make it much easier to develop chilblains (like poor circulation associated with diabetes), or put them at risk of skin damage once they have chilblains. In this case, we may help with elements like helping you dress the toes, using special props and toe separators to help prevent the toes from rubbing against one another and causing further damage, and helping heal any other foot-related problems currently present that may be further complicated by chilblains - like having hard or soft corns present between your toes. If you’re worried your toes may be infected, we can also assess this and help you take the right steps to treat and protect your feet.

Remember, in the case of chilblains, prevention is 100% the best cure - and preventing chilblains can be done by just following very simple principles - though we know that it can feel difficult when your feet are very cold and you just want some warmth and relief. In these cases, just avoid exposing your feet to direct heat and let them warm up somewhat first before jumping in the shower or getting that hot water bottle. Put an extra pair of socks on, jump under a blanket (not an electric blanket!) or try to stay at room temperature for 10-15 minutes before starting to actively heat your feet. Let your feet naturally adjust to a slight increase in temperature so the vessels gradually expand without damage.