There are 2 other common cold related complaints that typically affect the toes. Unlike direct tissue injury from cold like frost bite, these conditions are brought about by reactions in the small blood vessels in the digits. In Chilblains, exposure to cold leads to an inflammatory process in the small blood vessels, termed vasculitis. This can cause sensations of burning, itching and pain. A red patchy rash usually develops. The lesions can occasionally break open to superficial erosions. Treatment is supportive, keeping the area properly hydrated with moisturizers and treating erosions with antibiotic ointments to prevent infection. Reducing exposure to cold temperatures can help lessen symptoms. Extreme cold in not necessary to start the reaction. In some people, temperatures under 45 degrees, especially in damp conditions can lead to Chilblains. Raynaud’s syndrome is another cold induced condition affecting the extremities. Raynaud’s is caused by spasms of the smooth muscle in the small blood vessels of the digits in reaction to cold temperatures. This condition can result in similar symptoms of burning, itching and pain. Color changes of the toes from blue to white to red, are often seen. The underlying cause of this condition is unknown. It can be associated with connective tissue disorders such as Lupus and scleroderma. Treatment is preventative. Reducing cold exposure will minimize the symptoms. Blisters or wounds are rarely seen with Raynaud’s Underlying peripheral vascular disease and smoking can make either of these conditions worse. Nicotine constricts blood vessels, reducing blood flow. Peripheral vascular disease reduces blood flow in the large and small vessels by plaque formation on the walls of the arteries. It is important to identify and manage these risk factors early to prevent complications such as ulceration and infection which can lead to amputations. If you have any questions about the circulation of your feet and toes, come in for an examination and treatment recommendations.