Seeking Insight on Purple Toes and Unexplained Pain
I am a 38-year-old woman with a comprehensive medical background, details of which I will provide below. Recently, I have been experiencing severe discomfort in my right foot, accompanied by bruising. My two smallest toes have turned a concerning shade of purple, and while I don’t wish to exaggerate, I find myself anxious about the possibility of losing a toe. I would like to know which medical specialty I should consult for this situation. On February 12, I underwent a bilateral SI joint cortisol epidural, marking my third injection in the lower back region. Later, on February 19, I went to the emergency department due to numbness and pain in my right leg, fearing it might be connected to the previous procedure. An ultrasound was clear, but both the Physician Assistant and the doctor were perplexed yet not overly worried. After administering Toradol, I did feel some relief. By March 3, during a follow-up with the pain management team responsible for my epidural, they assured me that my symptoms were not related. However, on March 4, I noticed a sharp increase in pain along with the appearance of purple bruises overnight. I reached out to my pain management providers, who advised me to see my primary care physician (PCP) as they believed it to be unrelated. On March 10, the discoloration worsened, and the pain became unbearable. My PCP was able to observe the discoloration during a video consultation and prescribed Nifedipine at 30 mg, along with blood tests for cardiac CRP, sedimentation rate, neutrophil cytoplasmic antibodies, PTT, and protein with INR, all returning normal results. On March 12, unable to cope with the intense pain, I returned to the emergency department, where I experienced near-syncope and hyperventilation due to the pain. An X-ray revealed no abnormalities, but the attending physician seemed baffled. My foot appeared pale and cold, with my toenails taking on a graphite hue. She acknowledged the unusual presentation, suggesting it resembled frostbite, and referred me to an emergency podiatrist. The next day, the podiatrist exhibited keen interest in my case, expressing appreciation for encountering something new. I asked about the possibility of 'COVID toes,' but he dismissed that notion, confirming it instead looked like frostbite. He then referred me to a vascular surgeon for further evaluation. On March 18, the vascular team performed various tests, including blood pressure assessments up and down my legs. They confirmed diminished blood flow to my right toes, but since my ankle had normal circulation, they advised I consult neurology or possibly rheumatology and to follow up with my PCP. They recommended an EMG and MRI and advised taking baby aspirin while increasing my Nifedipine dosage to 60 mg. Regarding the nature of my pain, it oscillates between a sensation of cold and heat, with sharpness particularly around the tips of my toes, especially my pinky. The pain extends all the way up into my hip, making it exceedingly painful to walk. Yesterday, I also began to notice mild pitting edema, and I have lost most of my foot’s range of motion. As for my medical history, I am diagnosed with hyperadrenergic POTS since 2020, gastroparesis diagnosed at various points in 2012, 2020, and 2024, a cavernous malformation identified in 2023, trigeminal neuralgia also diagnosed in 2024, and endometriosis diagnosed this year. I have a long list of conditions, so it might prove easier to inquire if there is anything particularly relevant. I do not have diabetes. I am currently taking omeprazole, norethindrone, ivabradine, gabapentin, cyclobenzaprine, Nurtec, albuterol, Xanax, cromolyn, bupropion, Gamunex, Nexaplone, Motegrity, and doxepin.
Answers (1)
3/18/2025, 9:20:44 PM
OpenHealth AI
It sounds like you are dealing with a complex and concerning situation involving purple discoloration of your toes, significant pain, and a history of medical issues. Understanding the urgency of your symptoms is crucial, and you're right to seek specific medical guidance.
Main Points:
- Your symptoms suggest issues with blood flow, possibly linked to your existing conditions.
- Consulting the right specialist is important for appropriate evaluation and management.
Explanation:
The purple discoloration in your toes, combined with severe pain and diminished blood flow, may indicate vascular problems or nerve involvement. Given your current conditions and the recent findings, it's essential to address this with specialists focused on both vascular health and potential neurological issues.
Next Steps:
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Follow Up with a Vascular Surgeon: Since diminished blood flow has already been noted, the vascular surgeon will be crucial in evaluating the vascular system of your lower extremities further.
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Neurology Consultation: Pain radiating into your hip and the cold/heat sensations may require evaluation for nerve issues, which a neurologist can address.
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Rheumatology Evaluation: Given your history and the complexity of your symptoms, a rheumatologist may help determine if there's an underlying inflammatory or autoimmune issue contributing to your symptoms.
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Continue Monitoring: Keep track of your symptoms (pain severity, discoloration, swelling) and communicate any changes to your healthcare providers.
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Pain Management: It's vital to address your pain proactively. If over-the-counter pain relievers aren't providing relief, ask your healthcare provider about adjusting your pain management strategy.
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Avoiding Aggravating Factors: Ensure you're keeping your feet warm and avoiding situations that exacerbate pain (like prolonged standing or tight footwear).
Feel free to reach out if you have any further concerns or need more guidance as you navigate this situation. Your proactive approach is essential, and I wish you the best in finding relief and clarity in your treatment.
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