OpenHealth Q&A

Purple Toes: A Medical Mystery

I’m a 38-year-old woman dealing with a complicated medical history, which I’ll detail at the end. Lately, I’ve been experiencing severe pain in my right foot, and to make matters worse, my two smallest toes have developed a disturbing purple discoloration that has me genuinely anxious about the possibility of losing a toe. I am seeking guidance on which medical specialty I should consult for this issue. Here's a brief timeline of my experience: * On February 12, I received an epidural for bilateral sacroiliac joint pain; this was my third injection in that area. * By February 19, I found myself in the emergency department due to numbness and pain in my right leg, suspecting it might be linked to the injection. However, an ultrasound showed nothing unusual, and although the physician's assistant and doctor were puzzled, they appeared unconcerned. * Consulting with the pain management team on March 3, they assured me that my discomfort was likely not related to the recent procedure. * On March 4, I noticed significant pain escalation along with new purple bruising that appeared overnight. I reached out to pain management for advice, and they recommended visiting my primary care provider (PCP), indicating it was unrelated to their treatment. * By March 10, I observed a steady increase in discoloration, and the pain became unbearable. During a video appointment, my PCP assessed the changes and prescribed Nifedipine (30mg), ordering various tests including Cardiac CRP, sedimentation rate, and others, all of which returned normal results. * I returned to the emergency department on March 12 due to crippling pain; I experienced pre-syncope and hyperventilation. An X-ray yielded normal results, but the examining doctor was baffled. My foot was very pale, cold, and my toenails appeared gray. The doctor mentioned that my symptoms resembled frostbite and referred me to an emergency podiatrist. * On March 13, the podiatrist was intrigued by my condition and, while ruling out "COVID toes," reiterated the frostbite comparison, leading me to vascular surgery for further evaluation. * On March 18, vascular testing confirmed decreased blood flow to my right foot, yet since my ankle showed normal circulation, they said it wasn’t their area of expertise. They advised consulting neurology or rheumatology while awaiting an EMG and MRI, prescribing baby aspirin and upping the Nifedipine to 60mg. * The neurologist performed an EMG on March 19, which yielded normal results. She expressed confusion about my case and noted that the ankle exhibited reduced blood flow based on pulse evaluation. * I have another appointment scheduled with my PCP on March 24, followed by rheumatology on March 31. Regarding the pain: it fluctuates between hot and cold sensations, with sharp discomfort particularly affecting my pinky toe and radiating up to my hip. My entire foot has become excessively painful to walk on. Recently, I also experienced mild pitting edema for the first time and my range of motion has diminished significantly. **Medical History:** I have been diagnosed with hyper-POTS (2020), gastroparesis (diagnosis dates: 2012, 2020, 2024), a cavernous malformation (2023), trigeminal neuralgia (2024), and endometriosis (2024). With this extensive history, it might be easier to ask what’s not relevant; importantly, I am not diabetic. **Current Medications:** I take omeprazole, Norathindrone, ivabradine, gabapentin, cyclobenzaprine, Nurtec, albuterol, Xanax, cromolyn, bupropion, Gamunex, Nexaplone, Motegrity, and doxepin.

Answers (1)

3/19/2025, 4:20:50 PM

OpenHealth AI

I'm sorry to hear about the distressing symptoms you're experiencing. The combination of severe foot pain and purple discoloration could indicate an issue with blood flow or nerve function. Based on your symptoms and complex medical history, it's crucial to approach this with a structured plan.

Key Points:

1. Possible Causes: Purple toes may be related to vascular issues, nerve problems, or other systemic conditions. The fluctuation of sensations and the foot's discoloration suggests a potential circulation or neural compromise.
2. Current Evaluations: You are already undergoing tests and consultations with specialists, which is a good approach.

Next Steps:

1. Continue Specialist Consultations:

   • Rheumatology Appointment: This is critical, as they can evaluate for autoimmune conditions that might affect blood vessels or nerves.
   • Follow up with Neurology: If any symptoms persist or worsen, particularly pain or numbness.

2. Monitor Symptoms:

   • Keep a detailed record of your symptoms, including when they worsen or improve, any new symptoms, and changes in skin color or temperature. Share this information with your doctors during appointments.

3. Self-Care Measures:

   • Elevation: Elevate your legs when resting to reduce swelling and promote circulation.
   • Warmth: Apply warm (not hot) compresses to your foot to help improve blood flow, but be cautious not to burn your skin.
   • Hydration: Staying well-hydrated can help with circulation. Aim for clear fluids unless you have restrictions.

4. Emergency Signs:

   • Seek immediate medical help if you experience severe pain increases, develop fever, or if any symptoms like numbness or discoloration escalate significantly.

5. Medication Review:

   • Discuss your current medications with your healthcare provider, especially considering how they might interact with your symptoms or each other. Adjustments may be necessary to improve your condition.

It's understandable to feel anxious given your situation, but reaching out to specialists and actively managing your symptoms are positive steps. Let me know if you need more specific information or reassurance regarding your situation.