Are COVID toes a thing?
Posted: Aug 21, 2020
During the peak of the COVID-19 pandemic in the winter months there started to appear multiple reports from Spain and Italy of chilblains on the toes being common in those with COVID-19. Chilblains are more common in the winter months, so initially it was not clear if this was just a coincidence or it was part of the COVID-19 problem. As the number of reports increased and it was being noted in other countries, it was started to be taken seriously and not just as an odd finding. Chilblains are typically small painful red colored lesions on the toes that are due to a poor reaction of the small blood vessels in response to the colder temperatures. If they continue to occur and become chronic, they take on a darker blue color. They are typically treated by avoiding the cold, keeping the feet warm and using creams to stimulate the circulation and healing.
While a lot is still be learnt about COVID-19, it has become clear that as part of the process there is a cytokine inflammatory reaction that has a number of affects, one of which is that it increases the reactivity of the small blood vessels. Based on this understanding it could be seen how chilblains could be a factor in a COVID-19 condition making the COVID toes a real thing. Those with the conditions that develop the COVID toes are not typically those who would normally get a chilblain, but that issue with the vascular reactivity would predispose to them. They do appear to be more common in children. There has been some caution raised about this as it could be that the COVID toes actually have nothing to do with the COVID-19 infection and simply be a factor of lifestyle changes due to the lockdown, with more reliance on things like central heating in housing in the colder climate that is causing the increased prevalence of the chilblains. At this stage it is not totally clear which one of these is the issue.
Which ever it is, clinicians need to be on the look out for this thing that become known as COVID toes and be aware what the presence of that symptom means. For example, if someone has a chilblain that is atypical and they do not normally get chilblains in the colder weather, then a red flag might need to be raised to further investigate any other symptoms that might be present indicating a more serious problem. Alarm bells might need to go off. If someone does have COVID-19 and develop a chilblain, then that is going to need to be treated in the context of the bigger problem with all the usual precautions taken. The foot is going to need to be protected from the cold with the use of good shoes and socks that keep the foot warm. Advice is going to need to be given on how to avoid the cold. There are various creams and ointments that can be used to help with the pain and stimulate the circulation.
Craig Payne is a University lecturer, runner, cynic, researcher, skeptic, forum admin, woo basher, clinician, rabble-rouser, blogger and a dad.