Frostbite
Ask the Podiatrist
Don't Get Bitten by the Frost
--Dr. Jay C. Goldstein
Q: This past winter I went for a long hiking trip. I didn't plan adequately for the cold weather east of the Cascades. The tips of several toes became numb. When I finally got back to camp and was able to remove my boots and socks, I noticed that some of my toes were very grayish-white. As I warmed up, my toes became red and very painful. Eventually a black scab developed. The scab dropped off, along with some skin. The toes still become tender when I run, and often go through some color changes. When they become whitish, I soak them in hot water. Then they become red, and even more painful. I am 36 years old, and until this happened, I had no problems.
A: A long time ago, keeping warm was frequently a matter of survival. Caves did not come equipped with heat. Mother Nature decided that toes were more expendable than the brain, the heart, or the liver. Therefore, when exposed to significant cold, our bodies reduce the blood flow to our extremities, in order to keep the more essential parts of our bodies supplied with oxygen, nutrients, and heat. In more extreme cases, our extremities are literally being sacrificed in order to save vital organs. Since the toes are farthest from the heart, they get the least circulation, and, therefore, are among the first to suffer.
When your toes became numb, and turned white, you were in an early stage of frostbite. Once you got back to shelter, your body no longer needed to sequester blood, and rerouted the blood to the areas that needed it most, which in this case included your toes. Therefore, your toes became red. In addition, your nerves decided to inform you of their displeasure regarding the damage to your toes.
Unfortunately, the tissue damage was not quite so temporary. The skin that was damaged the most died. You observed the burial of the dead tissue when it turned black and dropped off.
PROPHYLAXIS
The nerves and blood vessels at the tips of your toes are still unhappy about the trauma they have suffered. They are more sensitive to stimulation, especially by the cold. Therefore, you must vow to keep them warm (but not hot). Your body will not keep your toes warm if other areas are cold. Thus, you must keep your head warm by wearing a hat in cool weather, even if you would not have done so previously. You may lose almost half of your body heat through your scalp.
The same argument applies to other parts of your body. Until you warm up thoroughly, when running, you may need to wear a windbreaker. As soon as you begin to perspire, adjust your body heat by zipping and unzipping your windbreaker. If you become very warm, remove the windbreaker and/or your hat, but do NOT allow yourself to cool off while still outside.
There are other factors that may be involved. The tissue that remains at the end of your shoes has had a hard time surviving. It is very prone to damage from even small amounts of trauma. Make sure your shoes are long enough so that they do not rub your toes, not even a little! This applies to all your shoes, including your street shoes. In addition, this is not a good time to play football or soccer.
Certain medications, such as decongestants, may cause your blood vessels to constrict. Such medications should be avoided, if possible. There are few activities that have been documented to constrict blood vessels at the tips of the toes as much as smoking.
TREATMENT
If your toes should become white and/or cold, warm them with water at about 100 oF. You may use other parts of your body to warm your toes if warm water is not available. Do NOT use hot water. Do NOT rub your toes. However, best of all, try to avoid such damaging situations; each time the tips of your toes are injured, healing will be increasingly difficult.
Eventually, your toes may improve, although they will probably always be somewhat sensitive to cold, and possibly also to trauma. If they do not continue to improve, certain medications may be helpful.
A final word of caution: Unless you are exercising, even outdoor temperatures as high as 60 oF. may cause hypothermia type problems if you are not properly clothed.
Perhaps the lyrics should have been: "Jack Frost nipping at your toes."
Dr. Goldstein is Board Certified in Podiatric Surgery, Podiatric Orthopedics, in Podiatric Medicine and his practice is located in Portland, Oregon. He has been running for many years. Thus far, he has kept Jack Frostbite at bay.