Two possible causes of cold toes

Dear Dr. Roach: I am 79. I have lupus, and my main focus is the lungs (COPD, asthma), which is under control. However, no one seems to be able to tell me what to do to prevent my toes from feeling like they have been soaking in ice. I wear warm socks day and night. I have asked the nephrologist, rheumatologist and pulmonologist, and no one has an answer. — M.M.R.

Dear M.M.R.: Although many people may have cold-feeling toes, your medical condition and age present two particular possibilities.

The first is peripheral artery disease. All of the body’s arteries can be blocked by cholesterol and calcium plaques. This condition is called atherosclerosis. It is the same condition that causes heart attacks and strokes when the blockages are in the arteries. Symptoms of peripheral artery disease also include pain or cramping. Diagnosis is important, because treatment can also help prevent a heart attack or stroke. Testing is with a Doppler ultrasound of the blood vessels of the legs. I’d recommend this to you.

The second is Raynaud’s phenomenon. Most people know that Raynaud’s can cause color change and a painful coldness of the hands when exposed to even very mild cold air, but the toes and feet may be affected as well. Occasionally, the feet alone are affected. The color change won’t be noticeable if you are wearing your warm socks and shoes.

Lupus is a common condition associated with Raynaud’s, but many people don’t know that inflammatory rheumatological diseases increase the risk of atherosclerosis as well. Doctors must have an awareness of the increased risk and stand ready to test for and treat heart disease in people with lupus.