The blue toe syndrome refers to the sudden appearance of one or more toes becoming blue to purple. Often a serious underlying disease is present.


Clinical features:

(1) sudden onset of discrete blue or purple areas involving the toes or foot

(2) painful initially, with discomfort decreasing after several days

(3) tender to palpation

(4) lesions darken if the leg is held dependent

(5) signs of ischemia may develop (ulceration to gangrene)

(6) asymmetric if bilateral



(1) small atheroemboli (see Section 06.26)

(2) vasculitis

(3) hypercoagulability (including DIC)

(4) hyperviscosity (cryoglobulinemia, macroglobulinemia, other)

(5) cardiac microemboli (often associated with endocarditis or atrial myxomas)

(6) calciphylaxis

(7) corticosteroid-related

(8) cold exposure with vasospasm

(9) following podiatric surgery or trauma


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