“Does anyone else have a foot or toes that turn bluish-purple? The foot gets ice cold when it does that. If I massage the foot, the normal color returns. My right side is the weakest, and it’s the right foot that does this,” one MyMSTeam member wrote.

Many others in the MyMSTeam community have described similar experiences. This uncomfortable and sometimes alarming symptom may be a sign that the toes aren’t getting enough oxygen-rich blood. Healthcare providers refer to this bluish or purplish discoloration as peripheral cyanosis.

Peripheral cyanosis isn’t a disease. It’s a term for when parts of the body like the toes or fingers turn blue or purple due to reduced blood flow or oxygen delivery. A common cause of this symptom is exposure to cold temperatures. Cyanosis can also be a sign of underlying health conditions, such as those that affect the nerves or blood vessels.

Multiple sclerosis (MS) doesn’t directly cause poor circulation, but it can make existing issues worse. By affecting the autonomic nervous system, which helps regulate blood vessels, MS can lead to circulation problems such as cyanosis.

Some people notice their toes or fingers take on a bluish tint, especially after being in the cold. This color change often comes with a cold, painful sensation. In most cases, the skin returns to its usual color after warming up, but a feeling of pins and needles may follow.

What Causes Blue or Purple Toes?

Blue or purple toes usually happen when the toes or fingers don’t get enough oxygen-rich blood. This may be caused by:

• A blood circulation problem
• A response to cold or stress
• An underlying medical condition

Factors such as narrowed blood vessels, nerve damage, autoimmune activity, or medication side effects can contribute to reduced blood flow in the feet. In people with MS, these issues may overlap.

Although peripheral cyanosis is sometimes caused by low oxygen levels throughout the body, it’s more often due to reduced local blood flow. Color changes that affect only the fingers or toes point to localized issues.

Many factors can contribute to reduced blood flow in the feet, including narrowed blood vessels, nerve damage, autoimmune activity, or side effects of certain medications. In people with MS, these issues may overlap.

Here are some of the more common causes of blue or purple toes, including Raynaud’s phenomenon, chilblains, diabetes, and other blood vessel conditions.

Raynaud’s Phenomenon

Raynaud’s phenomenon is a common cause of blue toes in people with MS.

Blood vessels naturally widen and narrow to regulate blood pressure and control blood flow to specific parts of the body. For example, when you exercise, the blood vessels in your muscles expand to increase blood flow and deliver more oxygen.

When you’re cold, the blood vessels in your skin contract to help reduce heat loss and keep your vital organs warm.

Raynaud’s phenomenon occurs when blood vessels in the extremities tighten too much, usually in response to cold or stress. Raynaud’s is divided into two types:

• Primary Raynaud’s phenomenon (also known as Raynaud’s disease) occurs in people with no underlying medical condition.
• Secondary Raynaud’s phenomenon is linked to autoimmune conditions like MS, lupus, or rheumatoid arthritis.

People with autoimmune diseases are at higher risk of Raynaud’s phenomenon. According to Mayo Clinic, the condition is more common among women than men and among people living in areas with cold weather.

Raynaud’s phenomenon can also occur due to an injury or as a medication side effect. Interferon beta — a disease-modifying therapy for relapsing forms of MS (marked by periods of new or worsening symptoms followed by times of recovery) — can lead to Raynaud’s.

Chilblains

Patches of dark blue skin may form on the feet due to chilblains — small, swollen, itchy areas on the toes, fingers, ears, or nose. Chilblains may develop as a result of cold temperatures and often go away within a few weeks. It’s important to avoid scratching chilblains because the weakened skin can break and increase your risk of infection.

Some members of MyMSTeam have discussed experiencing chilblains. “My toes are so sore,” wrote one member. “They keep getting chilblains, and they’re not going away.”

Another member commented, “I had terrible chilblains on my feet as a child, and as an adult have had them on my fingers, ears, and nose! I have poor circulation and now have Raynaud’s.”

Diabetes

Diabetes is another ongoing condition that causes blue or purple toes. Over time, high blood glucose (sugar) levels can damage blood vessels and reduce circulation to the feet. Diabetes can also affect the nerves. This can lead to tingling, prickly pain that may feel similar to what some people experience during a Raynaud’s flare-up.

Other Causes

Diseases that affect the blood vessels often cause blue toes. These conditions include atherosclerosis (plaque buildup in the arteries) and vasculitis (inflammation of blood vessels).

Blue toes can also be a sign of a serious condition called deep vein thrombosis (DVT) — a type of blood clot that typically develops in the legs. DVT can lead to potentially life-threatening complications, so it requires immediate medical attention. Blue toes also can be a sign of some blood diseases that cause the blood to thicken.

Should You Worry About Blue or Purple Toes?

Having your toes or fingers turn blue can be scary and uncomfortable. Most of the time, it’s not a medical emergency. However, you should keep track of how often this symptom occurs and how long it usually lasts. These details can help your healthcare team check for other health conditions.

When Should You Seek Medical Care?

Blue toes alone aren’t a cause for panic. However, if you have other symptoms of DVT or serious cardiovascular events, seek emergency medical treatment. These symptoms include:

• Swelling in the affected area of the leg
• A leg that feels painful, sore, or crampy
• A warm feeling in the leg
• Redness or other color changes on the leg

Peripheral cyanosis isn’t a disease. It’s a term for when parts of the body like the toes or fingers turn blue or purple due to reduced blood flow or oxygen delivery.

If you experience peripheral cyanosis so often that it makes day-to-day life with MS difficult, reach out to your healthcare team. Your primary care doctor or neurologist may want to do a physical examination or blood tests to rule out certain medical conditions.

What Should You Do if You Have Blue Toes From Raynaud’s?

Blue or purple toes can be one of the frustrating symptoms of living with MS. However, you can take action to manage this symptom and help reduce or prevent flare-ups.

Warm Up

When you have blue toes, the first step is to warm your feet back up. Be very careful, and use only mild heating sources to avoid burns. Try soaking your feet in warm water, but first test the temperature with the back of your hand.

“I regularly soak my feet in warm water and have cream massaged in,” wrote one MyMSTeam member who experiences blue toes.

Having your toes or fingers turn blue can be scary and uncomfortable. Most of the time, it’s not a medical emergency

Cold temperatures are a primary trigger for blue toes, so consider wearing two pairs of socks when you go outdoors in chilly weather. Likewise, wear socks to bed or use an extra blanket to keep your feet warm. However, be careful not to get too hot — overheating may trigger MS symptoms.

Consider a Foot Massage

A gentle foot massage may help improve warmth and comfort during a Raynaud’s flare-up. You can massage your own feet, ask a loved one, or see a professional massage therapist. While massage may encourage local blood flow, it does not treat the underlying cause of Raynaud’s.

One MyMSTeam member shared their approach: “Try lymphatic massage and elevating your feet above your heart for 20-minute intervals throughout the day.”

While techniques like massage and elevation may offer temporary relief, it’s important to talk with your doctor before trying new strategies — especially for circulation issues.

Talk to Your Doctor

For persistent circulation problems, your doctor may recommend other treatment options. Several types of therapy can help manage Raynaud’s phenomenon, including:

• Medications that boost blood flow, such as calcium channel blockers or vasodilators
• Injections to help block affected nerves
• Surgery to get rid of damaged nerves

Reduce Your Risk

Certain habits and lifestyle choices may make Raynaud’s symptoms worse. To help reduce the frequency of blue or purple toes, consider lifestyle changes such as the following:

• Avoid smoking and vaping — Both can narrow blood vessels and worsen circulation, making Raynaud’s attacks more likely.
• De-stress — Stress is a known trigger for Raynaud’s. Strategies such as practicing meditation, doing breathing exercises, or talking with a mental health professional may help you manage stress.
• Stay physically active — Regular exercise can boost circulation and help improve blood flow to your feet and toes.

Talk with your doctor before making any changes to your routine, especially if you’re living with other health conditions.

Find Your Team

On MyMSTeam, people share their experiences with multiple sclerosis, get advice, and find support from others who understand.

Have you had blue or purple toes along with MS? Share your experience in the comments below.