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Blue or Purple Toes and MS: Possible Causes and When To Seek Care

Updated on May 03, 2022
Medically reviewed by
Amit M. Shelat, D.O.
Article written by
Lorelei Tucker, Ph.D.

Many people with multiple sclerosis (MS) find that their toes and fingers will occasionally turn blue or purple, especially after exposure to cold temperatures. This sudden and confusing color change is often accompanied by an uncomfortable icy sensation. Most of the time, the toes return to normal after a little while, but sometimes they turn red and feel like they’re being pricked by pins and needles.

One MyMSTeam member wrote, “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.”

Many other MyMSTeam members shared that they too have experienced this symptom. This uncomfortable and often unsettling condition is called peripheral cyanosis.

What Causes Blue or Purple Toes?

Blue or purple toes can result from low blood oxygen levels in your hands and feet. (DermNet NZ)

Freshly oxygenated blood in your arteries normally has a bright red color. As the oxygen in your blood is delivered to the tissues, the blood turns a dark bluish-red color. Peripheral cyanosis occurs when your hands and feet aren’t receiving a steady flow of red, oxygen-rich blood.

Low blood oxygen levels can cause this issue, but if your skin color is only changing in your fingers and toes, it is most likely a blood circulation issue.

Raynaud’s Phenomenon

Raynaud’s phenomenon is a common cause of peripheral cyanosis in people with MS. In addition to Raynaud’s phenomenon, there are several other possible causes of blue toes.

Blood vessels expand and contract naturally as a way to regulate blood pressure and control blood flow to specific parts of the body. For example, the blood vessels in your skeletal muscles expand when you exercise to increase blood flow and deliver more oxygen. When you are cold, the blood vessels in your skin contract to help reduce heat loss and keep your vital organs warm.

In Raynaud’s phenomenon, some toes might turn white from lack of blood flow, then blue or red during rewarming. (Adobe)


Raynaud’s phenomenon occurs when the blood vessels in your extremities constrict inappropriately, generally in response to cold weather or stress. There are two kinds of Raynaud’s phenomenon — primary and secondary:

  • Primary Raynaud’s phenomenon is when the condition occurs in a person with no known health problems related to the disorder. This is also called Raynaud’s disease.
  • Secondary Raynaud’s phenomenon is when the affected person has a medical condition such as MS that is associated with the disorder.

People with autoimmune diseases like MS are at higher risk for Raynaud's phenomenon. Women tend to develop the condition more often than men, and it is more common in places with colder temperatures.

Raynaud’s phenomenon can also occur as an occupational injury or a side effect of some medications, including interferon-beta, a medication used to treat relapsing-remitting MS.

Chilblains

Patches of dark blue skin may form on the feet due to chilblains. Chilblains are small, swollen, itchy areas on the toes, fingers, ears, or nose. They may develop as a result of cold temperatures and often go away within a few weeks. You should avoid scratching chilblains, as you can easily break open the skin and increase your risk of infection.

Some members of MyMSTeam have discussed dealing with chilblains. “My toes are so sore,” wrote one member. “They keep getting chilblains and they are 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

Another chronic condition that is known to cause blue or purple toes is diabetes, which leads to a reduction of blood flow to the feet. Diabetes also causes a similar kind of tingling, prickly pain that people having a Raynaud’s attack may feel.

Other Causes

Diseases affecting the blood vessels, like atherosclerosis or vasculitis, are common causes of blue toes. In addition, peripheral cyanosis is associated with blood pressure changes and shock.

Blue toes can also be a sign of deep vein thrombosis (blood clot in the veins of your legs) — a life-threatening condition that requires immediate medical attention. Likewise, this symptom can be a sign of some blood diseases that cause the blood to thicken.

Should You Be Worried if Your Toes Are Blue or Purple?

Having your toes or fingers turn blue can be as scary as it is uncomfortable. Fortunately, most of the time, it is not a medical emergency.

You should, however, keep track of how often this symptom occurs and how long it usually lasts so your care team can check for other health conditions.

When Should You Seek Medical Care?

Blue toes alone are not a cause for panic, but if you have other symptoms of deep vein thrombosis or serious cardiovascular events, you should seek emergency medical care. Common symptoms include:

  • Leg swelling
  • Pain in the affected leg
  • A warm feeling in the leg
  • Other notable skin discoloration

If you experience peripheral cyanosis so often that it impairs your day-to-day life, you should also reach out to your health care team. Your primary care physician or neurologist may have you come in for a physical examination and may ask to perform blood tests to rule out certain blood conditions.

What Should You Do if You Have Blue Toes?

Blue and purple toes are one of the many inconveniences of living with MS. However, there are ways to manage this symptom with the help of health care professionals and your fellow MyMSTeam members. If your toes have turned blue from Raynaud’s, you can try several approaches to treat or prevent this symptom.

Warm Up

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

Keep warm when it’s cold out, too. Cold temperatures are a primary trigger for blue toes, so bundle up and try wearing two pairs of socks when you go out. Likewise, wear socks when you go to bed or keep your feet warm with an extra blanket. However, be careful not to get too hot, as overheating may trigger your MS symptoms.

Massage Your Feet

Massaging the affected foot is a great way to get the circulation back to normal. One MyMSTeam member said, “Try lymphatic massage and elevating your feet above your heart for 20-minute intervals throughout the day.”

Supplement With Vitamin D3

Some MyMSTeam members found that vitamin D3 supplements helped them treat their blue toes. This remedy is backed up by research suggesting that vitamin D3 supplements can help reduce Raynaud’s phenomenon symptoms.

Talk to Your Doctor

If you have persistent circulation problems, your doctor may recommend other treatments. For example, several different types of therapies 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

Finally, try to reduce your intake of things that can exacerbate Raynaud’s attacks. Smoking and vaping are associated with Raynaud’s symptoms, as is stress. Physical activity can also improve circulation and reduce the occurrence of blue toes.

Talk With Others Who Understand

MyMSTeam is the social network for people with multiple sclerosis. On MyMSTeam, more than 185,000 members come together to ask questions, give advice, and share their stories with others who understand life with multiple sclerosis.

Are you living with multiple sclerosis and blue or purple toes? Share your experience in the comments below, or start a conversation by posting on your Activities page.

All updates must be accompanied by text or a picture.
Amit M. Shelat, D.O. is a fellow of the American Academy of Neurology and the American College of Physicians. Review provided by VeriMed Healthcare Network. Learn more about him here.
Lorelei Tucker, Ph.D. has a doctorate in neuroscience from Augusta University. Learn more about her here.

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