Venous purple toe syndrome: a variant of acrocyanosis

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Society for Vascular Medicine Annual Scientific Sessions, September 9-11, 2021, Virtual


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Background: Acrocyanosis is commonly described as a painless condition characterized by discoloration of different shades of blue in the distal parts of the body that is marked by symmetry and persistence of color changes aggravated by cold exposure. The venous variety is often mischaracterized as blue toe syndrome, Raynaud’s phenomenon or pernio. This is first report of this variant.

Case: Retired female presents for 2nd opinion in regard to purple discoloration of toes. First noticed in past Winter with feet exposed to cold floors. Has been improving with warmer temperature in weeks of Spring. Patient with normal pulse examination. Toe discoloration resolves with elevation. See Figure.

Discussion: During COVID-19 pandemic more people are spending time indoors without shoes and often socks and as a result more frequently identify toe and foot discoloration. Patients can present for concern only about discoloration, but there can be foot pain and ulceration when noted in cooler months. A subclassification of acrocyanosis has venous congestion component. On presentation toes and sometimes entire foot have deep purple coloration. This can be distinguished from other arterial and vasospastic disorders in that this resolves with leg elevation and massage in cephalad direction. See picture for typical presentation.

Conclusion: Discoloration improves with compression which is hallmark. When present because of foot deformity that is not correctable warming measures can be helpful as well as potentially bioflavonoids.

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Cardiovascular (Heart)


Center for Cardiovascular Analytics, Research + Data Science (CARDS)



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