An Article Written by Yen-Chii Wong
Podiatrist – New Step Podiatry
PREVENTION AND TREATMENT
What are Chilblains?
Chilblains are a local inflammation of blood vessels (also known as vasculitis) in the peripheral extremities of the body. These body parts include the fingers, nose, ears, and most commonly in the toes. The medical term for chilblains is erythema pernio. Chilblains normally affect people who live in cooler climates, like Canberra. Growing up in sunny Brisbane, I had personally never experienced chilblains until I moved to Adelaide and Canberra.
Chilblains are identifiable through the description of your symptoms and from examination by your podiatrist. Blood tests and imaging aren’t needed to diagnose chilblains.
You may experience one or more of signs and symptoms listed here in your toes, ball of your foot or heel.
In severe and rare cases, untreated severe chilblains can start to blister or ulcerate. This can be a portal of entry for infection, so it is important to prevent them from forming or identify and treat them when they first appear.
What causes chilblains?
Our bodies are constantly adapting to the environment we’re in to keep us moving and healthy. When it’s colder, the body will restrict blood flow to the skin to keep our core temperature warmer and keep us alive (this is also why those with frostbite will lose their fingers and toes first). Sudden changes in temperature can cause the blood vessels to dilate and contract faster than they are used to, leading to damage to the vessels and surrounding areas.
Medical professionals still aren’t sure why chilblains affect some more than others. There are some factors that can increase your risk of getting chilblains:
– Being in cold, humid climates.
– Being female – chilblains are more prevalent in women compared to men.
– Putting your feet through sudden changes in temperature. For example, putting your frozen toes straight onto a heating vent or a heat pack, or putting thongs on your warm feet for a short trip out in the wintery air.
– Being less active. This can lead to a more inactive circulatory system.
– Smoking. Nicotine encourages constriction of blood vessels.
– Having a lower BMI. Simply put, there is less body fat available for insulation with those who are underweight.
– Having peripheral vascular disease (poor circulation) or other medical conditions that can affect circulation. These include diabetes, vasculitis, or Reynaud’s disease.
– Autoimmune disorders such as systemic lupus erythematosus
– Connective tissue disorders like Ehlers-Danlos syndrome
Is Raynaud’s disease the same as chilblains?
Raynaud’s disease also involves the constriction of blood vessels. They are both more common in colder climates and treatment can often be similar. However, having chilblains doesn’t automatically point to a Raynaud’s diagnosis. Chilblains develop from recurrent exposure to the cold.
On the other hand Raynaud’s can develop secondarily from inflammatory medical conditions or conditions that affect the immune system (e.g. lupus, Sjogren syndrome), peripheral vascular disease, certain drugs, infection, or because of stress to the sympathetic nervous system. You may also find that the symptoms of chilblains aren’t as persistent as those with Raynaud’s.
Those who have Raynaud’s will find that their extremities – in particular the tips of the fingers and toes – may the white or blue in colour.
How can I prevent chilblains?
As the weather is getting colder, you can try simple strategies to prevent chilblains from occurring. The main points of these prevention tips are to keep the feet at a warm, constant temperature and to encourage good overall circulation. One tip is to warm your cold feet up gradually and another tip is to not put your feet in situations where their temperatures will jump from hot to cold.
– Keep your body and other extremities warm buy wearing appropriate attire. You can do this by wearing thermals and jumpers to keep your core temperature warm, a beanie and scarf for your head, ears, and neck, and gloves for your hands.
– Make sure your feet are warm when lying in bed. When we lie flat on our backs, our legs and feet are at the same level as our heart. This means blood doesn’t flow downwards as easily as it would when standing or sitting. You can do this by wearing insulative socks to bed or a light electric blanket (make sure you test the temperature with your hand so you do not risk burning your feet when you sleep).
– Avoid walking barefoot on cold tiles or floorboards. Wear some insulative slippers, boots, or socks.
At New Step Podiatry, we have a range of Heat Holders which are socks that are 3-7x warmer than a basic cotton sock. They are made of Japanese-designed, cashmere-like acrylic yarn and are great for wearing around the house or with your work shoes. We also stock a range of slippers and boots with different widths and fits, built-in orthotic footbeds and padded fleecy lining.
– Keep active. The feet and toes are further away from your heart relative to your other extremities. Light exercise several times a week can help to get the blood pumping and improve circulation.
– Regular massage of feet and toes. This helps to boost the circulation in the narrower vessels in the toes. Some podiatrists have hypothesised that chilblain creams mainly work due to the massaging motion used on the toes when they are applied!
– Wear proper fitting shoes. Avoid putting excess pressure or friction on areas that are vulnerable to chilblains.
My chilblains are so sore, how can I treat them?
With chilblains, prevention is always better than cure. Normally, chilblains shouldn’t last for longer than 1-3 weeks. However if you already have chilblains and are looking for some fast relief, you can try:
– Self-massage of the affected areas.
– Akilwinter cream (made up of Ginkgo-Biloba, Panthenol, Beeswax, Vitamin A and E, Calendula Oil, Allantoin, Enoxolone). This can stimulate blood circulation and soothe symptoms.
– Capsaicin based cream like Zostrix HP to aid in improving blood supply.
– Low dose, over-the-counter topical steroid creams, calamine lotion, or witch hazel to soothe itching. Be careful not to smother the toes with a steroid cream as this can lead to skin thinning.
– Hirudoid cream application to help with dilation of blood vessels.
Please note that creams should only be applied to intact skin. Before using any topical treatments please discuss this with your podiatrist or GP.
– Warm paraffin wax bath. Weekly use can help to insulate and increase blood flow to your feet.
– Nifedipine or amlodipine (calcium channel blockers) which are vasodilators – they help the blood vessels widen so blood can get through more easily. These are prescribed by a general practitioner if no other treatments are effective.