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Cyanotic toes

Discussion in 'General Issues and Discussion Forum' started by Samj, Nov 29, 2010.

  1. Samj

    Samj Member

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    Hi everyone

    I would be very grateful for any advice/information regarding a patient I have seen. A 37 year old Somalian female complaining of 12 month history of painful discoloured toes. She is currently taking tramadol 50mg for back pain, non smoker or drinker. Presented with all toes cyanotic, slightly oedematous and painful to touch. There was no broken skin, foot pulses were palpable and the feet and toes were warm. Her fingers were normal. She stated that the toes remained the same colour over the summer months though slightly less painful. I do not think they are chilblains but would appreciate your help.

  2. Catfoot

    Catfoot Well-Known Member

    what did the vascular assessment reveal?

  3. Samj

    Samj Member

    Hi CF

    Sorry forgot to add to the original post - both the DP and PT pulses were triphasic, toes and feet were warm no atrophy of the skin. However, some of the nails were thin and crumbly and she stated that some of the nails just come off.

  4. Catfoot

    Catfoot Well-Known Member

    Hi Samj,
    I wonder if there is any chance of you posting a photo?

    Withdrawal symptoms from Tramadol include burning or tingling of hand and feet but not the cyanosis you describe. It certainly seems like there is some vascular incompetance present, but I wouldn't like to speculate as to a cause.

    What makes you think it isn't childblains? and what does this lady do for a living?


  5. Lisa M

    Lisa M Welcome New Poster

    Hi Samj,

    May be worth investigating for an acquired or congenital hypercoagulation disorder.

  6. toughspiders

    toughspiders Active Member

    Hi Sam

    I think it would be wise to post medical history (if any known).

    Has she been tested for any rheumatological disorder eg (Crest) Scleroderma.

    Has she has her ESR and CRP checked???

    Shes only 37 i guess there is definately some systemic problem somewhere..

    Are you in the UK ?? Its cold there at the moment isnt it - Raynauds??
  7. Samj

    Samj Member

    Hi all

    Many thanks for your suggestions. Yes it is freezing in England at the moment (going to get away from it for 2 weeks and go and get some sunshine!). I did not feel that it could be chilblains as the patient stated that the colour of her toes were the same during the summer though the toes were a little less painful (it was a hot one in the UK and can only go on what she told me). She had seen her GP for the last 10 months for this problem and had been prescribed cream – only came to see us as last resort as she was getting no where. CF- lady is a house wife.

    Based on what she has told me and her presentation I did not feel I could give a firm diagnosis. I have written to the GP to refer her for further investigations. I will try to follow her up as most GP tend not to feed back once patients have been referred back to them!

  8. In South Africa the patients with Raynauds can present with painful toes in extremes of either hot or cold weather. What are the chances of sending her to a vascular surgeon for assessment?
  9. Samj

    Samj Member

    Hi brainstormer

    thanks for your suggestion. My letter to the GP was for a request to the vascular surgeon just hope that he does it


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