Purple Toes Syndrome?

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Nancy

Well-known member
Joined
Jun 9, 2001
Messages
9,896
Location
upstate New York
Joe was in the hospital for two months. During that time he was off Coumadin for 3 weeks. He was started back on it shortly before coming home the first week in Oct.

This is a pic of his foot (sorry it is so graphic). His skin is peeling from all the edema and blistering that happened. But I am most concerned about the dark purple color around his nails and between the toes. The rest is reddish. He says it is not painful.

Do you think I am looking at purple toes syndrome?
 
He says it's NOT painful? Purple toes is painful from my understanding, but it sure does look like it.
 
Yep, Nancy. Looks just like Wayne's did a couple of years ago. He had it twice, if I recall. But, if I were you, I would still get him to the doctor.

Marybeth
 
Nancy:

Dunno. When did this start?

When I had bunion surgery on both feet in 1980, my feet swelled (toes looked like little pork sausages) and peeled very badly. But there was no discoloration.
 
I have an appt. with a podiatrist in December. Don't know if he has ever seen a case of "purple toes syndrome" though.

At first I thought it was poor circulation, but it did happen a week or so ago, and the timing is right for the advent of "purple toes" after the resumption of Coumadin. So I have a suspicion that this is what it is.

Did Wayne's resolve, and how long did it take?
 
Dear Nancy:

Frankly, Wayne's took quite awhile to resolve. They looked really bad for ten to 14 days, and then perhaps another two weeks to resolve.

He did go to see his PCP both times, and I might suggest you go with Joe as well. There is always the possibility it is cellulitis, or some other such thing.

The Dr. told us at the time, that it was caused by a "shower of micro emboli", that landed in the very tiny blood vessels/capillaries in his feet. Wayne also did not complain of "pain" just a vague feeling of "not quite right".

Marybeth
 
I KNOW it's not cellulitis. He's been on Vancomycin for two weeks for cellulitis in his legs and still on it three times per week, IV, at dialysis, although the cellulitis has resolved. Plus he was on it for two months prior in the hospital.

It could be a circulation problem, but that wouldn't come on suddenly, I don't think.
 
Nancy
After my OHS the doctor kept me in Coumedin for 4 moths for therapeutic reasons.. There were times that my toes were purple although not as much as Joe's. After the doctor took me out of Coaumedin, I stopped having purple toes. I don?t know whether this is of any help to you.

Just to put a smile on your face, I never had ?purple toes? before and I decided to look for ?purple toes?in the internet....WOW. Did not know there were so many toe fetishists out there:eek: :eek: :D
 
I know what you mean about the Internet. Every time I want to look up info about feet or shoes, I have to wade through some pretty weird stuff. I'm always hoping I won't open one by accident--who knew!!:eek:
 
Well, Nancy, it sure looks like you have correctly diagnosed his problem, since the antibiotics certainly would have taken care of it, were it cellulitis. Did you google dialysis/coumaden/purple toes? I think you are right though, it looks like the syndrome, and is acting like it.

Wayne ended up with it on one leg up maybe 6 inches from the ankle, on just one side though. The higher it went the less "purple" and the more reddish looking it was. Using a magnifying glass, you could almost see the individual capillaries.
Of all the complications he could have, as ugly looking as this one is, it certainly is far from the worst thing that could have happened.


God bless you, Nancy and Joe.

Marybeth
 
"Of all the complications he could have, as ugly looking as this one is, it certainly is far from the worst thing that could have happened."

You're sure right about that--I told him that a couple of others have had it, including Wayne, and that it eventually went away. I think he was relieved. And I am relieved to hear this too.

I just wish some of these things that happen weren't so--exotic.
 
Dear Nancy:

Please look up "cholesterol crystal embolism" via google.

I thought I recalled a Dr. telling us it could actually be cholesterol loosening from the coumaden, throwing off tiny embolisms to the toes. I recalled he said at the time, that it could have been to the kidneys. I think I just read that this diagnosis is becoming more common in dialysis patients.

Mb
 
Nancy:

I have PM'd you another way to look this up via Google. It sounds like this is more common in dialysis patients (read articles), and could portend something happening in the renal arteries as well. When did Joe go to dialysis last?

Mb
 
He went to dialysis today, he goes three times per week. Perhaps I will bring it up on Thursday with the renal doctor, but they really aren't interested in managing anything other than straight dialysis, even though it might be related--a rather peculiar group of people, not too cooperative. Joe also has an appt with the vascular surgeon who did his fistula. He might be interested enough to give me an opinion or some direction.
 
Nancy:

Well, it sounds like at least he is going to have someone take a look at it....soon. Best wishes.

Marybeth
 
It could be PTS. I have seen one case. When the man was referred the doctor told me that the only question was how much of his foot was going to have to be amputated. After several months it pretty much cleared up on its own. The only bad thing that happened was that the very tip of his middle toe died and fell off - like losing a big scab. He was coming 110 miles round-trip to the clinic. I had him come in every week so that we could be sure that his INR never dropped below 2.0.
 
Joe has an appointment with the vascular surgeon tomorrow to check out the fistula surgery and remove stitches. I will ask him to look at the toes, and get his opinion.

They did look at them at dialysis. The renal doctor knew about purple toes syndrome (which I was happy to hear), also blue toe syndrome, and some other more rare conditions like that. His feeling was that it was a circulation problem and thought that the vascular guy was the one to make a determination.

It looked slightly better today, the redness was less pronounced, but the very dark purple areas around the nails and between the toes was still there.

Certainly Raynaud's syndrome could be a possibility.

I hate these mysteries :( :( You never know who is right, and sometimes neither do they
 
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