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Are Your Cold Feet Trying to Warn You?

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As a cardiologist specializing in peripheral vascular disease, I'm often asked, "Doc, why are my feet always cold? What do cold feet mean?" I help patients tell the difference between an annoying discomfort and symptoms that could indicate a life-threatening condition. Here's what I share with my patients about cold and other sensations.

What Causes Cold Feet?

There isn't one simple answer to the causes of cold feet. It's always possible, for example, that the problem can be traced to insufficient home heating. In this case, the discomfort can be most noticeable in the hands and feet.

Medical conditions must also be considered, however. One medical cause for cold feet is a condition called peripheral neuropathy, the term for damage to nerves outside of the brain and spinal cord. If your feet are cold and you feel a burning sensation — or you feel as if you are walking on a cloud — you might have peripheral neuropathy. These symptoms can often get worse at night.

Peripheral neuropathy most often results in:

  • Weakness
  • Pain
  • Numbness

Other medical conditions linked to cold feet include:

  • Anemia (insufficient oxygen travelling throughout the body due to insufficient or abnormal red blood cells)
  • Reynaud's syndrome (a rare disorder of blood vessels)

When to See a Doctor

If you have cold feet all the time, it's important to seek medical attention. Be sure to tell your doctor if you notice that only one foot is prone to feeling cold. This could be a sign of peripheral vascular disease (PVD, also known as peripheral artery disease, or PAD).

When a person has PVD, blood flow is restricted. If left untreated, patients can develop potentially life-threatening conditions, including:

  • Heart attack
  • Stroke
  • Kidney disease
  • The need for amputation, particularly if the person also has diabetes

The Risks of Waiting

People with more severe PVD can experience pain in the foot, calf or thigh when they walk. Their affected leg can feel weak or fatigued, or they can suffer leg cramps at night. Early diagnosis and early therapy can lower the risk of serious complications. Unfortunately, when a patient delays seeking treatment until PVD has reached a more advanced stage, we often must resort to an invasive approach.

Treatment Options

When you see your primary care doctor or cardiologist about your cold feet, your doctor will:

  • Review your symptoms, which might include persistent discomfort, calf pain, poor healing of wounds and foot discoloration
  • Look at your risk factors for PVD, such as diabetes, high blood pressure and history of smoking
  • Examine your feet for healthy hair growth, coloration, pulse and circulation
  • Consider performing noninvasive in-office tests, including Ankle-Brachial Index (ABI) and Doppler ultrasound
  • Order imaging of the foot with magnetic resonance angiography (MRA), if necessary

If your problems are caused by PVD, and if it is diagnosed early, the first treatments are medicines such as aspirin or clopidogrel (another type of anti-platelet therapy). Cholesterol-lowering drugs are used to control the buildup of plaque in veins and arteries.

Exercise goes hand in hand with medical therapy for patients that are diagnosed early. By walking a little farther each day, you will increase your blood vessels' ability to circulate blood.

Tailored Treatment for the Whole Person

I always tell my patients that we don't treat the disease; we treat the whole person. For some, increased tolerance to exercise might be the goal. For people whose symptoms interfere with their quality of life, such as a 60-year-old who is miserable because they can't take a walk while on vacation, an intervention such as angioplasty, stenting (both minimally invasive) or surgery might be required.

Treatment decisions are always made in partnership with our patients. We discuss all options, taking into account your unique physical, emotional and even spiritual needs. The first step for you might be to make an appointment to talk with your doctor about your cold feet.

About the Author:

Keenan Adib, MD, FACC

Dr. Adib is an interventional cardiologist and specializes in the treatment of peripheral vascular disease (PVD), peripheral artery disease (PAD) and structural heart disease. Dr. Adib sees patients throughout Chicago's southwestern suburbs at his offices in Bolingbrook, Hinsdale and La Grange. He believes in a partnership between the patient and cardiologist to help achieve high quality and compassionate cardiac care.

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