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DISCOVERMAGAZINE.COMK
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BY TONY DAJER
He nodded.
I slipped them off to find bony feet,
parchment-yellow skin, tendons taut as
cords, no angry-red cellulitis, but yes,
there they were: blue toes. The fleshy tips
of the middle three on each foot sported
a daub of robin-egg blue. A cavalcade
of exotic, dangerous diseases trotted
through my head.
“Do they hurt?” I asked. The man
didn’t answer, so I asked again, in
Spanish: “Le duelen?”
“Un poco,” he answered. A little.
I ran two fingers over them. They were
soft — no obvious abscess or clot.
“Los puede menear?” Can you wiggle
them?
The toes rose and fell like little piano
keys.
The rest of his physical exam was nor-
mal: no joint swelling, no other skin dis-
coloration or palpable lesions, no heart
murmurs. His vital signs were normal,
though his pulse hovered around 60, a
little low.
The blue toes suggested one of three
things: bad blood, bad blood vessels or
deep-seated bacterial infection.
Bad blood could include “sludging”
diseases — like leukemia or other can-
cers that produce too many red cells,
white cells or platelets — and autoim-
mune conditions that cause runaway
clotting.
Bad vessels could arise from vasculitis,
an inflammation of arterial walls that can
be caused by an autoimmune attack,
such as lupus. At a mechanical level,
blood vessels can get clogged by the fat-
and-calcium plaque of atherosclerosis.
Moreover, fragments of plaque in large
arteries can break away to cork smaller
vessels downstream.
Another possibility for bad vessels is
Raynaud’s disease: Exposed to the cold,
arteries in the hands and feet will con-
strict to limit blood flow and conserve
core heat. Overconstriction can cause
severe blanching — and often excruci-
ating pain — followed by cyanosis, the
blue-green hue of oxygen-starved tis-
sues. Raynaud’s can happen by itself, or
as one aspect of a systemic disease.
Out of the Blue
Poor circulation in an older man’s toes
could point to something serious.
“My papa’s toes are blue.”
The stylishly dressed woman squared her shoulders to
hold my gaze. Three others — two sisters plus mom, I guessed
— completed the entourage. A 70-year-old man lying on the
stretcher had the wan but well-cared-for look of a convalescent
used to letting his daughters do the talking.
“He had a heart attack a month ago,” the lead daughter con-
tinued. “Two stents. Doing OK until a week ago. The feet started
aching. The tips of his toes turned blue. We turned up the heat
and put on thick socks, but it’s only gotten worse.”
I turned my attention to her father. “Hello, Mr. Mendez. May
I take off your socks?” I asked.
The
blue toes
suggested
one of three
things:
bad blood,
bad blood
vessels or
deep-seated
bacterial
infection.
O
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VITAL SIGNS