Blue Toe Syndrome: Causes, Diagnosis & Treatment

When you begin to notice a blue or purple discolouration on one or more of your toes, doctors call this discoloration blue toe syndrome. This article explores the possible causes, symptoms, how to treat and prevent blue toe syndrome.


Blue toe syndrome is also known as occlusive vasculopathy or trash foot. It is a form of acute digital ischemia in which one or more toes become blue or purple because of a low supply of blood.
Low supply of blood can cause damage to cells and tissues, causing them to change colour. Some people with this condition discover that their toes go back to their normal colour when they apply pressure on the skin or when they apply pressure on the skin or when they raise their foot.


The low supply of blood that causes discolouration can be a cause of any of the following:
1. Decreased arterial flow.

2. Impaired venous outflow.

3.Abnormalities in circulating blood.

4. Decreased arterial flow can result from several different conditions such as:

  • Embolisation
  • Renal failure
  • Atherosclerosis


Embolisation is when something obstructs the blood vessels. Sometimes, pieces of plaque or blood clots break away from the walls of the artery and move around the body in the bloodstream until they get stuck.

Embolism can occur spontaneously or originates from a cardiac tumor, renal failure, medication, or vascular surgery.


One of the functions of the kidney is to clean waste products from the blood and eliminate them in the urine and produce hormones that control blood pressure and red blood cells.
When the kidneys lose their ability to perform their functions properly, then they cannot clean out waste products from the blood, hence, obstructing blood flow.


This is the clogging of blood arteries caused by an accumulation of fatty deposits, usually cholesterol.
Cholesterol is a waxy substance, essential for making hormones and vitamin D. When cholesterol level increases in the blood, it can mix with other substances to form a plaque which can then block arterial blood flow.


Symptoms Blue Toe Syndrome

Aside from the obvious discolouration of your toes, you may also notice :-

  • Foot pain
  • Muscle pain in the leg
  • Bruising
  • Ulcers on the feet
  • Nodules on the feet


A major complication that results from blue toe syndrome is the possibility of the tissue in the affected toe(s) dying permanently if doctors do not restore blood flow to the foot. Experts call this gangrene.
Gangrene is a severe condition but can be treated by surgery, antibiotics, and oxygen therapy. The symptoms of this condition are:

  • Blue or Black Skin Colour
  • Pain
  • Numbness
  • Sores with a foul smell

Another complication that can arise from Blue toe syndrome is cholesterol fragments blocking the blood vessels to other organs. This can lead to a multi-organ disorder.


Diagnosis of Blue toe syndrome is based on the patient’s medical history and finding on examination.
The findings your doctor makes on examining you will provide him with clues to confirm the diagnosis investigation in the form of laboratory blood tests, radiological imaging, and tissue biopsies.

Diagnosis is based on the underlying cause of Blue toe syndrome and is usually made by histopathology of the affected tissue.

The specific blood test that can be carried out are:-

  • Blood cultures.
  • Cold Agglutinin.
  • Antinuclear antibodies.
  • Serum and urine protein electrophoresis.
  • Hepatitis C

Radiological imaging tests are:

  • Sonogram of the abdomen and a venous duplex ultrasound scan.
  • An echocardiogram to detect cardiac tumors.
  • Chest radiography or thoracic and abdominal computed tomography to detect any form of underlying cancer in malignancy associated conditions.


Mild cases of Blue toe syndrome are usually easy to treat, unlike severe cases like renal failure, which can lead to further complications.
The focus of the treatment is to restore blood flow to your toes, which usually follows relieving occlusion and restoring arterial or venous blood.

Depending on the underlying cause of your Blue toe syndrome, your doctor might suggest any of the following options.


This is a vascular surgery that involves a surgeon inserting a mesh tube known as a stent, into the affected blood vessel.  This is done to hold the blood vessel open to improving blood circulation to the affected tissue.


In this case, the surgeon collects healthy blood from another part of your body and creates a bypass around the obstructed blood vessel.


You are at risk of having a Blue toe syndrome condition if you smoke, perform activities that can raise your blood pressure, or consume a lot of cholesterol.
Your doctor will advise you to quit smoking, have plenty of rest time, keep warm, reduce your cholesterol intake and drink plenty of fluids.


Restricted blood supply to the feet can cause Blue toe syndrome, along with other causative factors such as renal failure, certain medical conditions like atherosclerosis, and certain drugs. 

The best way to avoid Blue toe syndrome is to keep your heart and vascular system healthy by avoiding smoking, drinking enough water, reducing cholesterol consumption, and having enough rest.

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