Staying warm in the winter can be a challenge, especially with changes to our body’s circulation. Our feet and hands can suffer especially – this is a natural response to heat loss which allows the vital organs to remain at their optimal temperature. This means having cold feet is a normal condition if the outside temperature drops. Nail growth slows down and skin will often become drier because nutrition to these tissues is affected.
In response to this temperature change, small blood vessels temporarily constrict and you may see this as a change in the colour of your skin, which may look pale or blanched and waxy at first, before becoming bluish. This is because the oxygen in the blood has been used up by the tissues. The skin is also cool to touch. Returning to warm conditions usually remedies this and the skin becomes pink and warm again.
However, in some individuals, this response is exaggerated and prolonged. The condition is known as Raynaud’s phenomenon and can be inherited. The same response will occur but much more readily and will last longer, so the colour changes are more marked. As a result of being deprived of oxygen for longer, some injury occurs to the soft tissues and can make fingers and toes numb while they remain cold. When the blood vessels do finally relax and blood returns to the area, fingers and toes can throb and burn, turning bright red with inflammation. Eventually, things return to normal but repeated episodes of this can lead to dry, devitalised skin and changes in nail shape and texture.
Chilblains occur for much the same reason. These are painful, itchy swellings that often occur on the tops of small toe joints but can occur on other bony areas too, such as the back of the heel. Tightly fitting footwear can add to the misery by constricting blood flow further and rubbing on the painful skin. Chilblains are not caused by using hot water bottles, as commonly thought, they are a cold injury. The attempt to relieve the intense itch by scratching merely compounds the problem as it tends to break the skin and causes sores and sometimes infection.
Cold feet at night can keep you awake or disrupt sleep.
What can be done to help?
If you are susceptible to cold extremities, it is important to keep yourself generally warm, so listen to the temperature forecasts and dress accordingly. As well as suitable outer clothing, trousers, tights or socks will help to keep the whole limb warm. Fibres such as wool or bamboo are good insulators and several light layers, rather than one thick layer, traps more air and heat. Remember to wear roomier footwear to allow for thicker socks without compressing the skin.
Footwear should have a good rubber or composite material sole, to insulate against cold pavements – adding insoles of cork or lambswool can improve insulation and comfort. The sole should have good grip for traction on slippery pavements.
Keep active, as this improves circulation, and have plenty of hot drinks and food throughout the day.
At home, a warm (not hot) foot-bath will help. Dry with a rough towel and apply a cream or lotion with a massaging action. Some preparations include ingredients such as capsaicin or ginger, to stimulate the circulation. Afterwards, put on loosely-fitting, warm socks or slippers to maintain the effect. If the feet are warm before going to bed, they are likely to stay warm. Bed socks in wool or cashmere can be very helpful. Water bottles or gel pads should not be over-heated, as sensation can be unreliable in cold feet.
Preventative action should reduce the likelihood of chilblains developing, but if they do, an antipruritic (anti-itching) cream or ointment can be obtained from pharmacies, and menthol-based products can also be very soothing.
If the skin becomes broken, antiseptic creams such as Savlon help the skin to heal and prevent infection. Cover with a gauze pad after applying, which can be secured with finger bandage or held in place with a cotton sock.
In the aftermath of chilblains, the affected skin is often dry, thin and rough, so use a moisturising cream to restore normal texture.
People who suffer from eczema will find that cold weather tends to make the skin even drier and more cracked. Use plenty of ointment to keep the skin well hydrated and wear hose to help trap moisture and warmth. Silk is a good choice of material and is thin enough to wear under a thicker, outer sock.
In severe or recurrent cold weather problems in the feet, consult your GP who may advise a prescription drug to relax the constricted vessels and thus improve blood flow to the extremities.
Podiatry at Fleet Street Clinic
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