Blue toe syndrome is the bluish discoloration to toes as a result of tissue ischemia (lack of blood flow). The syndrome is caused by the blockage of small vessels that lead into the toes. One or more toes may be affected; in severe cases this can also manifest itself as a multi-organ problem. There are a few causes of blue toe syndrome but the most common is the breakage of a small piece of arterial plaque usually from the abdominal aorta-iliac-femoral arterial system (located in the abdomen and groin area) which then travels down the arterial tree into the small vessels of the foot where it becomes lodged. This is known as an embolism. All tissue distal (in front of) the blockage will then turn a bluish color which represents a lack of oxygen to the tissue. Generally patients are in their 40s, 50s, 60s, and older. The condition can occur insidiously or may be the result of abdominal surgery or an invasive vascular procedure or test. The affected toes become cyanotic but there are other etiologies such as trauma, connective tissue disease like Scleroderma, hypercoagulability of blood as seen in polycythemia vera , atrial fibrillation and Raynauds phenomenon. In Raynauds the fingers will usually also be involved and this generally occurs in younger patients without any known history of atherosclerotic disease. At the local level, blue toe syndrome may occur in diabetic foot infections and those who have undergone foot surgery. Blue toe syndrome is easily misdiagnosed because in most cases the larger arteries of the foot are palpable and that directs the doctor away from a diagnosis of occlusive disease. Treatment is geared towards alleviation of the blockage further up the arterial tree through stenting, bypass surgery, or anticoagulant therapy. Vasodilator drugs have no proven effectiveness in treatment of this condition, since this is not a vasospastic disorder. Mild forms of the disease which affect just the toes have a good prognosis and usually subside on their own. It should be noted that sometimes the pain in the toes is disproportional to the extent of involvement of the toes and adequate analgesics should be prescribed. Multi-systemic forms where the kidney is also usually affected, the prognosis is more dubious. In the foot, should the condition not resolve itself there is always the possibility that the condtion will worsen to gangrene and subsequent amputation of the affected toes.
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