(transcript below)
Hello and welcome to healthy living I'm
Dr. Donald Pelto and today we're going
to talk about a different topic for New
England because during this winter time
it seems like it's just going on and on
and there have been many people that
have come into the office with different
types of cold injuries on their feet and
that's their going to be the topic today
so you can see in this first slide is a
picture of a foot that had an incident
with cold injuries and we're going
to be discussing the different causes of
cold injuries and more importantly how
you can prevent cold injuries and there
as well how you can treat cold injuries
so let's look at what are the different
types of cold injuries that can happen
to the foot you can see on this slide a
picture of someone's toes and there's a
little bit of a blister on the big toe
and then the little toes have little
areas of red right at the tips of the
toes this is a person that came in and
they didn't know what was wrong with
their foot they had been out in the
winter shoveling snow wearing boots
going out for long periods of time as
all of us have been doing in New England
this year and her toes became red and
painful and itchy and she didn't know
what was going on and when she came into
the office she wasn't she was concerned
did she have a problem with circulation
did she have a problem with her skin and
we were able to calm her down and
explain that what she had was a
experience of something called
chilblains or pernil this is a condition
that can happen in your foot when you
get exposed to the cold weather for a
longer period of time and one of the
biggest problems is if your feet sweat
in your shoes many times people they go
outside they really get bundled up they
wear two or three pairs of socks and
then they go out and work for hours at a
time and when their feet sweat what
happens is that that sweat can freeze it
can freeze into the boot freeze into the
sock and it can cause injury to the toes
so chill Bland's and pernil are very
similar they're a lighter type of a of a
frost or an injury to the to the toes
from cold frostbite on the other hand is
a little more severe frostbite is
where your foot actually becomes frozen
and this is not just for a few hours
this is exposed to cold weather for a
number of it can be a number of hours
but it may even be a number of days for
example of someone that needs to be
working outside or is living outside
they can get a condition called
frostbite and then something that isn't
quite a frozen injury it's something
called trench foot or a non freezing
cold injury and this is a condition that
can happen if your foot it really
doesn't freeze but if it's been cold and
especially wet for a long period of time
alongside these conditions we're going
to look a little bit at a condition that
many people may be aware of
it's called Raynaud's phenomenon or
Raynaud syndrome if you look at this
next slide you can see that in the toes
there's certain areas that the skin is
pink and there's other areas where the
skin is white and for many people they
see this in their hand for example in
your hand when you go outside you may
see that one of your fingers may be
white and the other ones may be pink
this is a condition called Raynaud's and
it's a condition where the blood vessels
in that one finger or that one toe is
vasoconstricted or it's shrunk down
for a period of time it goes into
something called vasospasm where it
spasms and then there's no blood going
to that finger or that toe usually this
is for a short period of time and it's
usually reversible and doesn't cause
other conditions these conditions of
rain odds can also be seen with other
health conditions it's not just due to
the cold but it can be caused by other
health conditions I tend to find people
with rain odds tend to be slimmer and
slender and younger females that have
this condition or slender females when
they go outside that cold weather really
affects them that's called the rain odds
condition so what really causes a cold
injury let's look at this next you can
see in this in the slide here the most
common cause of a cold injury is
extended exposure to cold or damp or wet
in it that's what we've been seeing this
year isn't it in New England we've been
out in the cold
we've been shoveling our walkways we've
been going for walks trying to stake a
stay active and then your feet can get
damp whether or not you step into
something or that snow then penetrates
into your shoe or penetrates into your
boot and it makes your shoe and your
boot and your sock wet and damp and
because of this your toes because
they're so cold in order to to protect
them and also protect to the other parts
of your body you get vasoconstriction or
vasodilation of your body are located so
for example your body is going to first
try to protect your brain you're gonna
try to protect your heart
it's gonna try to protect your other
internal organs before it for example
tries to protect your fingers or your
nose or these other areas that can be
problematic when it's very cold outside
when you look at the areas that get
affected it's usually what we call the
the most distal extremities so you the
distal or the furthest part away from
your your hands such as your fingers the
furthest part of your feet is your toes
and then also the tips of your nose and
your ears these are the areas and when
they're exposed to cold they become
affected most commonly that's done it
basal constricts or stops the blood flow
to those areas to shunt the blood flow
and shunt all of the warmth to the inner
part of your body to keep that area warm
once again who is affected by these cold
injuries you may want to know am i at
risk
those that are at risk are usually young
and middle-aged women it's more common
to have these cold injuries such as
Pernis oh and these little red toes like
we can see in this picture and young
females or slender women also you have
to be careful of the children when they
go outside because the children can also
develop these conditions and then those
that are a little bit older once again a
little bit slimmer you can have these
conditions of cold injury these are
these common cold injury issues where it
turns red maybe a little bit of blister
and this tends to go away over time if
any any one it doesn't need to be any of
these types of people if they're outside
for days on end or if they do let's say
a lot of hiking outside you're much more
to getting frostbite or one of these
other types of conditions that can
happen to your foot or your toes also
people that have a low body mass meaning
they're very slender those that are
diabetics you have to be very careful
because with diabetes what can happen is
you can have poor blood flow to the
extremities the blood flow going to your
toes the blood flow going to your feet
it can be reduced and with that reduced
blood flow it can affect the circulation
and then someone who would normally
wouldn't have their toes get cold or get
injured because of the cold
they don't recognize that or they do
recognize it but there there's nothing
they can do about it and it gets colder
than normal so you really have to keep
bundled up if you have diabetes one of
the other conditions of diabetes that
can affect your toes is something called
neuropathy in araba these a condition
where you don't have any sensation in
your toes and because of that if you
don't have any feeling you could become
Frost bit you could have frostbite or
another cold injury on your toes and not
know it and they would just continue to
be problematic and sometimes that can
even lead to death of some of the tissue
and that's called gangrene that that's
where it really turns to a dark black
color and that's something that's very
dangerous because with a gangrene it's
very common that you're going to lose
that extremity whether it be a toe or a
part of your foot we also see people
with that are in the military that that
get this condition because those that
are in the military they tend to be out
in extreme climates both hot and cold
for long periods of time where their
feet get wet and what we we saw that in
a lot of the previous Wars where people
were let's say involved in these areas
where it's very cold and swampy their
feet really got affected by some of
these cold injuries and these thermal
injuries weren't the freezing type these
were the the non freezing type that
we're going to show a few pictures as we
go on and how do you tell if you have a
cold injury well if you look at these
pictures these are really classic for a
beginning type of a cold injury this
type of a cold injury isn't where your
foot is frozen this is a type where
you've been sensitive to the cold and
you tend to see swelling of the toes so
if you see that
only at the tips of your toes such as
this picture up on the top if there's
swelling in the toes you may have a cold
injury or the swelling takes a long time
to go down people sometimes come into
the office and they think well do I have
gout do I have arthritis do I have
something else but many times if they've
been outside in the cold
they could have a cold injury to their
toes do you see on these pictures these
little red dots people come in with
these red dots and they wonder what is
it is it a malignancy is there something
a dermatological problem on my skin did
I get a blister on my skin a lot of
times what happens is these cold
injuries it affects the these the tips
of the toes and there's these little red
spots that develop and these red spots
they'll eventually may change color they
may change black and they may slough off
the skin they may create a type of a
blister and that blister is gonna kind
of come off the skin kind of like a scab
because that's all dead skin that red
area is gonna be dead skin it's gonna
need to slough off and turn over and
you'll also usually see this in the
fingers and the toes and many times you
can see blisters because you see on the
picture on the bottom on that big toe
that little area of red is turning into
the blister and also the areas on the
toes there's going to be blisters and if
these blisters become too big they can
kind of open up a little bit and when
they open up they can we call ulcerate
and ulcerate is nothing more than a
blister that kind of pops and you can
see that that red beefy tissue
underneath the ulcer and when you can
see that that that's kind of a more
severe type of a cold injury that
someone may have in most people when
they come into the office their
complaint is a little bit of the that
red color their toes may be a little bit
of swollen but as well they're tender
they're very tender to touch for a long
period of time and that tenderness for
these types of conditions that we're
looking at in these two pictures this
tenderness will eventually go away but
it takes a long time it may take a
number of months it may take until the
summer comes around before you you have
that back to normal and then while it's
healing people come in because they also
have itching and so they have itching of
the toes and they sometimes think well
do I have an athlete's foot or don't
have something
going on the itching is a normal
response as your tissue is starting to
become normal one thing you have to
realize is once you have a cold injury
like this to your toes you're more
susceptible to getting a cold injury
again because once you have it your skin
has been affected it's been partially
frozen or it's been cold for a long
period of time you've developed the
blister you may develop some scarring
and next time you may be more sensitive
to that cold and people kind of they
wonder what what can I do you know how
can i how can I treat it and how can you
tell if you have it well really if you
have this this cold intolerance or a lot
of pain or injury you you probably have
a cold injury you should probably seek
out professional help to take a look at
it and try to figure out how you can
contrive gonna show you is a little bit
strong graphically but I want to show
you an example of what someone that has
frostbite looks like this is much more
severe than that that's simple little
red dots if you look at this next slide
this is severe frostbite you can see the
dark discoloration to the toes you can
see to the heels this isn't something
that happens in just two or three hours
outside this is something that's going
to be a number of days maybe being
exposed to cold putting your foot in the
cold maybe not having a place to live
for a period of time where your feet can
get it affected by now this would be a
frozen injury and I want to explain the
difference when you have a frozen injury
when your foot is actually frozen this
is considered a medical emergency this
isn't something that you should treat on
your own that you should be just dealing
with on your own you should go to the
emergency room because this needs to be
treated there are a lot of things that
need to be done but the most important
thing is you have to heat that foot up
as quick as possible okay because the
foot is frozen to prevent any further
injury probably shouldn't be doing that
on your own you also have to be aware of
