Cold Feet

What is it?

Cold feet is a symptom, not a condition on its own. Feet can be cold to the touch, or they can simply feel cold to you. The reason matters, because the cause decides what helps.

Sometimes cold feet are a sign that blood isn't reaching your feet as well as it should. Sometimes the small blood vessels in your toes squeeze shut for a short time. And sometimes the nerves are affected, so your feet feel cold even though they are warm.

It isn't known how many people have cold feet overall. The conditions behind it are better understood, and they are covered below.

What can cause it?

Narrowed arteries (peripheral arterial disease)

This is a build-up of fatty plaque in the walls of the arteries. The arteries become narrower and less blood flows to the legs and feet. It is often called peripheral arterial disease, or PAD.

Cold lower legs or feet are a common sign. You might also have weak or missing pulses in your legs or feet. Another sign is cramping leg pain when you walk that eases when you rest. Doctors call this claudication.

If the disease is severe, you can have pain in your feet even at rest, often at night. You can also get sores on your feet or legs that won't heal. In the most serious cases, tissue can die (gangrene).

If you have diabetes, PAD often causes no symptoms, or unusual ones. Nerve damage can hide the pain, and some nerve changes can make the foot feel warm. So warm or pain-free feet don't always mean the blood flow is good.

Raynaud's phenomenon

In Raynaud's, the small blood vessels in the fingers and toes go into a short spasm. The skin changes colour while this happens. It is usually set off by cold or by emotional stress. It affects the fingers mostly, and the toes less often.

Some people have Raynaud's with no clear cause. Others have it because of another illness, certain medicines, or work-related causes such as long use of vibrating tools.

Nerve changes (neuropathy)

With neuropathy, your feet can feel cold even though they are warm to the touch. You may also have numbness, or you may not feel pain or temperature properly. Other signs are tingling, prickling, and burning or shooting pains.

Losing feeling in your feet is a problem because pain is a useful warning of injury. It also means you can burn or hurt your feet without noticing.

Who gets it?

Because cold feet have different causes, the risk depends on the cause. For narrowed arteries, the main risk factors are:

• smoking
• high blood pressure
• diabetes
• high cholesterol and triglycerides (types of blood fat)
• getting older
• a family history of heart and blood vessel disease

Kidney disease, especially severe kidney disease together with diabetes, is also a strong risk factor for PAD and limb loss.

The part of the leg affected can differ too. Women may be more prone to narrowing above the knee. Older men and people with diabetes are more likely to have narrowing below the knee.

How is the cause found?

Your podiatrist or GP will start by asking about your risk factors and your symptoms. They will ask whether your feet are cold to the touch or only feel cold. They will also ask about colour changes, numbness, tingling, burning, and any leg pain when you walk.

They will then examine your legs and feet. This includes feeling the pulses in your legs and feet and checking your skin colour and condition. If you have diabetes, pulse and foot checks should be part of your regular reviews.

The usual blood flow test is the ankle-brachial index (ABI). It compares the blood pressure at your ankle with the pressure at your arm. In people with diabetes or kidney disease, the ABI can be misleading because the artery walls are stiff. A normal-looking result doesn't rule out artery disease. Your practitioner may measure the pressure in your toes instead, or arrange other tests.

Scans of the arteries are used mainly when restoring blood flow is being considered.

Treatment

Treatment depends on the cause. If you might have narrowed arteries, or you have diabetes or kidney disease, get the cause checked before you try to manage cold feet on your own.

Looking after it at home

If you smoke, stopping is one of the two most important steps for narrowed arteries. It lowers the risk of the disease getting worse and of other serious heart and blood vessel problems. Ask your GP or pharmacist about support.

The other most important step is regular exercise. It reduces how severe and how often your leg symptoms are. A supervised or structured walking programme is one of the first things recommended. A home programme is a good option if a supervised one isn't available.

Look after your feet every day:

• Wash and dry them, and care for your skin and nails.
• Wear well-fitting socks and shoes.
• Don't walk barefoot.
• Protect your feet from heat and cold.

To keep your feet warm, wear socks or cover your legs and feet with a blanket or shawl. If you can't feel temperature well, take extra care:

• Test bath water with your elbow.
• Avoid foot spas.
• Keep your feet away from heaters, hot radiators and fires.
• Take hot water bottles out of the bed before you get in.

Treatment from your podiatrist

Your podiatrist can check your pulses, skin and feet, and refer you for blood flow tests or to a specialist if needed. They can also teach you how to look after your feet.

If you have reduced feeling, foot deformities, hard skin, or a past foot ulcer, special footwear can lower your risk of foot sores. Leave corns and hard skin to your podiatrist.

Other options

If narrowed arteries are the cause, your doctor will also work on your risk factors: blood pressure, diabetes, kidney problems and cholesterol. You will usually be offered a medicine that makes blood less sticky (an antiplatelet). Medicines for narrowed arteries can have side effects, so a doctor should start them and review them.

A medicine called cilostazol can ease leg pain when walking. It doesn't change the risk of dying from heart and blood vessel disease, or your quality of life. Side effects include headache, diarrhoea, dizziness and a pounding heart (palpitations). It isn't suitable for everyone.

If walking pain or cold feet aren't improving after exercise, stopping smoking and medicines, ask your GP or podiatrist about seeing a vascular specialist (a doctor for blood vessels). Procedures to restore blood flow, such as angioplasty (opening the artery) or bypass surgery, are kept for people whose walking is badly limited, or whose limb is in danger. Both carry a small risk of serious complications, including heart attack, stroke and death.

For Raynaud's, treatment is mostly supportive. It isn't yet clear which treatments work best.

Will it get better?

The outlook depends on the cause. For most people with leg pain on walking, the risk of losing a limb is small: 1 to 3 per cent over five years. In more advanced poor blood supply, without successful treatment to restore blood flow, the risk may reach 30 to 40 per cent. These figures come from people with more serious blood vessel disease. They shouldn't be applied to mild cold feet.

Getting the cause checked early, and acting on the steps above, gives you the best chance of keeping your feet healthy.

Preventing it

If you have diabetes or neuropathy, check your feet every day for blisters, breaks in the skin, pain, or signs of infection such as swelling, heat or redness. Have regular professional foot checks as well.

Any break in the skin of your feet can become serious. Wash minor cuts with water and cover them with a non-adhesive sterile dressing. If the wound doesn't heal or gets worse, get help.

If you have had a diabetes-related foot ulcer that has healed, ask your podiatrist about shoes or insoles that relieve pressure and fit your foot shape. If you have several risk factors, checks and professional foot care every 1 to 3 months may help.

Not smoking and keeping blood pressure, diabetes and cholesterol under control also protect your arteries.

When to see a podiatrist

Book an appointment if

Book an appointment with your podiatrist if your feet are often cold and you don't know why, or if the cold comes with colour changes triggered by cold or stress, numbness, tingling or burning, or cramping leg pain when you walk that eases with rest. Book too if you smoke or have diabetes, high blood pressure, high cholesterol or kidney disease. If you have diabetes, get any new foot problem checked promptly.

Seek prompt assessment if

Call your local emergency number if your leg or foot suddenly becomes numb, white or cold, or you suddenly can't move it. Don't wait to see if it settles. This needs urgent medical assessment: see your GP today, or go to an urgent care clinic or the nearest emergency department if you have pain in your foot at night that eases when you dangle your foot or stand up, or a sore on your foot or leg that won't heal, or dark or dead-looking skin or tissue. The same applies if you have diabetes and a foot infection or a foot ulcer, if you have neuropathy and one foot feels warmer than the other, or if you have unusual redness, swelling, pain or soreness. A foot that is swollen, painful or throbbing, with colour change or fluid from the skin or nail, also needs urgent medical assessment. Tell your podiatrist or doctor straight away if you have neuropathy or diabetes and feel unwell with a fever or flu-like symptoms.

Frequently asked questions

Should I see a podiatrist or my GP about cold feet?

Either is a good start. Your podiatrist can check your pulses, skin and feet and refer you for blood flow tests. Your GP can look at your overall health, arrange tests, and start or review medicines. Tell them whether your feet are cold to touch or only feel cold, and about any colour change, numbness, tingling or leg pain when walking.

I have diabetes and my feet feel warm and don't hurt. Does that mean my circulation is fine?

Not necessarily. With diabetes, nerve damage can hide pain and can make a foot feel warm even when blood flow is poor. A normal-looking test result doesn't always rule out artery disease either. Have your feet checked regularly, including a pulse check.

Is Raynaud's the cause of my cold toes?

It could be, but toes are affected less often than fingers. Raynaud's brings short spells of colour change set off by cold or stress. Your practitioner can look at the pattern and check for other causes, such as narrowed arteries or nerve changes.

Further reading

• Cold Feet Causes & Treatment Cleveland Clinic
• Peripheral vascular disease - complications, treatments and symptoms healthdirect
• Raynaud Phenomenon MedlinePlus
• Raynaud’s phenomenon NHS
• Cold Feet - Foot Health Facts FootHealthFacts (American College of Foot and Ankle Surgeons)