Lindsey Ebbs Podiatry - Podiatry Insights

Covid Toes

`COVID- toes` is a symptom of contracting Covid-19, it can present in any age group, across all continents and in a full range of skin types. Although it tends to be more common in children and young adults.

COVID-toes is easier to diagnose in the summer months as `cold weather chilblains` do not normally present in the warmer weather.

Due to the large number of patients with Covid 19 reporting persistent chilblains, they are now considered to be a symptom of Covid-19, long Covid and there have also been cases that have presented after the mRNA Covid -19 vaccines.

What do COVID- toes look like?

Chilblain-like lesions, presenting on the toes and the soles of the feet, in some cases they have been sited on the fingers as well.

They are dusky blue/purple in the background and redder in the centre, almost like a bruise in appearance. The toes can be red, swollen, inflamed and often end up looking like a blistered area of skin.

How long do they last?

Usually, they stay for a couple of weeks but in some cases with patients that have had long Covid, they can present for much longer. Further investigations are recommended to rule out any other medical causes if the chilblains have lasted longer than 60 days.

What do they feel like?

Some patients do not feel anything at all but are just concerned by their appearance, whilst others feel a constant burning hot pain in their feet and are tempted to plunge them into cold water, sadly, making the situation worse!

Is there any treatment for COVID-toes?

If the chilblains are truly Covid-19 related and painful then an application of a topical steroid is helpful, alongside oral aspirin and if they are severe enough- possible vasodilator medication?

How can you tell the difference between COVID-toes and weather-related chilblains?

The simple answer to that is, not easily, especially in the winter months but from a clinician’s point of view, a good medical history should separate the two.

Are there any special tests to confirm COVID- toes?

Most of the standard Covid tests taken with patients with suspected Covid toes have often registered a negative Covid -19 result. However, tissue samples taken from the chilblain lesions themselves, have shown positive markers for Covid 19. Confirming that the chilblains are COVID -toes.

Why do some patients with Covid 19 get COVID- toes and others do not?

This can be explained by the current favoured hypothesis, Covid -19 in younger patients usually have a rapid clearing of the infection due to the release of interferon. This happens before any immunity to Covid -19 develops, suggesting the higher levels of interferon released is a key aspect of these chilblains. Unfortunately, if the child is exposed to the virus again, as there is no immunity generated by the first exposure, then the chilblains will present again

There have also been cases of COVID-toes appearing after the Pfizer and Moderna vaccines, first and second doses. This certainly fits with the picture I was seeing in January-May 2021, where I have never seen so many chilblains present in clinic, especially when most of it was spent in lockdown!

Until more data and research are collected, any theory remains a hypothetical causal association.

If you are not sure whether you have weather related chilblains or COVID toes, then please check our blog on chilblains; the link is below or book an appointment in the clinic so we can have a look and help with a diagnosis and a treatment plan for any of the causes of chilblains.

The Foothub Whitby
3, Byland Road
Whitby
YO21 1JH

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