The cold weather makes my toes hurt????



As the colder weather approaches, our office sees an increased number of patient complaining of pain and color changes associated with Raynaud’s syndrome. Raynaud’s disease is characterized by numbness and pain in the fingers and toes (along with an exaggerated response to cold and stress) and caused by spasms in the blood vessels in our extremities. Let’s look at this condition more closely.

What is Raynaud’s disease?

The terms phenomenon, disease and syndrome are often used interchangeably with Raynaud’s, but strictly speaking, there are two types of Raynaud’s:

  1. Primary Raynaud’s is the most common form of the condition, even though there’s no clear medical cause for blood vessels to contract. Typical onset is before age 30.
  2. Secondary Raynaud’s does have a clear and serious medical cause (e.g. scleroderma, rheumatoid arthritis and Lupus). Typical onset is around age 40 or later. Raynaud’s most commonly affects women and people living in cold climates.


We still don’t know exactly what causes attacks of Raynaud’s, but we can link the blood vessel spasms to certain underlying conditions, including:

  • Emotional stress
  • Cold temperatures
  • Drugs that narrow blood vessels, e.g. amphetamines, some beta-blockers
  • Arthritis and autoimmune conditions, e.g. scleroderma, lupus
  • Repetitive activity, e.g. typing, heavy hand tools like jackhammers
  • Smoking – this constricts blood vessels
  • Injuries, e.g. frostbite
  • Family history: one-third of the people with primary Raynaud’s have a family member with the condition


The symptoms of a Raynaud’s attack vary with the intensity and frequency of the blood vessel spasms. Typical symptoms in the extremities, especially fingers and toes, are:

  • Cold
  • Numbness
  • Color changes in the extremities during the attack (typically white, then blue) and during warming or stress relief (red)

How to prevent or address an attack of Raynaud’s

You can take several steps, including:

  • Control stress and practice stress-reduction techniques
  • Stay warm at all times, especially at the extremities
  • Smoking – stop, or don’t start
  • Exercise to increase blood circulation

Diagnosis and Treatment

Even mild Raynaud’s affects one’s quality of life, so a medical consultation is essential. Dr. Giacalone’s goal in treating your condition is to reduce and prevent attacks. He will diagnose any underlying condition, order targeted blood tests, recommend lifestyle changes, and prescribe appropriate medications if needed. There are several topical and oral medications that have been extremely effective in reducing and limiting the pain associated with Raynaud’s.

Foot Fracture in Women, A Hidden Issue.


Foot fractures are one of the most common conditions treated in my office, with metatarsal fractures in women among the most frequent, especially of the fifth metatarsal (the bone on the side of the foot just behind the 5th toe). Several recent studies reported fifth metatarsal fractures account for between 56% and 68% of all metatarsal fractures.

Fifth metatarsal fractures are most often associated with an ankle sprain or twisting motion, resulting in what is typically referred to as an avulsion or Jones fracture, respectively. A spiral or twisting fracture at the middle of the bone, known as a “dancer’s fracture”, is not uncommon.

Studies show that there is an age-related rise in frequency of fifth metatarsal fractures in women. This may be linked to a steady decrease in bone mineral density resulting in osteoporosis as women age, typically not seen in men. As women age, they are more likely to develop issues related to osteoporosis, which weakens the bones, making them more susceptible to fracture. Osteoporosis related fractures are more commonly in the spine (vertebral), femur (upper leg, especially near the hip), wrist and foot. A woman experiencing any of these fractures has an 86% increased risk of having another. Studies suggest however that osteoporosis related metatarsal fractures tend to occur in younger women suggesting that these fractures may be an important indicator or early warning sign of osteoporosis which has yet to be diagnosed.

Many physicians, including myself, and hospitals have implemented a program to identify a patient with an osteoporosis related fracture and refer her (or him) for bone density testing in order to evaluate for osteoporosis and begin a prevention and treatment program. A woman who thinks she might have suffered an osteoporosis related foot fracture should discuss this issue with her Podiatrist or Orthopedist.

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