For most of us here in the high country, winter is the busy season. When the temperatures drop, the snow accumulates and skiers, snowboarders and other winter sports enthusiasts, spend long days on the mountain. Without proper protection any outdoor activity can pose a potential health risk. Fortunately, understanding what can happen to your feet and taking some simple precautions can help avoid many of the more serious cold-related injuries.

What Can Happen?

Frostbite

In conditions of prolonged cold exposure, your body sends signals to the blood vessels in your hands and feet telling them to constrict in order to preserve blood flow to your vital organs. This helps the body by preventing a further decrease in internal body temperature by exposing less blood to the outside cold. As this happens, your toes and fingers become colder and colder eventually leading to injury of the involved tissues. In mild cases where the exposure is limited, swelling and redness of the tips of the toes may be seen. If the area remains chilled, then numbness, tingling, itching and pain may be experienced. With increasing exposure to cold, frostbite may occur where regions of the tissue may appear white and frozen. After prolonged exposure the deeper tissues may be injured, and eventually all sensation is lost. The severity of frostbite is directly related to time of exposure and is classified into four degrees based on the depth of the injured tissue.

Chilblains

While frostbite is caused by actual freezing of tissue, the more common cold-related injury we see here in the mountains is chilblains. Also called pernio or perniosis, chilblains are caused by inflammation of the small blood vessels in your skin when there has been repeated exposure to cold temperature. This inflammation causes painful or itchy red patches and occasionally blisters on the toes or fingers. No one knows exactly what causes chilblains, but they may be an abnormal reaction of your body to cold exposure followed by rewarming. Rewarming of cold skin can cause small blood vessels under the skin to expand more quickly than the deeper blood vessels can handle. This results in a bottleneck effect and blood leaking into nearby tissues. Swelling of the fingers or toes can occur and red or purple patches on the skin are common. Fortunately, chilblains will usually resolve on their own, but treatment to decrease inflammation and improve circulation to the injured tissues can help speed the process.

Who’s at Risk?

While anyone who spends a lot of time outdoors during the coldest winter months is at risk, many individuals are more susceptible to cold injury. People with poor circulation, diabetes, or taking certain medications are at particular risk. Children and athletes with low body fat have less natural insulation. Also, ski racers with minimal clothing and extra-snug race fit boots will often have to stand and wait for their turn in the gates. Finally, if you have had a previous cold injury, the chances of developing another injury to the same tissue are increased.

For some people, the temperature does not have to drop that far in order for injury to occur. A condition known as Raynaud’s phenomenon can cause excessive constriction, or spasm, of the blood vessels in the toes and fingers, even with modest exposure to cold. Patients with the condition will notice toes suddenly turn white, then blue, becoming cool to the touch and eventually numb. As the attack subsides, usually in a warmer setting, the areas will flush a deep red and may tingle, throb or itch. Raynaud’s phenomenon can be related to other medical conditions, so if you have any of these symptoms consult with a physician.

What to Do?

Footwear Considerations

To avoid problems with your feet and keep them healthy and ready for action this winter, choose your footwear wisely. Make sure your boots fit properly and keep your feet dry. For all but the most serious ski racers, ski boots should allow your toes to wiggle just a bit. Use of battery powered boot heaters can help prevent excessively cold toes as well. These devices are best used to regulate the temperature of your feet rather than actually heating them up. Keeping your toes “not cold” is usually preferred to having them “feel warm.”

Stay Warm

Prevention is the best treatment for cold-related injuries. Keeping your body core warm helps prevent the shunting of blood flow away from your extremities. Hats, gloves, and waterproof, moisture-wicking clothing should be part of any outdoor enthusiast’s wardrobe. Being aware of the on-mountain temperature is also necessary, realizing that very often wind chill combined with high speed skiing or riding can compound the cold effects. If being outdoors is optional, elect to stay in if temperatures are too cold for safety.

Maintain Circulation

Maintaining circulation and blood flow to your extremities is paramount. Avoid nicotine, caffeine and alcohol as all of these can contribute to decreased blood flow to your extremities. Supplemental Niacin, also known as vitamin B-3, can help blood vessels dilate, increasing blood flow to the skin and may be helpful for people with Raynaud’s phenomenon. In areas that have already been injured, topical prescription medications containing powerful vasodilators may also be used to promote blood flow and speed healing of inflamed tissues. In the most severe cases, prescription blood pressure medications may be used to dilate blood vessels even further.

When to see us?

Most cold injuries are minor and cause minimal down time, but if the early warning signs are ignored they can turn into bigger problems. If you have diabetes or circulatory problems seeking medical care immediately can help avoid complications. If you develop an open wound or signs of infection, it’s best to seek treatment as soon as possible. Please contact our Avon or Frisco office to set up an appointment.