



Purple feet can be a sign of poor circulation, which can be dangerous. But they can also be nothing to worry about. Cold exposure, vein disease and medications can result in purple discoloration of the feet. Diagnosing the cause requires asking the correct questions and choosing appropriate testing. Of course, treatment depends on the diagnosis and is different for each cause.

Purple Feet from Poor Circulation

Poor circulation is not a medical term. It can mean many things. But, sometimes it means artery blockages. For artery blockages to cause purple feet they need to be severe. If that is the case, diagnosis and treatment are urgent.

Artery blockages can sometimes also result in blue toes. It may surprise you to find out that purple toes can actually be more severe than when the whole foot is purple. Sometimes blue toes are a sign of particles that block the arteries. These particles may signify a serious clotting porblem. Sometimes they signify a risk for other serious issues like stroke.

Cold Exposure

Arteries constrict in the cold. In some people the arteries constrict more than in others. Sometimes the result is a reduced blood flow. This can result in pale feet or a purple color. The changes can be mild or severe. Some people will have it every time they are cold. For example, some people’s feet turn purple every time they walk barefoot on the floor. If the color changes turn from white to blue to red, that might be Raynaud phenomenon Obviously, the most severe form of cold exposure is frostbite. People who suffer from frostbite can develop irreversible changes.

Acrocyanosis

Acrocyanosis is simply Latin for blue extremity. This is the most common cause for purple feet. If your feet turn purple when standing, or if your feet turn purple when sitting you likely have this condition.

There are two types of acrocyanosis: Primary and secondary. Primary is the most common. It simply means there is no underlying cause. Sometimes it is just one of the cold feet causes (or a result of cold feet). Primary acrocyanosis results in discoloration of the feet that resolve when the feet are made warmer or elevated. Secondary acrocyanosis means that there is an underlying cause. It can be a disease or medication.

Purple Feet from Low Blood Pressure

For blood to reach the feet the heart needs to work properly and there needs to be adequate blood pressure. In states of heart failure or very low blood pressure the feet may not receive enough blood. Sometimes medications that are meant to elevate the blood pressure constrict artery flow. This can artificially cause poor circulation to the feet. All these can result in purple discoloration of the feet.

Purple Feet from Vein Disease

“Vein disease” is a very broad term. However, there are several ways for vein disease to cause color changes in the feet. Here are two examples:

Blood clots – These are also known as deep vein thrombosis or DVT. If the DVT is very extensive, it can prevent blood from returning properly to the body. Blood ends up pooling in the feet. Blood that pools looses its oxygen and turns blue. This may cause the feet to seem purple. If the clot is even worse it can elevate the pressure in the leg to block artery flow. If that happens that is called phlegmasia. Then the whole leg can seem purple.

“Leaky” valves – Veins are supposed to take blood from the feet to the body. This is against gravity. To make this system work, veins have valves. If the valves malfunction, some of the blood pools in the feet. This is also called venous insufficiency. As before, pooled blood can loose its oxygen and look blue. Also, patients with leaky valves tend to have dilated bluish veins. These are called reticular veins. Clusters of these veins can make the foot seem blue.

Bruising

Bruising can cause accumulation of blood that can look purple. It may seem weird, but sometimes patients do not remember the injury. Bruising can be in the toes themselves, or higher up in the foot. Also, an injury to the knee or calf can result in blood in the ankle and foot. This is because blood will track down with gravity.

Purple Feet in Elderly

I have noticed there was special interest regarding purple feet in elderly. The complaint of “My feet turn purple when standing” is especially common in elderly people. The color change may also be coupled with edema.

First, remember that all the causes I mentioned above can present in elderly people. So if you happen to be someone who is here to learn more about potential causes for purple feet in an elderly person, I would recommend to read through the whole article. Having said that, the most common causes are probably dependent edema and benign (primary) acrocyanosis. But, in elderly things may be more complicated. For instance, many elderly people take medication that can make leg swelling worse. Also, they may also have medical conditions that might reduce the tone of their small arteries and veins. For instance peripheral neuropathy might contribute to purple or blue feet in diabetes.

Diagnosis

The diagnosis is usually clinical. This means it is usually done by talking to the patient and examining them. But sometimes testing can add information. Knowing which test to get and what to do with the results is key. That is why we put together another article about testing for purple feet. You may want to check it out.

Treatment Options for Purple Feet

In medicine, treatment depends on the diagnosis. So, different causes will require different treatments. But, there are still some simple things you can try that may help.

Avoid cold exposure

If that works, it is a relatively simple thing to do. You could opt for warm socks, avoid walking barefoot and make sure to wear appropriate shoes.

Stay active

Many people’s feet turn purple when they are not moving. For instance, their feet turn purple when standing or sitting at a desk. Getting up and moving around from time to time can take care of that. This is because walking will get the blood flowing and pump fresh, red, blood into your feet.

Try compression stockings

To be fair, they are not always comfortable. But compression stockings can prevent pooling of blood. If blood does not pool, it stays flowing. Flowing blood usually does not turn blue or purple. If you do your research, you will notice that compression stockings come in many degrees of compression. Also, there are many companies that make them. But my advice is to remember that in the end they are… a kind of socks. The same way you will probably need to try on a few pairs of pants before finding the ones you like, you may need to try a few stocking brands before finding the ones you like the most. Remember that while compression stockings are 99% safe, people with very severe artery blockages should avoid them.

Review your medication

Of course, you should always do this together with your doctor. But, maybe you can identify a medication that was added before the discoloration appeared, like Adderall. Maybe you will be able to replace a medication, reduce a dose or at least have an explanation for what is going on.

Look for Warning Signs

There are a few things about purple feet that should tip you off that something unusual is happening that you should pay close attention to: