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Hematology/Purple left pinky toe


QUESTION: Since Sept 8/13 I've had this purple toe.  It is somewhat painful.  I've had x-rays, it is not broken.  Blood work came back normal low iron and b12 but on meds for that.  toe still not getting better.  Had Doppler done and no vascular issue.  Med. Family history include diabetes, heart attacks, gout.  grand father died at 42 of heart attack, aunt had one at 39.  Grandma had leg amputated due to diabetes also had stomach embolism.  Have an echo set up waiting on appointment but slowly running of options as to what this could be.  I am 39 and a smoker, about 30 lbs over weight, normal eating habits.  I am hoping to find someone who has had this before or someone who has seen someone with a toe like mine.  Dec 18th is day 102.  forgot to mention cannot wear shoes or socks, having toe under water hurts.  Standing too long make the toe burn and tingle.
Any suggestions you may have are welcomed.
Thank you for your time

ANSWER: Hello Sue!
Warm welcome to you!
Sorry for the late reply, was out of station. It seems your problem could be due to a complex of 2-3 underlying issues. One is low iron and b12. Also you have mentioned family history of diabetes, heart attacks, embolism. Also your history says you are overweight n smoking. So normally my doubt is may be a fatty plaque is causing a regional cyanosis. So have you got your lipod profile checked? You mentioned you had doppler for vascular abnormalities. Was the doppler done with regards to the pinky toe? or was it a general cardio-vascular doppler?

This could be either purple toe syndrome(if there any vascular blockages) or since you told standing too long make the legs tingle and burn I guess there is abnormal venous drainage in legs. It could be due to varicose veins.

Anyway it would be much better if you could send me a pic of it.

Thanking you!

---------- FOLLOW-UP ----------

Thanks for the reply.  Here is a photo of the toe taken maybe 10 days ago.  Still looks the pretty much the same.  Hope the visual helps.
The Doppler was on my legs, arms and chest area (legs were done twice at two seperate labs) 1st results were normal that's why I had the second more elaborate one done and specialist said no obstructions and is sending me to a cardiologist for the echo.  I don't have many varicose veins maybe 2-3 very very small just looks like a little hair.  I am not sure about the lipod but I know he did a full work up and everything else was in the normal range.  He has since taken me off the B12 inj. and put me on a low dose aspirin a day along with the iron pill but will mention it when I see him.
Thanks again for your time,

ANSWER: Hi sue,
Nice to hear from you!
It seems as I suspedcted your doctor also suspected lipid plaques clogging the blood vessels/ embolism. The aspirin is an anticoagulant, lipid reducing drug which will dissolve/retract the clots. Thats why he is giving aspirin to you!

But considering the fact that only one toe(pinky toe) is involved, its either a clot in micro-circulation or othe conditions like frostbite, bullous diabeticorum (if you are a diabetic). So it can be confirmed after lab investigations. But can you tell how the swelling first developed? when you started noticing it? Do you feel its fluid filled? I see you are wearing a ring on second toe. Did you wear any such ring on pinky toe?

Thanking you!

---------- FOLLOW-UP ----------

QUESTION: Thanks for replying.
As far as blood work I have not tested positive for diabetes.  I know the toe looks swollen but it isn't it's just purple.  It varies from dark like in the picture to a pink.  It is somewhat desensitized and painful around the nail area and tip of the toe.  normal touch doesn't really hurt but a gentle light rub hurts.  I can grab the toe and move it and it doesn't hurt it doesn't feel fluid filled at all.  No that's the only ring I have as i thought maybe a hair had gotten tangled around my toe but no.  woke up on Sunday Sept 8th, got in the shower and realized I had a purple baby toe.  It was more sensitive in the beginning and as time went by I feel less and less everyday of the toe.  That whole purple area scabbed up and fell off almost looks like it starting over again.
thanks again for your time
I do appreciate it
this picture was taken on Nov 18th 2013 2 months 10 days with discolored toe

Hi sorry for the late reply! Was busy in hospital rounds all week. The fact that only single toe is involved and no the abnormalities in blood work then it could be just a local infection like Paronychia.You can use over the counter topical antibacterial-antifungal combination creams. If not you can apply clindamycin. Daily soak the toes in antibacterial/antiseptic solution. Try to avoid factors which aggravate it.

Thank you!


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Dr.Shrinidhi Kulkarni


I can answer all questions related to hematology. RBC, WBC, Platelet and blood forming organs etc and related questions. hematology also includes blood proteins, hemoglobin and disorders related to clotting abnormalities. So questions about all aspects of hematology are welcome!


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KIMS Banglore

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