Cold Hands & Feet Overview

When your hands or feet (and sometimes other parts of the body, especially your ears and nose) get too cold, they can be injured or react in different ways.

The most severe cold injury is frostbite, which is true tissue freezing (ice crystals form in the skin and other tissues of the body). Frostbite causes permanent damage to blood vessels and other structures. Frostnip is also ice crystal formation in tissues but only in the very outer layer of the skin. It causes no permanent damage. Immersion injury results from exposure of wet feet (or hands) to cold temperatures at or above freezing. It develops over hours to days and damages the nerves and muscles. Like frostbite, immersion injury causes permanent damage. Other conditions of cold hands or feet are pernio, Raynaud's phenomenon, cryoglobulin formation, and cold urticaria.

Cold Hands & Feet Causes

Humans are tropical animals. We are adapted to a warm climate. When exposed to cold, the body tries to stay warm. If the body is cooling off, circulation decreases in the arms, legs, ears, and nose so that the rest of the core body can stay warm. When temperatures are below freezing, ice may form in these areas with less circulation.

Nonfreezing cold injuries are also caused by cooling of the skin. In immersion injuries, the nerves and blood vessels are damaged after exposure to cold, wet conditions at or above freezing temperatures. Pernio is caused by exposure to cold for a long period of time without freezing or by very wet conditions. Raynaud's phenomenon is an abnormal narrowing of the blood vessels that constrict with cooling of the fingers or toes. Cryoglobulins are proteins, which are normally dissolved in the blood, that become solids or gels when cold. Cryoglobulinemia is the condition associated with cryoglobulins in the blood, whereby cold exposure leads to bluish discoloration of the fingers or toes. The formation of hives in response to cold exposure of the skin is called cold urticaria.

Cold Hands & Feet Symptoms and Signs

Frostbite and frostnip o Frostbitten body parts are white and hard or waxy. They may be whitepurple or white-yellow. o Frostnipped parts are white but not hard and are generally very small areas. o Frozen parts have no feeling. o During the freezing process, they may tingle or feel like a block of wood.

Once frostbitten areas thaw, they may be painless or tingle. When they are rapidly rewarmed in warm water by the recommended method, they may be painful. o Over the next few days, the part is often painful and swollen. o Blisters may appear, and severely affected areas turn black. Immersion injury o Areas affected by immersion injury are first red and then turn pale and swollen. o Numbness or painful tingling may occur. o After the first few days, the part becomes very red, tingling, swollen, and may have blisters, skin breakdown, or even liquefy. Pernio o Pernio is a rash on the lower legs, feet, toes, hands, or ears that may be red or blue and may form scaly areas or lumps. o Rarely, affected parts may bleed, blister, or have skin breakdown. o Often pernio causes itching and burning. Raynaud's phenomenon refers to constriction of the blood vessels of the hands or feet in response to cold exposure. Raynaud's phenomenon causes white, then blue, then red-colored fingertips and toes and is often painful. Cryoglobulins cause a wide array of symptoms, depending on whether or not internal organs are involved, including deep-blue fingertips. Cold urticaria refers to raised red bumps or hives produced in response to cold exposure.
o o

When to Seek Medical Care

If you suspect that you have frostbite or immersion injury, do not call the doctor. Go to a hospital's emergency department. If you suspect that you have pernio or other coldinduced injuries, you should call your doctor. If you have any white hard areas on hands, feet, or other parts of the body or if you had white areas that have thawed, go to the emergency department for treatment of frostbite. If your hands or feet have been cold and wet for an hour or longer, you may have immersion injury and should also go to the emergency department. If a part of your body that has been exposed to cold is painful, go to the emergency department.

Diagnosis
Frostbite is diagnosed by the way it looks, not by tests. There are no specific tests for other conditions caused by cold, except blood tests for cryoglobulins. As with frostbite, testing may be needed for other injuries or conditions.

If there are other injuries such as hypothermia (below normal body temperature) or possible broken bones, tests may be needed for the other injuries. If the frostbite seems severe, a bone scan may be necessary. This is a painless procedure that shows the doctor which areas of the hands or feet still have circulation. Other tests often done for frostbite include blood tests, especially tests of the tendency of the blood to clot, and X-rays.