Q. I have painful purple toes despite taking pain medications. Kindly help me.

Answered by
Dr. Basuki Nath Bhagat
and medically reviewed by Dr. Sushrutha Muralidharan
This is a premium question & answer published on Jul 16, 2021

Hi doctor,

I have purple toes and pain. I am taking Metformin, Alprazolam, Prozac, and Aspirin. Kindly help me.



Welcome to

I saw the picture attached (attachments removed to protect the patient's identity). It seems like it is a secondary Raynaud phenomenon. It is vascular insufficiency due to arterial disease caused by other entities.

Since how many days you are having this? Any similar appearance on exposure to the cold or emotion?

I mentioned secondary because usually, the primary Raynaud phenomenon occurs in young women. Secondary means it is the manifestation of some underlying cause. I would suggest you visit your local doctor. The necessary investigation is to be done to know the cause of it, and hence proper treatment can be initiated.

I hope this was helpful. Please get back if you have further doubts.

Hi doctor,

Thank you.

No, they are not cold. ER said blue toe syndrome, gave me pain medications. They told me to talk to vascular, and that is 50 miles away on Tuesday. I have severe anxiety and agoraphobia and do not travel. I go by ambulance, is there any way you can help me with something with pain. At bedtime, it is horrible. Kindly give your opinion.



Welcome back to

Raynaud phenomenon is one of the causes of blue toe syndrome. There are other causes too. The treatment of blue toe syndrome revolves around addressing the cause of it. This usually in the form of relieving occlusion.

I understand your concern about anxiety and agoraphobia, but you should go to the hospital as the cause of it has to be found through investigation. You should not postpone or delay going to the hospital as severity might increase and the prognosis may change.

Pain medications are just temporary to relieve pain. The main treatment lies in identifying the cause and treatment accordingly. Take pain medication before bedtime to relieve it as suggested by ER (emergency).

I hope this was helpful.

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