From the Guidelines
Blue toe syndrome is a condition characterized by a sudden cyanotic discoloration of one or more toes, typically caused by embolic atherosclerotic debris from proximal arteries.
Cause
The cause of blue toe syndrome is usually due to embolic atherosclerotic debris from the proximal arteries, which can be detected through clinical examination and measurement of the Ankle-Brachial Index (ABI) 1.
Management
While the provided evidence does not explicitly outline the management of blue toe syndrome, clinical examination and measurement of ABI can aid in diagnosis and inform treatment decisions 1.
Clinical Presentation
Blue toe syndrome presents with sudden cyanotic discoloration of one or more toes, and can be a sign of underlying peripheral artery disease 1. In clinical practice, it is essential to consider blue toe syndrome as a potential sign of embolic events or peripheral artery disease, and to manage it accordingly, with a focus on preventing further embolic events and improving peripheral circulation.
From the Research
Definition and Cause of Blue Toe Syndrome
- Blue toe syndrome (BTS) is a condition characterized by the spontaneous onset of a painful unilateral blue toe, usually caused by fibrinoplatelet microemboli arising from an upstream stenotic or occlusive lesion of the iliac or femoral artery 2.
- The condition can also be caused by end-arterial occlusion, which is frequently the first manifestation of a systemic disorder, such as atheroembolism or vasculitis 3.
- Other potential causes of BTS include compression of the dorsalis pedis artery due to extrinsic compression by the extensor hallucis brevis tendon 4, and cholesterol embolization leading to occlusion of small vessels 5.
Management of Blue Toe Syndrome
- Treatment options for BTS include antiplatelet and anticoagulant therapy followed by delayed percutaneous transluminal angioplasty (PTA) 2.
- Angioplasty with stenting has also been shown to be an effective treatment for BTS, with good initial angiographic success and hemodynamic improvement 6.
- Surgery remains a viable treatment option, particularly for cases where embolization is suspected to be caused by an ulcerated atherosclerotic plaque located in the aorto-iliac-femoral arterial system 5.
- In some cases, treatment of the underlying condition, such as myeloproliferative syndrome or thromboangiitis obliterans, can lead to significant improvement or full recovery 3.