Question
I had athlete's foot for 3 months during the winter time. After that went away, my feet would start turning purple when they got cold and would go numb, but it would always be worse on the foot that had the athlete's foot. Now its very warm out and that same foot (the left foot) is always pink, but sometimes purplish and swollen.  Sometimes both feet will turn purple during the typical onsets of Reynauds, but its usually my left foot that has the symptoms and sometimes for no apparent reason.  Does this sound normal?

Answer
Hi Melissa,

Unfortunately it does sound typical, not normal.

Usually, your condition effects the upper extremities, there is also a difference between Raynauds disease and Raynauds phenomena. I am sure you are aware of this, just in case, I thought I would point it out. If you need further indepth information, just Google it and learn more.

Try taking Niacin, it is a peripheral dilator and should relieve the symptoms. Other than that, not much is known about causation and treatment aside from it is fond of particular races and gender.

Hope the niacin works;
Dr. Timothy Durnin

I copied this out of Merck for you, they don't mention niacin but it is the safest treatment.

It is easier to read if you just go to the site.

http://www.merck.com/mmpe/sec07/ch080/ch080g.html#sec07-ch080-ch080g-1726

Raynaud's phenomenon (Raynaud's disease) is vasospasm of parts of the hand in response to cold or emotional stress, causing reversible discomfort and color changes (pallor, cyanosis, erythema, or a combination) in one or more digits. Occasionally, other acral parts (eg, nose, tongue) are affected. The disorder may be primary or secondary. Diagnosis is clinical; testing focuses on distinguishing primary from secondary disease. Treatment of uncomplicated cases includes avoidance of cold, biofeedback, smoking cessation, and, as needed, vasodilating Ca channel blockers (eg, nifedipine) or prazosin.

Primary Raynaud's phenomenon is much more common (> 80% of cases) than secondary; it occurs without symptoms or signs of other disorders. It is sporadic in about 75% of cases but may be familial. About 15 to 20% of people with primary Raynaud's phenomenon develop a more serious systemic disorder.

Secondary Raynaud's phenomenon accompanies various disorders and conditions, mostly connective tissue disorders (see Table 1: Peripheral Arterial Disorders: Causes of Secondary Raynaud's Phenomenon).
commonly contributes to it but is often overlooked. Raynaud's phenomenon may accompany migraine headaches, variant angina, and pulmonary hypertension, suggesting that these disorders share a common vasospastic mechanism.

Overall prevalence is about 3 to 5%; women are affected more, and younger people are affected more than older. Raynaud's phenomenon is probably due to an exaggerated ?-adrenergic response that triggers vasospasm; the mechanism is not defined.

Symptoms and Signs

Sensations of coldness, burning pain, paresthesias, or intermittent color changes of one or more digits are precipitated by exposure to cold, emotional stress, or vibration. All can be reversed by removing the stimulus. Rewarming the hands accelerates restoration of normal color and sensation.

Color changes are clearly demarcated across the digit. They may be triphasic (pallor, followed by cyanosis and after warming by erythema due to reactive hyperemia), biphasic (cyanosis, erythema), or uniphasic (pallor or cyanosis only). Changes are often symmetric. Raynaud's phenomenon does not occur proximal to the metacarpophalangeal joints; it most commonly affects the middle 3 fingers and rarely affects the thumb. Vasospasm may last minutes to hours but is rarely severe enough to cause tissue loss.

Raynaud's phenomenon secondary to a connective tissue disorder may progress to painful digital gangrene; Raynaud's phenomenon secondary to scleroderma tends to cause extremely painful, infected ulcers on the fingertips.

Diagnosis

Diagnosis is made and primary and secondary forms are distinguished clinically, supported by nail fold capillaroscopy and blood testing. For nail fold capillaroscopy, a drop of immersion oil is placed at the fingernail base; nail fold capillaries are magnified and examined using an ophthalmoscope set at 10 to 40 diopters. Distorted or dilated capillary loops suggest a connective tissue disorder as the cause. Blood tests (eg, measurement of ESR, antinuclear antibodies, rheumatoid factor, anticentromere antibody, anti-SCL-70 antibody) are done to detect accompanying disorders.

Diagnostic criteria for primary Raynaud's phenomenon are age at onset < 40 (in 2⁄3 of cases), mild symmetric attacks affecting both hands, no tissue necrosis or gangrene, no history or physical findings suggesting another cause, and normal nail fold capillaries, ESR, and blood test results.

Diagnostic criteria for secondary Raynaud's phenomenon are age at onset > 30, severe painful attacks that may be asymmetric and unilateral, ischemic lesions, history and findings suggesting an accompanying disorder, enlarged and tortuous nail fold capillaries, and abnormal ESR and blood test results.

Raynaud's phenomenon differs from acrocyanosis, which causes persistent cyanosis that is not easily reversed and does not cause trophic changes, ulcers, or pain.

Treatment

Treatment of the primary form involves avoidance of cold, smoking cessation, and, if stress is a triggering factor, relaxation techniques (eg, biofeedback) or counseling. Drugs are used more often than behavioral treatments because of convenience. Vasodilating Ca channel blockers (extended-release nifedipineSome Trade Names
ADALAT
PROCARDIA
Drug Information
60 to 90 mg po once/day, amlodipineSome Trade Names
NORVASC
Drug Information
5 to 20 mg po once/day, felodipineSome Trade Names
PLENDIL
Drug Information
2.5 to 10 mg po bid, or isradipineSome Trade Names
DYNACIRC
Drug Information
2.5 to 5 mg po bid) are most effective, followed by prazosinSome Trade Names
MINIPRESS
Drug Information
1 to 5 mg po once/day or bid. Topical nitroglycerine paste, pentoxifyllineSome Trade Names
TRENTAL
Drug Information
400 mg po bid or tid with meals, or both may be effective, but no evidence supports routine use. ?Blockers, clonidineSome Trade Names
CATAPRES
Drug Information
, and ergot preparations are contraindicated because they cause vasoconstriction and may trigger or worsen symptoms.

Treatment of the secondary form focuses on the underlying disorder. Ca channel blockers or prazosinSome Trade Names
MINIPRESS
Drug Information
is also indicated. Antibiotics, analgesics, and, occasionally, surgical debridement may be necessary for ischemic ulcers. Low-dose aspirin may prevent thrombosis but theoretically may worsen vasospasm via prostaglandin inhibition. IV prostaglandins (alprostadilSome Trade Names
CAVERJECT
EDEX
MUSE
Drug Information
, epoprostenolSome Trade Names
FLOLAN
Drug Information
, iloprost) appear to be effective and may be an option for patients with ischemic digits. However, these drugs are not yet widely available, and their role is yet to be defined. Cervical or local sympathectomy is controversial; it is reserved for patients with progressive disability unresponsive to all other measures, including treatment of underlying disorders. Sympathectomy often abolishes the symptoms, but relief may last only 1 to 2 yr.