Chilblains By Catherine Nicol

If you have ever experienced chilblains, you will be well aware that these itchy, red or purple, tender lesions can be seriously irritating. The recent drop in Victorian temperatures is a stark reminder that winter is not far away, making now the perfect time to learn all about the potential perils of chilblains and how to best prevent them.

What are Chilblains and where are they found?

Chilblains are a form of localised vasculitis that causes the formation of inflammatory lesions, most commonly on the toes, fingers and ears. These lesions typically present with a red or purple discolouration, with localised swelling and are the result of prolonged exposure to extreme cold, damp and wind. Chilblains are believed to be caused by the peripheral blood vessels of the toes constricting in response to the cold and then as they are rewarmed, often too quickly, blood leaks into the tissue and causes localised swelling. Chilblains often feel itchy, can be excruciatingly tender and in extreme cases can result in blistering, pustules and ulceration of the digits. They typically last 7-14 days, but often last much longer, especially if the cause of the presentation is not addressed.

Who is most at risk

Chilblains most commonly occur in children and the elderly, as well as those with impaired peripheral circulation, which may occur as a result of diabetes, smoking and peripheral vascular disease. Other contributing factors include heredity, low body weight, and conditions such as Lupus and Raynaud’s Phenomenon. Although chilblains are more common in children and the elderly, they really do not discriminate, and as someone who has spent past winters working hard to prevent their recurrence, I can certainly sympathise with the pain and discomfort they can cause.

Prevention is better than the cure

Take it from a past chilblain sufferer, when it comes to these itchy, painful lesions, prevention is definitely the best option. Anyone who is spending a prolonged period of time outdoors through the cooler months, would be wise to consider some of the precautionary measures, whether it be part of your regular working day, your frosty early morning run, or your weekly 18 holes on the golf course.

One of the main stays of chilblain prevention is to try to maintain your feet at a constant temperature as best as possible. This means if your feet are cold definitely do not put them straight in front of the heater or on a hot-water-bottle, or go straight from the freezing cold bathroom tiles to a piping hot shower, as they need gradual rewarming to avoid the sudden vasodilation of the peripheral vessels.

Some handy tips include:
● Wear thick woolen socks or other natural blend socks always
● Make sure you wear enclosed footwear outdoors (keep those toes hidden away)
● Wearing slippers with sheep or lambswool lining around the house (one of the few times a
podiatrist condones slippers)
● Do not sleep with your electric blanket on, but rather use it to warm up your bed and make
sure it is switched off before jumping in
● Put lambswool insoles in your footwear
● Regular exercise to help promote peripheral circulation
● Heat up the cold shower tiles with warm water before getting into the shower
● Make sure your home and workplace is well insulated and free from cold drafts if possible.

How to treat chilblains:

Although prevention is definitely the best way forward for happy and chilblain free feet, if you do find yourself with chilblains, there are still a number of treatment options available. Applying Hirudoid Ointment to help dilate the peripheral vessels of the toes and help to reduce the swelling is a great and simple option. This particular ointment is commonly used to help bring out bruising when you have injured yourself and can be very useful in treating chilblains.

Another mode of treatment involves the use of several layers of Friar’s Bolsom and cotton wool on the affected toes, to create a little protective cocoon. Whilst a little fiddly and time consuming, over my 11 plus years as a podiatrist, I have found this to be one of the more effective ways to address chilblains. The process involves applying a layer of Friar’s Bolsom to the affected toe, followed by a thin layer of cotton wool. This process is then repeated several times, with the tackiness of the Friar’s Bolsom causing the layers to stick together thus creating an insulated cocoon for the toe, with a light application of hypafix tape to secure the final layer. These are best left in place for a number of days and repeated as needed. It can definitely be a sticky, messy business, but your itchy, inflamed toes will thank you for it!

As always, if you have any questions about this condition or any of the advice above, please contact Catherine the clinic on 5254 2668.

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