Patient Care / Covid Toes

Treatment of COVID Toes

Before any treatment for COVID toes is initiated, you should ensure that you have not been diagnosed with COVID-19 by submitting yourself for COVID-19 testing. If you are being treated or have been treated for COVID-19, you should ensure that you are no longer infectious if you intend to visit a podiatrist for persisting COVID toes.

COVID Toes typically resolve without treatment in less than two weeks but have been known to persist for several months.

Information derived from: https://www.aad.org/public/diseases/coronavirus/covid-toes

Patient Care During COVID-19

It is vital to maintain optimal patient care during a pandemic so as to ensure the local healthcare system is not overstretched with additional cases of preventable lower limb complications caused by neglect or improper treatment of the feet.

Patients with diabetes, cancer, heart disease, autoimmune, or rheumatological conditions are strongly advised to maintain their follow-up appointments with their podiatrist to maintain their foot in a stable infection-free status.

Soft tissue conditions that can turn serious should be seen without hesitation. These can include:

Ingrown toenails
Ulcerations, lacerations and wounds
Presence of pus or swelling
Signs of spreading infection such as warmness in the foot or dark streaks or lines
Changes in colour of the limb

Paediatric cases with time-sensitive conditions or ongoing treatments should be followed up closely either via teleconsultation, WhatsApp messaging or in-clinic review.

Musculoskeletal conditions that cause aches and pains in the lower limbs should be evaluated for risk factors that lead to worsening. Acute injuries that have occurred recently or chronic injuries where pain has worsened need to be evaluated clinically and treated promptly to ensure recovery and minimal deterioration of the foot and ankle complex.

Ligament and tendon tears
Fractures
Ankle sprains with bruising and swelling
Inability to weight-bear

The following chart may be useful for determining if cases are of sufficient urgency to warrant critical intervention.

Taken from: https://jfootankleres.biomedcentral.com/articles/10.1186/s13047-020-00425-9

If your patient is stating that they have chest pain or pressure, difficulty breathing or shortness of breath, or their family are reporting loss of speech or movement, these are emergency symptoms associated with COVID-19. The patient should go directly to the nearest A&E for emergency care of these arising problems. In such a scenario, it is not advisable to continue to focus on their lower limb health at this point.

The Most Common Symptoms Associated with COVID-19

Fever
Dry cough
Tiredness

Less common symptoms:

Aches and pains
Sore throat
Diarrhoea
Conjunctivitis
Headache
Loss of taste or smell
Rash on skin, or discolouration of fingers or toes

COVID Toes

Although it has been over a year, COVID-19 is still relatively new to us. COVID-19 carries a variety of symptoms that can range from mild to severe including cough, fever, red dry and itchy eyes. Of particular relevance to us at the Association of Podiatric Medicine (Singapore) is a lesser-known symptom that includes the cutaneous changes of the lower limb where localised vasoconstriction and vascular changes occur indicating COVID-19. In laymen terms, this refers to the changes in the toes that patients diagnosed with COVID-19 experience, more commonly known as ‘COVID toes’.

Common Symptoms of COVID Toes

Swelling of one or more toes
Pink, red or purplish colour change to the extremity
Round, brown spots
Affects all ages
Generally in a healthier patient (no co-morbidities)
Mild general symptoms (dry cough, muscle aches, fever)
Blisters, often accompanied by pus
Itchy and painful raised lumps

COVID toes can resemble chilblains or measles. With paediatric cases, there is a risk that the child is suffering from a serious systemic reaction called Multisystem Inflammatory Syndrome.

There is still much to learn, and it is currently unknown if you are infectious when experiencing symptoms of COVID toes. If you are experiencing such symptoms, you should assume that you are infectious and see a doctor immediately regarding COVID-19 testing.