Why Are My Toes Blue?

A 28-year-old woman with no significant medical history presents to the clinic with bilateral, symmetric, painless, and blue discoloration of her toes that has been going on for a day. She started noticing it after running. She also notes occasional swelling and coldness of her toes bilaterally. She denies a personal or family history of blood clots, hypercoagulable disease, or connective tissue disease.

On physical examination, dorsalis pedis and posterior tibial pulses are 2+ bilaterally. Her feet and toes are nontender to examination but are cold with patchy blue discoloration up to mid foot. Upon application of pressure on the feet/toes, blanching is noted and followed by a slow and irregular return of blood from the periphery toward the center. There is no ulceration or gangrene noted. A photograph of her right foot is available (Figure 1).

Figure 1

Figure 1

Which one of the following is the most likely diagnosis?

Show Answer