Numb toes in cold weather: Raynaud’s, neuropathy or a pinched nerve?

As November turns colder in New Jersey, many people notice numb toes on the walk to the car or at a weekend game. Most of the time that is your body doing its job. Sometimes it is a clue to a circulation problem, a nerve problem, or both. Here is how to tell them apart, and when a Foot and Ankle Surgeon can help.

Why do you get numb toes in cold weather?

When you get cold, blood vessels near the skin narrow to hold on to body heat.^[1] Less warm blood reaches the toes, so they feel stiff, tingly or numb. Once you warm up, color and feeling return. That is normal.

Raynaud’s toes: what do the color changes mean?

Raynaud’s phenomenon is an exaggerated version of that response. The vessels in the fingers and toes narrow quickly and stay narrow too long. During an attack, the skin turns pale or white from lack of blood, then blue, cold and numb, then red as blood returns. The red phase can tingle, burn or throb. Attacks last minutes to hours. Cold is the most common trigger, but stress, smoking and vaping can set them off.^[1]

There are two kinds:^[1]

• Primary Raynaud’s has no known cause. It is more common, usually mild, more frequent in women, and usually starts before age 30. A pooled review put it at about 4.85% of people.^[2]
• Secondary Raynaud’s is linked to another condition, such as lupus, scleroderma or rheumatoid arthritis, or to some medicines. It is less common and more serious.

Tissue damage is common in secondary Raynaud’s but not in primary. A close look at the tiny blood vessels at the base of the nail is the standard way to tell the two apart.^[5] Severe attacks can cause painful sores on the toe tips.^[1]

Raynaud’s is not something we treat with foot nerve surgery. Keeping warm comes first, and medicines that relax blood vessels are the usual next step. For severe cases, specialists may use injections or an operation on the nerves that control blood vessels (sympathectomy), though how well that surgery works long term is uncertain.^[5] Your primary care physician or a rheumatologist manages it, and we coordinate with them.

Chilblains and frostbite: when is cold an emergency?

Chilblains are patches of skin inflammation that appear after cold, damp weather that isn’t freezing. They usually clear up on their own. Keeping your feet warm and not smoking are the first steps.^[6]

Frostbite is freezing of the skin and tissue. It starts with pins and needles, then numbness. The skin becomes hard, pale and cold, and turns red and very painful as it thaws. Severe cases blister or turn black.^[4] If help is far away, soak the area in warm (never hot) water for 15 to 30 minutes. Don’t rub it, use dry heat or let it refreeze. Severe frostbite needs the emergency room, and so does any frostbite where color and feeling don’t come back promptly.^[4]

Trench foot comes from feet staying cold and wet for a long time without freezing. It can leave lasting nerve pain and sensitivity to cold.^[7]

Numb feet in cold weather: is it neuropathy?

Peripheral neuropathy is nerve damage that usually starts in the toes of both feet and slowly creeps upward. Diabetes is the most common cause.^[8] Cold can make numb feet more noticeable, but numbness from neuropathy is there in warm weather too.

Neuropathy also makes winter riskier. With nerve damage from diabetes, you might not notice a burn on your feet. Skip heating pads and hot water bottles on your feet. Wear socks to bed and lined, waterproof boots outside.^[9] If your feet are cold and pale, circulation may be part of the story; see cold or numb feet: circulation or nerves?

Cold numb toes in winter from a pinched nerve

Cold doesn’t pinch a nerve, but an irritated nerve may react more to cold. In people treated for nerve injuries or pinched nerves in the arm, worse cold sensitivity went along with worse feeling in the hand.^[10] After hand injuries, cold can bring on pain, numbness and color change, through both blood vessel and nerve changes.^[11]

Winter footwear adds pressure too. Thick socks in snug boots and tight laces can press on the nerves on top of the foot. The deep peroneal nerve is most often trapped under the band of tissue at the front of the ankle, and removing outside pressure is the first step.^[12] See numb top of the foot from tight laces.

Clues that point to a pinched nerve rather than cold alone:

• Numbness or burning in one spot, such as between the third and fourth toes (Morton’s neuroma) or across the sole (tarsal tunnel syndrome).
• Zings, burning or pins and needles that don’t fade once your feet are warm.
• One foot only. Numbness that is clearly worse in one foot doesn’t fit the usual neuropathy pattern.^[13]

When does surgery fix numb toes?

When a nerve is pinched, freeing or removing it treats the cause. Dr. Efe Ozturk, a double board certified Foot and Ankle Surgeon and podiatrist, performs nerve release and neuroma surgery for appropriate patients.

• Morton’s neuroma. In 160 people followed a median of about seven years after removal, 89.4% reported a good result.^[3] See Morton’s neuroma surgery.
• Tarsal tunnel syndrome. In 76 feet followed at least five years, 65% did well with non-surgical care. Adding a nerve release after six months without relief raised that to 78%.^[14]
• Deep peroneal nerve. Shoe changes come first. If they fail, surgery can release the nerve.^[15]

Shoe changes, padding and time come first, and surgery is the answer when they don’t work. Vascular causes such as Raynaud’s or blocked arteries go to the right specialist. Our limb salvage team explains black or discolored toes (external site).

What are the limits?

The Morton’s neuroma study was from a single center and looked back at past patients.^[3] An older review said neuroma surgery success rarely tops 83%.^[16] The cold sensitivity studies were in hands, not feet.^[10,11]

Common questions

What does it mean when your toes go numb in the cold?

Usually, that your body is saving heat. Color changes or numbness that won’t fade can mean Raynaud’s or a nerve problem.^[1]

Why do my toes turn purple in the cold?

In a Raynaud’s attack, toes go white, then blue or purplish, then red as blood returns.^[1] New attacks with sores need a medical evaluation.

Is numbness after cold weather dangerous?

Toes that stay numb, hard or pale after warming can be frostbite and need emergency care.^[4] Read more about numb toes.

When to see a specialist

Book an evaluation if your toes stay numb after warming, burn or zing, or bother one foot more than the other. We see patients in Lyndhurst, Paramus and Millburn. Please call our office at 908-215-5953 to inquire about your insurance.