Cold feet in cold weather are normal. But one foot colder than the other, with pallor, weak pulses, pain on walking or slow-healing wounds, may mean narrowed leg arteries and needs a Doppler and ankle-brachial index test.
"My feet are always cold" is a complaint we hear a lot. Usually it means nothing serious, but sometimes it is the first sign of reduced blood flow to the feet.
Common harmless causes
- Cold weather and inactivity.
- Raynaud's phenomenon: toes or fingers turning white then blue with cold or stress, then red as they warm.
- An underactive thyroid or anaemia.
- Very low body weight.
When is it from narrowed arteries?
Narrowing of the leg arteries from fat and calcium build-up reduces blood reaching the foot. Signs include:
- One foot clearly colder than the other.
- The foot going pale when raised and dusky red when lowered.
- Weak or absent foot pulses.
- Calf pain on walking that eases with rest.
- Slow-healing wounds, hair loss on the leg, or shiny skin.
This cause is more likely with smoking, diabetes, high blood pressure, high cholesterol and age. Read about peripheral artery disease.
Tests
- Ankle-brachial index (ABI): a simple test with a blood-pressure cuff and Doppler that compares ankle and arm pressures.
- Arterial Doppler: shows where the narrowing is and how severe.
- CT angiography: when planning treatment.
Treatment
It starts with stopping smoking, controlling sugar, blood pressure and lipids, and a regular walking programme, with medicines that protect the arteries. In advanced cases the artery can be opened with a balloon and stent through a small puncture.
Advice for people with diabetes
Don't use a hot-water bottle or heater close to your feet if your feeling is reduced; you could get burned without noticing. Use warm cotton socks and check your feet daily.
Frequently asked questions
Do cold feet mean poor circulation?
Not always. But if it is one foot, or comes with pallor, weak pulses or pain on walking, the arteries should be checked.
Which test detects poor leg circulation?
The ankle-brachial index (ABI) and an arterial Doppler are the main tests.
Does walking improve leg circulation?
Yes. A regular walking programme is one of the best ways to increase pain-free walking distance in arterial disease.
Content on this website is for awareness only and does not replace a specialist medical examination.