Foot Turns Purple When Not Elevated After Injury

In August 2012 I was working on an article about purple toes when my husband came into the room to tell me I had a phone call. It was Dr. Anthony Kelleher, orthopedic surgeon at Stony Brook Medicine Hospital. He said he wanted to know if I would mind having surgery because he thought it might help with pain relief for my back problems. I didn’t hesitate. “Of course,” I told him. And then he asked me another question. “Do you have any bluish discoloration anywhere?”
I looked down at my feet. They were pale blue-white. I’d been wearing white athletic shoes all day, so I figured they must be turning purple like those old movie stars who had gangrene — or worse. But what could possibly cause them to turn this weird color?
The doctor explained that the foot turned purple when there’s a blockage in one of the arteries that supply blood to the lower leg and ankle. This condition is called peripheral arterial disease (PAD). PAD is caused by narrowing of the artery walls, making it hard for blood to flow freely. As the arteries narrow, pressure builds up on either side of the narrowed section. The result is high blood pressure, which puts extra strain on the heart. This causes damage to the heart muscle over time.
A person who has symptoms of claudication may not need treatment right away. Claudication means walking becomes painful after exercise. A patient may feel discomfort or tightness during activity but not actually experience pain until later. If untreated, however, claudication eventually progresses to critical limb ischemia, where severe pain occurs even at rest. In this case, blood circulation is blocked completely and no longer supplies oxygen and nutrients to the muscles. Without these essential substances, tissue begins to die. Critical limb ischemia requires immediate medical attention.
If you’ve ever had a toe amputated, you already understand how important proper wound care can be. Wounds should be kept clean and dry; dressing changes should be performed every two days. Keeping wounds elevated above the level of surrounding skin will reduce swelling and prevent fluid buildup, both of which restrict blood flow. If your wound turns purplish, red or black, don’t try to treat it yourself. See a physician immediately.
Even though I knew I needed to elevate my sore feet, I couldn’t bear the idea of putting my new sandals off any longer. My husband helped me put on flip flops, and we made our way home. I felt terrible. All I could think about was how much money I’d wasted on the bright pink heels.
Next morning, my feet were still blue-white. So I went looking online for information. I found lots of articles describing people who got their hands on some kind of mystery cream that turned their feet purple overnight. One woman claimed she used the stuff before bedtime and woke up the next morning to find her soles were purple! Another woman took the same mysterious ointment and rubbed it directly onto her big toe and watched as the nail began to peel. Others reported getting their feet wet, only to watch them change colors within hours. Some of these stories included photos showing the culprits’ feet floating in murky water.
I decided to take matters into my own hands. No matter how badly I wanted to get my flip flops back, I wasn’t going to use anything crazy. Instead, I tried soaking my feet in warm saltwater for 20 minutes three times a week. At first, nothing happened. Then, gradually, the color started to fade. Within four weeks, my feet were almost normal again.
My experience taught me that sometimes the best treatments are simple remedies. It also reminded me that the human body is capable of amazing things. Even though my feet weren’t exactly beautiful, they healed just fine.
So why do purple feet happen? How does a lack of elevation affect blood flow in a healthy foot? Find out on the following page.
How Do Feet Work?
Your foot consists of 26 bones connected to each other by 33 joints. Your foot works like a lever, with bone structures serving as levers that move relative to each other. Bones are attached to ligaments, which hold them together. Ligaments connect bones to tendons, which attach bones to muscles. Muscles contract to pull bones toward the center of motion while stretching opposing muscles further apart. Tendons transfer force from muscles to bones. Together, all these parts work as a unit to bend, stretch and lift your foot.
Each part plays an important role in helping your foot function properly. Healthy feet absorb shock from falls, keep your weight evenly distributed across your legs and maintain balance. Poorly functioning feet lead to deformities such as flat feet, hammertoes and bunions.
Flat feet occur when the arch flattens outward, instead of downward. When your arches collapse, your feet lose their ability to support your entire body weight. You’ll notice this most when standing barefoot on a sturdy surface and seeing how easily your feet sink slightly under your weight. Flat feet often go undiagnosed because people who suffer from them rarely complain of pain. However, flat feet can cause chronic backache, knee problems and shin splints.
Hammertoes happen when the second, third and fourth toes point inward. These crooked nails make it difficult to walk normally. In addition, the constant pressure of the toes against the floor can damage the soft tissue underneath. Hammertoes are more common among women than men, especially older women due to hormonal imbalances.
Bunions form on the ball of your foot. The joint between your long and middle toe curves upward, creating a bump that pushes upwards when you stand upright. Bunions usually occur on the big toe because its large size makes it particularly susceptible to stress. Bunions are painful due to inflammation and pressure on the sensitive skin around the base of the toe.
Turning purple feet aren’t something to worry about unless you’re experiencing actual pain or numbness. Foot color isn’t always a good indication of trouble, though. Next, let’s look at what happens when blood doesn’t reach your feet properly.
Blood Flow Basics
When you’re lying down, your heart pumps blood throughout your body using muscular contraction. Once you rise, gravity pulls blood down from the top of your head and sends it rushing back toward the heart. This process is known as gravitational return flow. When blood returns to the heart, it picks up additional energy from the pump action of the heart. It then leaves the heart via the arteries, carrying oxygen and nutrition to the rest of the body.
Arteries are tubes lined with elastic cells. When blood flows through the tube, the pressure inside the tube keeps the cell walls taut. Arteries branch out to smaller tubes called capillaries. Capillaries have tiny holes in their thin outer walls through which blood passes. Since the diameter of capillary openings is small, only molecules of certain sizes can pass through. Molecules larger than 70 kiloDaltons won’t fit through capillary walls. They instead squeeze past the walls on the outside of the arteries and veins, traveling through the interstitial space between tissues.
In a healthy foot, blood circulates smoothly through the arteries and capillaries without stopping. The blood carries nutrients such as glucose and amino acids to the tissues. Oxygen diffuses through hemoglobin, which releases oxygen for the tissues to use. Proper blood flow also helps waste products leave the tissues. Waste products include carbon dioxide and lactic acid, which accumulate when muscles don’t receive enough oxygen. Excess lactic acid leads to fatigue and cramps. Carbon dioxide contributes to headaches and dizziness.
Since blood needs to travel farther to pick up more energy, the heart must beat faster to push the blood forward. Over time, the increased demand on the heart results in structural changes. Left unchecked, these changes can lead to cardiovascular disorders such as coronary heart disease or congestive heart failure.
How can you improve circulation in your feet? On the following page, learn how elevating your feet can increase blood flow.
Elevate Your Feet
You probably know that sitting or lying down increases the risk of developing varicose veins. Similarly, elevating your legs can decrease the amount of pressure exerted on the veins in your calves. Veins contain valves that regulate blood flow. Compressing vein valves damages them, leading to leakage and increasing the risks associated with deep vein thrombosis. Severe venous stasis can also interfere with the movement of lymphatic fluid, causing lymphedema.
To avoid pressure on your calf veins, lie on your left side or prop yourself up on pillows. Or sleep in a chair with your legs propped up. To minimize the effects of edema, wear compression stockings to keep excess fluids from building up beneath your skin.
Compression socks also work well. They wrap around your ankles snugly to provide gentle compression. For optimal effectiveness, choose socks with fabric composed mostly of nylon or spandex yarn. Avoid socks made of polypropylene, cotton or wool. Socks shouldn’t exceed 10 millimeters (0.4 inches) below the ankle.
Another option is pneumatic shoe inserts

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