Blue Toe Syndrome

Blue toe syndrome is the acute rupture of atheromatous plaque causing digital ischemia or infarction with intact peripheral pulses. The toes assume a blue-red color that may be interspersed with normal skin, causing a lacy appearance (livedo reticularis). The emboli may come from the aorta or other proximal vessels and may be spontaneous or caused by vascular intervention.

A source should be sought and treated. Unilateral involvement points to a common iliac source. Bilateral involvement points to an aortic source. Bilateral involvement with synchronous renal failure points to a thoracic aortic source. 90% of untreated patients will have recurrent embolization in five years.

References

• Kaufman JA and Lee MJ. Chapter 15. in Vascular and interventional radiology: The Requisites. Mosby 20004.
• Kronzon I, Tunick PA. Aortic atherosclerotic disease and stroke. Circulation. 2006 Jul 4;114(1):63-75.