At a house visit a 58 year old South Indian lady comments on | Figure 1

Genghis_swan

Family Medicine Resident

At a house visit a 58 year old South Indian lady comments on her toes. She states that during the day her toes show symptoms of hyperperfusion with red, hot toes but no swelling but pain. This redness occurs mainly in the evening but also during the day but to a lesser extent. The rest of her feet feel cold with a noticeable colour difference from the MTP onwards. She has had previous episodes last year of this but it went away lasting a few months. On examination she has no sensory loss in either feet, full motor function and all her pulses are palpable. Her soles of her feet have numerous callouses. Her past medical history includes diabetes for 6 years, asthma, depression, hypercholesterolemia and general arthritis in her knees, back and hands. Any idea what the cause of these random toe hyperperfusion is?

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