Sudden ischemic toe: 'The blue toe syndrome'

Sudden ischemia of toes resulting from pure obliterative arteriosclerosis, in the absence of pathological conditions such as diabetes mellitus, Buerger's disease or collagen diseases, usually appears late in the course of the vascular disease. The 'blue toe syndrome' may well appear in warm, seemingly well perfused limbs, with palpable peripheral pulses and a normal or fair oscillometric index. These cases must be correctly diagnosed and promptly treated surgically as limb-salvage procedures; the blue discoloration signifies impending necrosis. 3 such cases are described, in whom the 'blue toe syndrome' was the presenting symptom (in one case shortly preceded by bilateral calf claudication) of obliterative atherosclerotic disease of the great vessels (iliac artery, in 2 cases, lower abdominal aorta in the third). All 3 underwent thrombendarterectomy with excellent results - immediate relief of pain, gradual subsiding of the blue discoloration and a symptom-free followup course. We believe microemboli of atheromatous or fibrinoplatelet debris from the proximal occluding lesion are the cause of the sudden appearance of ischemic toes.