COVID-19 is a respiratory illness but has several signs and symptoms that have been reported, including but not limited to fever, dry cough, diarrhea, headache, loss of smell and taste, muscle ache, and fatigue. However, most recently there seems to be another finding that presents in the lower extremity, specifically the toes.

According to numerous sources out of Italy, France, Spain and China, and case reports from dermatologist and podiatrist in the United States, COVID-19 lesions are described as similar to those found in chickenpox, measles, chilblains, frostbite, and depending on the time of presentation, they could look similar to infection or dermatitis.

The lesions are purple-colored that appear on the toes but can also be found at the arch and heel region, and on the fingers. There is an array of clinical findings, most commonly a red rash or hive-like eruption. Interestingly, a frostbite-like area of typically red or purple discoloration has been reported but doesn’t appear to have a correlation to weather or injury.

The condition usually starts with red or purple discoloration (bruise-like), and the skin may become raised, and the skin may slough, blister or develop a wound. The typical presentations are on the ends of toes, or on the tops of toes. The patients have also reported feeling the skin is hot, burning, itchy, or tingling, but reports of pain with pressure and while walking are not uncommon.

Unfortunately, the cause of these atypical skin conditions is not yet known, but some experts claim it may be a robust response by the patients’ immune system to the virus that causes downstream clotting of small blood vessels. Dr. Esther Freeman, a dermatologist at Massachusetts General Hospital in Boston, MA developed an international registry for clinicians to report suspected cases or those that have tested positive and have dermatological conditions. This information could then potentially be used for testing criteria when it becomes more readily available.

If you or someone you know may be suffering from ‘Covid toes’, please don’t hesitate to call the doctors at North Texas Foot and Ankle for instructions.