Why Are My Feet Cold? Common Causes and When to See a Doctor

The temperature of the hands and feet is not constant throughout the day. It can change depending on the environment, physical activity, and individual characteristics. Some people, for example, are more likely to have cold extremities because they have a very slender build. Others may be affected by spending many hours sitting or standing without moving enough.

Stress can also play a role. In certain situations, the small blood vessels in the skin constrict, which can make the sensation of cold more noticeable, particularly in the hands and feet.

“In these cases, the symptom usually improves with movement. A walk, a few exercises to stimulate circulation, or simply moving to a warmer environment are often enough,” explains the doctor.

The situation is different when cold feet are not an occasional problem but become a constant sensation. In these cases, one possible explanation is reduced blood flow through the arteries of the lower limbs. When less blood reaches the tissues, several signs may appear, not just a sensation of cold.

One condition associated with this problem is peripheral artery disease (PAD), which is characterized by narrowing of the arteries that carry blood to the legs. In most cases, it is related to atherosclerosis, the progressive buildup of plaque inside the blood vessels.

“However, this symptom alone is not enough to indicate peripheral artery disease. It becomes more significant, when it is accompanied by other signs or occurs in people who already have cardiovascular risk factors,” the angiologist explains.

Cold Feet Due to Raynaud’s Phenomenon

When we think of cold feet, arteries often come to mind first. In reality, there are several possible causes, and they are not always related to a circulation problem.

"One example is Raynaud’s phenomenon, a condition in which the small blood vessels in the fingers or toes temporarily constrict in response to cold or stress. It can affect both the hands and feet and, during an episode, can cause changes in skin color: the fingers or toes may first turn white, then bluish, and finally red as blood flow returns to normal,” explains the angiologist.

In most cases, Raynaud’s phenomenon is not associated with serious health problems. In some people, however, it may be linked to other conditions and require further evaluation.

Cold Feet Due to Peripheral Nerve Disorders

A sensation of cold in the extremities can also occur in the presence of peripheral nerve disorders, which alter the way the body perceives temperature and sensation. Thyroid disorders, anemia, and certain medications can also contribute to the problem.

“This is why it is important not to stop at the first assumption,” explains Dr. Mainente. “The same symptom can have different causes. An evaluation helps determine whether there is a vascular problem or whether another explanation should be investigated.”

Cold feet themselves are not necessarily a cause for concern; what matters is the overall combination of symptoms. It is advisable to seek medical advice if your feet remain cold even when the outside temperature does not explain it, if the problem mainly affects only one foot, or if other symptoms occur, such as:

• pain or cramps in the calves while walking that improve when you stop;
• numbness or loss of sensation;
• very pale skin or skin with a bluish discoloration;
• thin, shiny, or particularly dry skin;
• wounds that are slow to heal;
• a reduced ability to walk compared with the past.

The specialist to consult for persistently cold feet is an angiologist. When a person seeks medical advice for cold feet, the first step is to review the history of the problem. The specialist will seek to understand:

• when the sensation began;
• whether it affects both feet or only one;
• whether it changes throughout the day;
• whether there are situations that trigger or worsen it.

The specialist will then assess aspects of the person’s general health and family history of cardiovascular disease, as this information is important in determining the risk of developing arterial problems.

During the examination, the angiologist examines the lower limbs and evaluates several key factors:

• the presence of arterial pulses;
• skin temperature;
• skin color;
• any skin changes.

“Further tests are performed only if the evaluation identifies findings that make them necessary. These include arterial Doppler ultrasound, a non-invasive examination that makes it possible to assess blood flow through the arteries and identify any narrowing or abnormalities,” says the specialist.

Another test that may be considered when Raynaud’s phenomenon is suspected, in order to rule out anatomical abnormalities of the more peripheral blood vessels, is nailfold capillaroscopy. This examination can be used to assess constitutional and anatomical abnormalities of the peripheral subcutaneous capillary bed and subsequently plan appropriate treatment.

There are several conditions that increase the risk of developing peripheral circulation problems. These include:

• cigarette smoking;
• diabetes;
• high blood pressure;
• high cholesterol levels;
• being overweight;
• a very sedentary lifestyle;
• a family history of cardiovascular disease.

“Prevention also depends on daily habits. Regular physical activity, avoiding smoking, and keeping blood pressure, blood sugar, and cholesterol levels under control are simple measures that help protect blood vessel health over time,” concludes Dr. Mainente.