COVID-TOES. HAVE YOU HEARD OF THOSE?

Wait, there’s a thing called COVID-TOES? Yep, I’m adding Covid-Toes to the symptoms list. Chiropractors are Essential Service Providers, so I’ve been seeing patients throughout the entire shelter-in-place order. I’ve also been carefully monitoring the literature for information on clinical presentations for Covid-19 in primary care.  In addition to what we know, the virus has…

Wait, there’s a thing called COVID-TOES?

Yep, I’m adding Covid-Toes to the symptoms list.

Chiropractors are Essential Service Providers, so I’ve been seeing patients throughout the entire shelter-in-place order. I’VE ALSO BEEN CAREFULLY MONITORING THE LITERATURE FOR INFORMATION ON CLINICAL PRESENTATIONS FOR COVID-19 IN PRIMARY CARE. 

In addition to what we know, the virus has some, uh, stranger symptoms.

The most prominent signs of coronavirus infection are a fever, dry cough, and shortness of breath — but the virus has also been linked to a string of other unusual and diverse symptoms. On April 29th the CDC added several new symptoms to its list for the coronavirus — chills, muscle pain, headache, sore throat, repeated shaking with chills, and a loss of taste or smell. And now, as I’ve recently discovered, we may need to add Covid-Toes.

Covid-Toes can present like Frostbite.

Lately dermatologists have been bombarded with patients complaining of frostbite-like symptoms. These lesions, called CHILBLAINS, are caused by inflammation in small blood vessels — a reaction to cold or damp conditions. Usually this is only seen in the dead of winter, and rarely in Santa Cruz County.  

At the time of writing this blog post, federal health officials do not include ‘toe lesions’ in the list of coronavirus symptoms. Some Dermatologists Say the Lesions Should Prompt Testing for the Virus, even though many patients have no other symptoms.

I may be seeing COVID-Toe in my office. 

Some patients may have mid-foot pain and be limping. The limping can lead to acute low back and hip pain, which leads them to come into the Golden Chiropractic office. They may also have some swollen, purple fingers. Patients often present with multiple complaints, so initially I think it’s nothing unusual. 

Small bumps forming on swollen fingers are consistent with arthritis, after all. Arthritis in the fingers is just something that can start to happen when we live more than 50 years. But, since Covid-related symptoms are on my doctor radar, I am keeping the following in mind — 

Symptoms of arthritis in the hands and/or feet may include —

1. Pain in some or all of the joints, including joints of the fingers, wrists, and thumbs.
2. The growth of bony knobs on finger joints.
3. Numbness in fingers.
4. Swollen, red, or warm joints.
5. Stiffness in the fingers, especially in the morning with rheumatoid arthritis.

Symptoms of the chilblains-like lesions of Covid-Toe may include —

1. Pain in some or all of the joints in the fingers, toes, and maybe even the ears.
2. Purple and/or red bumps, often involving the tops of the toes and sometimes the bottom of the feet.
3. Some have been described as target-like or Erythema Multiforme–like. 
4. In others there may not be individual discrete lesions, but rather a redness or bluish, purplish discoloration accompanied by edema of the entire toe or several toes.

I’ve read some clinical literature on Covid-Toe. 

Recently on a Saturday Afternoon, While Lounging in the Sun, I Was Reading the Clinical Literature and Came Across This Article on Covid-19 Skin Manifestations. As a Chiropractor, I Wasn’t Clear on the Dermatology Language Describing the Lesions, So I Did More Research. This Article Piqued My Attention. I Thought About My Patients With Swollen Fingers. Joint Pain and Swelling is Something I Often See in My Clinical Practice. What I Don’t Often See is Chillblains(Don’t Click the Link if You Don’t Want to See Them, They Are Kind of Gross). I’m Not Trained as a Dermatologist, and Had Minimal Training in Chiropractic School on This Subject. Still, I Am a Highly Curious Science Nerd, So I Wondered…

Could my patients with swollen fingers and toes have Covid-?Toe?

Thinking about this possibility, I took in a deep breath of air. My brain went a little crazy for a moment.

Keeping my clinic open during a pandemic puts me at risk. 

It’s why I’ve increased my SANITATION PROTOCOLS at the office. I’ve increased the length of office visits to keep the volume of patients to a minimum. It’s my priority to prevent infection and flatten the curve. 

Being put at risk, I also prioritize getting tested. And YES, it hurts.

I may have to randomly cancel my appointments and subject myself to the rather uncomfortable process of getting tested. 

Who, exactly, is at risk for Covid-Toe anyway?

According to THIS ARTICLE —

In the US, patients with this complaint present with it occurring late in the illness or in asymptomatic young people. The patients are typically children or young adults and are otherwise healthy. Half of them didn’t even have COVID symptoms. If they did have COVID symptoms they were typically mild. So we think the pernio-like lesions are most often occurring in the late stage of the disease and now represent a secondary inflammatory response.

Better to be safe than sorry.

I don’t often refer out for diagnostic testing. 

When I do make the decision to refer for further testing, it’s because I want what’s best for my patients, and for public health. I am always grateful when I’m proved wrong with a negative test. That’s always the best outcome.  

To my chiropractor colleagues — 

Keep an eye out for this. And take all the necessary precautions to protect yourself and your patients.

To my patients —

Covid-Toe is a pretty benign presentation of COVID-19 in a healthy individual. If you present with these symptoms, call your MD ASAP. Get tested for coronavirus. And rest easy knowing that your immune system is doing it’s thing — keeping you healthy by fighting this disease.