The most common form of Raynaud's Disease is ideopathic primary Raynaud's Disease and is found in young women in 60-90% of the cases reported. Secondary Raynaud's Disease may be due to other connective or soft tissue disorders such as rheumatoid arthritis, systemic lupus or scleroderma. Occasionally, secondary Raynaud's Disease may be due to peripheral vascular occlusive disease, neurogenic lesions or drug intoxications.

The cause of Raynaud's Disease is unknown.  Any condition or contributing factor that results in peripheral vasospasm may be considered a contributing cause of Raynaud's Phenomenon and Raynaud's Disease.  Contributing conditions include anxiety, depression, rheumatoid arthritis, systemic lupus (SLE) and scleroderma.  Contributing factors include cold exposure and nicotine.  Raynaud's Disease is often seasonal and most active in the cold weather months.  Exposure to cold air (air conditioning) during the summer can also initiate the onset of Raynaud's Phenomenon. 

The picture to the left shows an interesting case of Raynaud's Disease that effects only the weight bearing surface of the digits.  This 73 y/o patient described a 3 year history of sores on the bottom of her toes that began during the winter months and ended in spring with the onset of warm weather.  The patient was not active and sat for long periods of time with her feet flat on the floor.  The ischemic changes seen in the skin are specific to the weight bearing portions of her toes.  This was caused by a combination of arterial vasospasm (Raynaud's Disease) and direct pressure to the skin by the floor that inhibited normal blood flow to the plantar surface of the digit.  Treatment for this problem included linitation of cold exposure and elevating the feet to eliminate floor pressure against the toes. 

Treatment of Raynaud's Phenomenon and Disease

Initial treatment consists of avoidance of any contributing factors to the condition such as cold exposure, emotional swings or smoking. Nicotine is a potent vasoconstrictor. Sedatives, mood stabilizers and psychological counseling may be helpful to control contributing factors such as stress and anxiety.

Visual imagery techniques are helpful for some patients. As an example;

Wendy has had problems with Raynaud's Disease for years. She is a mom and employed as a banker. On days where she is particularly busy, her fingers will blanch white and become cold. Wendy has found that she can control these symptoms by stopping everything that she is doing. She folds her hands in her lap and visualizes in her mind a beam of sunlight coming through a window focused on her hands. She feels the warmth of the sun on her hands. Wendy performs this exercise as needed. In addition to improving the temperature of her hands, she also notices a reduction in her stress level and tightness in her back.

Topical L-arginine cream can help warm hands and toes. L-arginine cream is a good prophylactic trick to pre-empt cold exposure and is handy for going outdoors in cold climates in winter. In-shoe warming devices are also helpful in this regard. Several oral medications are helpful in reducing peripheral vasospasm. Those medications include calcium channel blockers such as nifedipine (Calan/Verapamil) and prazosin. A surgical procedure performed by a neurosurgeon, called a sympathectomy, is reserved for the most severe cases.

Warm feet are the product of good circulation. Warmth is brought to the foot by way of arterial blood flow. Warm blood nourishes the tissue of the leg and foot providing oxygen and stabilizing the body temperature. The most obvious reason for cold feet is a decrease in normal circulation. Many folks with compromised circulation describe feeling cold feet not only in the winter months but year round.

Another consideration in keeping the feet warm is heat loss. There's a number of ways that the body looses heat. Heat can be lost by conduction. Water is a great conductor of heat. Heat is also lost by windy conditions (convection) and contacting a cooler surface (radiation) such as standing on snow. And forget all the old tales about peppermint schnapps. Alcohol, hunger, anemia and cardiovascular disease all make you more susceptible to heat loss and cold weather injury.

Here’s a few tips to protect yourself from the cold this year.