Doctors Weigh In On 'COVID Toes' And What To Look For

by Wendy Wisner
Originally Published: 
‘COVID Toes’ Are A Possible Symptom For Us To Watch Out For
Courtesy of Dr. Amy Paller, Northwestern University

When COVID-19 began making headlines a few months ago, there were only a few symptoms that we knew of: fever, coughing, and shortness of breath. But as the weeks and months have progressed, we’ve learned that the virus seems to have a bunch of other possible symptoms.

Just last week, in fact, the CDC added six new symptoms to the list of possibilities, including chills, shaking with chills, muscle pain, headache, sore throat, and new loss of taste or smell.

If you’re anything like me, just hearing the list of symptoms multiply right before your eyes is enough to give you a mini panic attack. But it’s important to understand that the reason we are being bombarded with all kinds of new and scary news about the virus all the time is that it’s a brand new virus—a novel virus—and doctors and scientists are learning what it does in real time, along with all of us.

In other words, it’s not necessarily true that the virus is getting worse or coming up with its own new symptoms to freak us the heck out. Rather, we are learning more about the beast as more and more people become infected by it and doctors are able to gather data on what they are observing.

Cool. So now that I have hopefully prepared you, I will share with you perhaps the weirdest possible (and honestly, most disgusting) COVID-19 symptom to date that I am aware of: COVID toes.

I mean, I don’t really like looking at anyone’s toes that close up. But yeah, this looks to me like some kind of nasty, itchy, burning rash that I would want to avoid at all costs.

Now, before we go any further, let me make it abundantly clear that COVID toes are not in any way an official COVID-19 symptom. They are not on the CDC list of symptoms, nor has any medical official come out and said, “If your toes look like this, you definitely have COVID-19.”

What they are is a possible symptom that many in the medical world are seeing and are hypothesizing is one of the manifestations of COVID-19.

Dr. Amy Paller, a pediatric dermatologist at Northwestern Medicine, said in a press release that she’d seen about 30 cases of COVID toes in her practice. Dr. Paller is participating in a “national pediatric dermatology registry” and collecting images of COVID toes from around the U.S. so that she and her colleagues can better understand this strange phenomenon.

Although she and other doctors have seen an uptick in cases of these red swollen, itchy toes, no one is sure what is causing them, and the idea that COVID-19 might be the culprit is only an educated guess.

A teenage patient’s foot as pictured on April 21, 2020, four weeks after the onset of the skin condition being informally called “COVID toes.” Courtesy of Dr. Amy Paller, Northwestern University

“We don’t know for sure if it’s related to COVID-19, but when it’s so common right now during a pandemic and is occurring in otherwise asymptomatic or mildly affected patients, it seems too much of a coincidence not to be a manifestation of the virus for patients in their teens and 20s,” explained Dr. Paller.

Her guess is that the swelling and redness might be as a response to inflammation caused by the virus.

“We know this involves the small blood vessels in the hands and feet and is an inflammatory reaction,” she explained in the press release. “And we think something like this may be happening in response to the inflammation, perhaps caused as part of the response to the COVID-19 virus.”

Okay, so what exactly do COVID toes look like, and what other symptoms might be present?

Dr. Ebbing Lautenbach, who is chief of infectious disease at the University of Pennsylvania’s School of Medicine, shared her opinions about this with USA Today.

“They’re typically painful to touch and could have a hot burning sensation,” said Dr. Lautenbach.

She also confirmed that most cases of COVID toes are seen in younger patients: children and young adults. Additionally, these symptom are usually observed in patients who don’t have many of the more concerning symptoms of the virus—at least not initially.

Dr. Lautenbach noted that the symptom might be your first sign of COVID-19.

“This is a manifestation that occurs early on in the disease, meaning you have this first, then you progress,” Dr. Lautenbach explained. “Sometimes this might be your first clue that they have COVID when they don’t have any other symptoms.”

A teenage patient’s foot as pictured on April 6, 2020, three days after the onset of the skin condition being informally called “COVID toes.” Notice the dusky hue to the discoloration. Courtesy of Dr. Amy Paller, Northwestern University

Ughhh. Okay—so yeah, that’s kind of nerve-wracking. I mean, my kids get all kinds of bumps and bruises and weird rashes. That kind of comes with the territory of being a kid. The idea that I might notice a red mark on their toe and then have to worry that they are developing COVID-19 is pretty damn concerning. Sigh.

So what exactly should a parent do if they suspect their kid might have developed a case of COVID toes?

Dr. Amy Edwards, a pediatric infectious disease specialist who works at University Hospitals, told the Cleveland Clinic that she’s had lots of doctors contact her about these mysterious toe rashes.

Her advice? If you have any concerns about a rash that your child has, contact their pediatrician right away. At the same time, she urges us parents not to worry if your kids don’t have fevers or coughs along with the rashy toes.

A teenage patient’s foot as pictured on April 3, 2020, at the onset of the skin condition being informally called “COVID toes.” Courtesy of Dr. Amy Paller, Northwestern University

Yeah, that “don’t worry” thing is obviously easier said than done, right?

Look, these are scary times. There is so much devastation happening every day. There are so many uncertainties. Thankfully, although a symptom like COVID toes is weird and a little unsettling, it doesn’t sound too terribly serious—unless, of course, it’s coupled with some of the more extremely serious symptoms of COVID-19.

I think our best bet here is to stay informed, stay vigilant, but remember to keep things in perspective.

And, of course, it can’t be said enough: If you have any questions or concerns whatsoever about any symptom that you or your child is experiencing, please contact your doctor right away.

Information about COVID-19 is rapidly changing, and Scary Mommy is committed to providing the most recent data in our coverage. With news being updated so frequently, some of the information in this story may have changed after publication. For this reason, we are encouraging readers to use online resources from local public health departments, the Centers for Disease Control, and the World Health Organization to remain as informed as possible.

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