Cold hands and feet: causes, what helps and when to see a GP

Hands and feet are the furthest parts of the body from the heart, and their small blood vessels narrow in the cold to save heat. For many people that is all it is. A few causes are worth knowing about because they have specific features and specific treatments. The table summarises the ones the NHS describes.

No single feature proves a cause, so use the table as a guide to what to mention to a GP rather than as a way of diagnosing yourself.

The NHS says Raynaud’s affects your blood circulation. When you are cold, anxious or stressed your fingers and toes may change colour, and other symptoms can include pain, numbness and pins and needles. The skin may turn white or lighter as blood flow is restricted, then blue, then red as blood flow returns. On brown or black skin the NHS says the fingertips may simply look paler.

Some people also find that their ears, nose, lips or nipples are affected. Attacks usually last from a few minutes to a few hours.

The NHS says Raynaud’s is sometimes caused by another health condition, by taking certain medicines, or by working with vibrating tools for a long time. A GP may arrange tests if they think it could be a sign of a more serious condition such as rheumatoid arthritis or lupus. It also notes that pins and needles lasting a few minutes can come from resting or sleeping on a part of the body, and that breathing too quickly (hyperventilation) can cause trembling hands and pins and needles without colour change.

People often use "poor circulation" to describe cold hands and feet. The NHS uses the term for specific conditions. Raynaud’s is one. Peripheral arterial disease (PAD) is another: a build-up of fatty deposits in the leg arteries that restricts blood supply to the leg muscles.

The NHS says many people with PAD have no symptoms, but some develop a painful ache in the legs when they walk that goes away after a few minutes of rest. Other symptoms include hair loss on the legs and feet, numbness or weakness, brittle slow-growing toenails, ulcers that do not heal and skin turning paler than usual or blue. It names smoking as the most significant risk factor, along with diabetes, high blood pressure, high cholesterol and growing older.

Cold feet on their own, without leg pain, sores or colour change, are far more often a normal reaction to cold. If you have recurring leg pain when exercising, the NHS says to see a GP, because there is no reason an otherwise healthy person should have it.

The NHS lists feeling cold more than usual among the common symptoms of an underactive thyroid, alongside extreme tiredness, weight gain, constipation, difficulty concentrating, low mood, dry skin and hair, a croaky voice and irregular or heavy periods. It says symptoms usually develop slowly and that a GP can check with blood tests for thyroid-stimulating hormone and thyroxine. An underactive thyroid is usually treated with levothyroxine tablets.

The NHS says iron deficiency anaemia is the most common type of anaemia and is diagnosed by a full blood count. Its symptom list is tiredness and lack of energy, shortness of breath, noticeable heartbeats and paler than usual skin. The same blood test also checks for vitamin B12 or folate deficiency anaemia, where the NHS lists extreme tiredness, pins and needles, a sore red tongue and muscle weakness.

These conditions are common and treatable, which is why a GP will often start with a simple set of blood tests when someone describes being cold and tired.

The NHS describes chilblains as small, itchy patches that can appear on the skin a few hours after being in the cold, most often on fingers and toes. The skin can itch or burn and fingers or toes may turn red or purple, which can be harder to see on brown and black skin.

Chilblains usually go away on their own in 2 to 3 weeks. The NHS advises seeing a GP if they have not improved after that time, there is pus, you have a very high temperature or feel hot, cold or shivery, you keep getting them, or you have diabetes.

The NHS advice for Raynaud’s is practical and applies to most cold hands and feet. It also asks you to avoid anything that narrows blood vessels.

• Keep your home warm and wear warm clothes in cold weather, especially on your hands and feet.

• Try to avoid sudden changes in temperature.

• Exercise regularly, which helps improve circulation.

• Try breathing exercises or yoga to help you relax, and eat a healthy, balanced diet.

• Do not smoke. The NHS says quitting improves your circulation.

• Avoid too much caffeine (tea, coffee, cola and chocolate), which may trigger Raynaud’s symptoms.

• For chilblains, dry and slowly warm the skin and do not put hands or feet on a radiator or under hot water.

The NHS says to see a GP if you have symptoms of Raynaud’s that are very bad or getting worse, if it affects your daily life, if symptoms are only on one side of the body, if you also have joint pain, skin rashes or muscle weakness, if you are over 30 and get symptoms for the first time, or if your child is under 12 and has symptoms.

For the legs and feet, the NHS says PAD symptoms that develop quickly or suddenly get worse could be a sign of a serious problem requiring immediate treatment. If you think you are developing symptoms of critical limb ischaemia, which include severe burning pain in the legs and feet even at rest, pale, shiny skin, ulcers that do not heal or skin that turns black, it says to contact a GP immediately, or call 111 if that is not possible.

A leg or arm that is suddenly cold, pale and painful, or cold hands and feet with chest pain, breathlessness, weakness or confusion, should be treated as an emergency. Call 999 or go to A&E.

A GP will ask about your symptoms and medical history and may arrange blood tests. For suspected Raynaud’s linked to another condition, the NHS says tests can look for conditions such as rheumatoid arthritis or lupus. For suspected PAD, the NHS says it is usually diagnosed by physical examination and comparing blood pressure in the arm and ankle (the ankle brachial pressure index).

Treatment depends on the cause. For Raynaud’s the NHS says a GP may prescribe nifedipine if symptoms are very bad or getting worse. For an underactive thyroid it is usually levothyroxine. For PAD it is mainly exercise, stopping smoking and treating blood pressure, cholesterol and diabetes, with medicine or surgery in some cases.

On the NHS the first step is usually a GP, who can arrange blood tests and refer to a specialist such as a rheumatologist, vascular specialist or endocrinologist if a particular cause is suspected. Most people with ordinary cold hands and feet will not need a specialist.

Private consultations and tests can be used to speed up assessment if a cause such as thyroid disease, a connective tissue disorder or arterial disease is suspected. The same warning signs apply whichever route you take.