Healthcare staff need to assess patients for ‘COVID-toes’, expert warns

Clinicians have observed a sharp increase in the number of patients being referred to vascular clinics.

Matt Bodell
31 July 2020

Patients have symptoms similar to arterial disease but then test positive for COVID-19.

An expert is sounding the alarm on a newly-identified symptom of the coronavirus dubbed COVID-toes.


A vascular Nurse Consultant and senior lecturer at the University of Huddersfield, Dr Leanne Atkin, has witnessed a sharp increase in the number of patients being referred to vascular clinics, with similar symptoms to arterial disease but, who then test positive for COVID-19.

Dr Leanne Atkin is a member of the University’s Institute of Skin Integrity and Infection Prevention and works as a Vascular Nurse Consultant at Pinderfields Hospital in Wakefield, part of The Mid Yorkshire Hospitals NHS Trust.

The dermatological manifestation known as COVID-toes was formerly identified as being a symptom of COVID-19 in April by Spanish podiatrists and appears as asymmetrical lesions which can look very similar to chilblains.

Some children have also been identified as showing symptoms of toxic shock syndrome and atypical Kawasaki Disease.


Patients can experience burning sensations, itching with pain or tenderness around the affected areas and do not seem to be in correlation with the severity of the illness.  In other words, explained Dr Atkin, they can be seen on patients who have mild symptoms of COVID-19 and who go on to make a complete recovery within a couple of weeks, this includes the pain and discolouration in the feet returning to normal.

Recognise the early symptoms.

Since April, Dr Atkin has noticed an alarming rise in the number of patients requiring Vascular opinion with acute limb ischemia and perfusion injuries, all of which are related to the COVID virus.

“It’s imperative that there is an increased awareness among practitioners and clinicians of patients’ feet and how changes in colour could be a sign of infection even in the absence of any other symptoms,” said Dr Atkin.

Acute limb ischaemia, Dr Atkin explains, is a restriction in blood supply to tissues and can cause a shortage of oxygen that is needed for cellular metabolism which keeps the skin tissue alive. If patients are not monitored closely to help prevent tissue loss it can result in them having to undergo limb amputation.


In addition to the increased health risks imposed upon the patient if COVID-toes goes undiagnosed, the possible spread of infection is also greater.

“These patients are coming into a normal vascular clinic surrounded by normal staff,” said Dr Atkin.

“Yes, we are wearing basic PPE but, this is why it is imperative for practitioners to be aware of this relatively new symptom of the virus, because, if this is actually a sign of COVID, we should be stepping up our protection for the staff and for our other patients.

“It is really important that people start to recognise these early symptoms and if they notice any of them, they should be arranging for the patient to be tested for COVID-19 and considering carefully the need for referral onto Vascular Clinics.”

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