Deep Purple Discoloration on Elderly Feet: Causes and Treatments

My mother's feet have a deep purple color on the dorsum, resembling bruising, accompanied by streaks of blood?

My mother's lower leg has a dense network of purple microvessels, and the top of her foot is deep purple, which worsens in cold weather.
She has been suffering from dementia for nearly 10 years and has foreign caregivers, but she is not taking any medications for chronic diseases.
A few years ago, during a Barthel Index assessment, it was noted that her cholesterol levels were slightly elevated.
She is unable to communicate effectively, so we do not know how to consult a doctor.
What could be the issue with her legs, and what treatment options are available?

Miss Hou, 60~69 year old female. Ask Date: 2021/02/22

Dr. Liang Yinpan reply Geriatrics

Dear Ms.
Hou,
Your mother is likely experiencing poor circulation in her lower extremities due to her age, which has led to varicose veins causing a purplish discoloration of the skin on her feet.
This condition may worsen in cold weather due to vasoconstriction.
I recommend taking your mother to see a vascular specialist to determine the underlying cause so that appropriate treatment can be administered.

Wishing your mother a speedy recovery.
Sincerely,
Dr.
Liang Yin-Pan, Geriatrics Department, Changhua Hospital
February 25, 2021

Reply Date: 2021/02/22

More Info

The deep purple discoloration observed on your mother's lower legs and feet could be indicative of several underlying conditions, particularly in elderly individuals. Given her age and the presence of microvascular changes, this discoloration may be attributed to a combination of factors including poor circulation, venous insufficiency, or even skin changes associated with aging.

Possible Causes:
1. Venous Insufficiency: This is a common condition in older adults where the veins struggle to send blood back to the heart. This can lead to blood pooling in the lower extremities, resulting in discoloration, swelling, and even varicose veins. The deep purple color you observe could be due to blood pooling and the breakdown of red blood cells in the tissues.

2. Peripheral Artery Disease (PAD): This condition occurs when the arteries that supply blood to the limbs become narrowed or blocked. It can lead to poor circulation, resulting in discoloration, especially in colder temperatures when blood flow is further restricted.

3. Dermatological Conditions: Conditions such as livedo reticularis, which is characterized by a mottled purplish discoloration of the skin, can occur due to various factors including vascular issues or autoimmune diseases.

4. Age-related Changes: As people age, their skin becomes thinner and loses elasticity. This can lead to more visible blood vessels and discoloration, particularly in areas where the skin is more fragile.

5. Medication Side Effects: Although you mentioned that she is not on any chronic medications, it’s important to consider any over-the-counter medications or supplements that could contribute to skin changes.

Recommended Actions:
1. Medical Evaluation: It is crucial to have a healthcare professional evaluate her condition. Given her cognitive impairment, it may be beneficial to involve her caregiver or a family member to assist in communicating her symptoms to the doctor. A thorough examination, including a review of her medical history and possibly imaging studies (like Doppler ultrasound), can help determine the underlying cause of the discoloration.

2. Compression Therapy: If venous insufficiency is diagnosed, compression stockings may be recommended to help improve blood flow and reduce swelling. These stockings apply pressure to the legs, aiding venous return to the heart.

3. Lifestyle Modifications: Encouraging movement, even gentle exercises, can help improve circulation. Elevating her legs when sitting or lying down can also alleviate some symptoms.

4. Skin Care: Keeping the skin moisturized can help prevent further skin breakdown. Gentle cleansing and the use of emollients may be beneficial.

5. Monitoring: Regular monitoring of her condition is important, especially as she has cognitive challenges. Keeping track of any changes in her skin color, temperature, or swelling can provide valuable information for her healthcare provider.

6. Nutritional Support: Ensuring she has a balanced diet rich in vitamins and minerals can support overall skin health and circulation. If she has difficulty eating, consulting a nutritionist may be helpful.

7. Consideration of Cognitive Impairment: Since your mother has been living with dementia for nearly a decade, it’s essential to ensure that her care plan addresses her cognitive needs as well. This includes regular check-ups and possibly involving a geriatric specialist who can provide a comprehensive approach to her health.

In conclusion, while the deep purple discoloration on your mother's feet could be due to various causes, a thorough medical evaluation is essential to determine the exact nature of the problem and to initiate appropriate treatment. Early intervention can help manage symptoms and improve her quality of life.

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