Frostbite Freezes, Chilblains Inflame: Knowing the Difference Could Save Your Feet

The ice fishing trip on Lake Lowell seemed perfect until you noticed your feet had lost all feeling. Back home in Caldwell, numbness turned to intense itching and now, your toes look alarmingly purple. Cold weather foot injuries don't always make sense at first—frostbite and chilblains both happen through completely different mechanisms and demand separate approaches to care. The podiatrists at Rocky Mountain Foot & Ankle know how Idaho's winter weather affects your feet and can help you determine whether you're dealing with frozen tissue that needs emergency care or inflamed blood vessels that heal with proper treatment.

What Happens Inside Your Feet When Cold Strikes?

Frostbite occurs when tissue actually freezes. Blood vessels constrict in response to extreme cold, cutting off circulation to your toes, heels, or other exposed areas. Ice crystals form inside cells, rupturing them from the inside out. Tissue that freezes becomes hard, waxy, and pale or grayish. Once rewarming begins, the affected area may blister, swell, and turn black if cells have died.

Chilblains, also known as pernio, typically develop after cold exposure ends. When your feet rewarm too quickly—for example, stepping into a hot shower right after being outside—small blood vessels near the skin's surface become inflamed. They leak fluid into surrounding tissue, causing red or purple patches, swelling, and intense itching or burning. The skin stays intact, but the discomfort is often startling.

How Can You Recognize Early Symptoms of Frostbite?

This cold weather foot injury begins with warning signs that are easy to dismiss. In its early stage, called frostnip, your skin feels cold and numb with tingling or prickling sensations. The affected area looks pale or red, but the tissue hasn't frozen yet.

However, as the condition advances, the danger multiplies:

• Superficial frostbite. Your skin turns white or yellowish-gray and feels firm to the touch, but deeper tissue remains soft. Blisters may form within 24 hours of rewarming.
• Deep frostbite. Tissue below the skin freezes completely hard. The area may look bluish or mottled. After rewarming, large blood-filled blisters appear, and blackened tissue signals permanent damage.
• Loss of sensation. Once numbness sets in, frostbite progresses without pain—making it easy to ignore until damage becomes irreversible.

What Do Chilblains Look Like and Feel Like?

Chilblains announce themselves hours after you've warmed up. Affected areas—often the toes, heels, or sides of the feet—become red, swollen, and intensely itchy. The skin may feel hot despite having been cold earlier. Small blisters can form, and in severe cases, skin may break down into open sores.

The itching and burning sensations often feel worse than the original cold exposure. Scratching provides temporary relief but damages skin and invites infection.

When to Seek Emergency Care vs. Routine Treatment at Rocky Mountain Foot & Ankle

Frostbite demands immediate medical attention. Don't attempt to rewarm deeply frostbitten feet at home, as improper rewarming techniques cause additional damage. If the skin is hard, waxy, and discolored, or if you've lost all sensation, get to an emergency room.

Chilblains, while uncomfortable, usually heal without emergency treatment. Keep affected areas clean and dry, avoid scratching, and gradually rewarm feet with room-temperature air—not direct heat. If blisters break open or symptoms persist, our experienced Idaho podiatrists at Rocky Mountain Foot & Ankle will evaluate your condition and prevent further complications.

Who Faces the Greatest Risk for Cold Weather Foot Injuries Like These?

At Rocky Mountain Foot & Ankle, we believe it’s essential to educate our patients about who may be more susceptible to frostbite and chilblains and why. For instance: 

• People with diabetes, poor circulation, or Raynaud's syndrome struggle to regulate blood flow to their extremities. 
• Individuals who smoke, as it constricts blood vessels, compounding the problem.
• Inadequate footwear and prolonged exposure raise the stakes. Wet socks or boots trap moisture against skin, accelerating heat loss. 
• Standing still in freezing temperatures prevents the body from generating enough warmth through movement.

How to Prevent Frostbite, Chilblains, and Other Cold Weather Foot Injuries 

Start before you head outdoors. Small adjustments in how you dress and respond to cold. Here are some recommendations: 

• Wear insulated, waterproof boots with room to spare. Tight footwear restricts circulation and accelerates heat loss, so choose boots with enough space for thick socks without cramping your toes.
• Layer moisture-wicking socks. Wet fabric pulls warmth away from skin far faster than cold air alone. The best socks for cold weather are Merino wool, wool blends, Alpaca fleece, and fleece blends. 
• Keep moving to maintain circulation. Standing still for extended periods allows cold to penetrate deeper into foot tissue. Movement generates heat and keeps blood flowing to your extremities.
• Rewarm gradually with room-temperature air. Sudden temperature changes from fireplaces, hot water, or heaters trigger the inflammation that leads to chilblains. Let your feet warm up slowly.
• Act immediately when numbness begins. If your feet tingle or you start to lose feeling, get indoors right away. Early intervention prevents serious damage from progressing.

Dr. P. Roman Burk offers these additional winter foot care tips to help you and your family stay safe throughout the season.