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Frostbite of the Feet and Toes — What You Should Know

Reviewed by
Dr. Patrick DeHeer

When our extremities—in particular our fingers and toes—are exposed for too long to sub-freezing temperatures, frostbite can often result. Frostbitten toes constitute a medical emergency that requires immediate attention.

What Causes Frostbite?

Frostbite occurs when the skin and sub-dermal tissue freezes. Every cell in your body is filled with water, and water expands when it freezes; individual cells are therefore damaged when ice crystals form inside them.

The most common cause of frostbite of the toes is exposure to the elements—ill-prepared hikers and skiers are especially at risk. The colder you get, the more your body tries to maintain its core temperature and protect your brain and internal organs by restricting blood flow to your extremities, leaving your toes vulnerable.

Frostbite can also be caused by prolonged direct contact with freezing materials such as ice or metal that has been in freezing temperatures.

Certain risk factors can make you more susceptible to frostbite. Generally speaking, any medical condition that is accompanied by poor circulation, such as diabetesperipheral vascular disease, or neuropathy, can predispose you to frostbitten toes or feet.

What Are the Symptoms of Frostbite of the Feet and Toes?

The early stage of this condition is called frostnip. At this stage, your toes have been exposed to the cold long enough that they will have begun to hurt, but no serious tissue damage has yet occurred.

Your toes will feel cold to the touch, and they will have a reddish appearance; if they continue to be exposed to the cold they will begin to become numb. At this stage no damage has been done, although re-warming your toes will cause them to tingle painfully, and you may suffer chilblains afterward.

When your frostbite reaches the next stage, the redness will give way to a pale, grayish-yellow or white color.

The skin may still be soft at this stage, but some ice crystals will probably have formed in the tissue, and you may have lost all sensation in your toes.

If your frostbitten toes are warmed and treated at this stage, they will sting and burn, and there may be swelling. Blisters may form within a day or two of warming.

When frostbite reaches its most severe stage, the tissue will be affected well below the surface of the skin. The numbness will be more pervasive at this point, and you may no longer feel pain or discomfort, but this is only because serious damage has already been done to the nerves.

Your skin will feel waxy to the touch at this point, your muscles and joints will be functioning poorly or not at all, and tissue death is not far off.

Other symptoms of frostbite of the toes may include:

  • Pain and swelling in the affected toes
  • Blisters and/or discharge from the skin
  • Fever, possibly above 100° F
  • Dizziness or sleepiness

If you begin to experience any of these symptoms, seek medical attention immediately if at all possible.

What Are the Consequences of Frostbite of the Feet and Toes?

As previously noted, chilblains are a likely consequence of even a mild case of frostbite. More severe frostbite may necessitate amputation of the affected toe(s), or even of the entire foot.

Other consequences may include

  • Frostbite arthritis, a condition resulting from damage to the bones and cartilage
  • Permanent numbness or other nerve damage
  • Infection
  • Increased susceptibility to frostbite in the future

Are There Additional Risks from Frostbite of the Toes or Feet?

Hypothermia is a possibility in any situation in which the cold is severe enough to cause frostbite. Hypothermia is a life-threatening condition that can cause the failure of your heart and respiratory system.

Your risk of hypothermia rises if you have been drinking alcohol. Alcohol dilates your blood vessels, and this makes you feel warmer—and indeed, may even delay the onset of frostbite—but it also speeds the loss of your precious body heat, and the results can be catastrophic.

Moreover, increased alcohol consumption will slow your thinking and make you less able to respond to the emergency situation in which you now find yourself.

How Are Frostbitten Toes and Feet Treated?

It is important that first-aid be administered correctly in cases of frostbite of the toes and feet. The skin must be warmed gradually, in order to avoid further damage.

If you are not out of danger and there is a chance that your toes and feet will freeze again (if, for example, you are lost in the woods), wait before rewarming them—refreezing can worsen the tissue damage.

If you have already rewarmed your frostbitten toes or feet, you must do everything in your power to prevent them from freezing again.

If at all possible, avoid walking on your frostbitten feet; putting weight on them can further damage the tissue. As soon as you are safely out of the cold, remove your wet shoes and socks.

Then, as quickly as you can, immerse your feet in warm water (104° to 108° F) and keep them there for 20 to 30 minutes (carefully add small amounts of hot water periodically to maintain the water temperature).

It is important that you resist the temptation to rub your feet or toes while you are waiting for the water to warm up. Do not apply direct dry heat to your feet (e.g., from a fireplace or space heater).

As your feet and toes begin to warm up, you are likely to experience tingling, burning pain as the sensation returns; be prepared for this, and try not to touch or handle your toes and feet.

When you see a doctor, he or she will probably be able to diagnose your frostbite with a simple visual examination. If your frostbite is severe, however, your doctor may want to take x-rays to determine whether the damage extends to your muscles and bones.

Even after the emergency has passed, your doctor will want to see you regularly in order to monitor the healing process.

Debridement (removal) of dead tissue may be necessary within a few weeks in order to prevent infection, and your doctor may prescribe antibiotics if there appears to be infection of any sort.

While you are recovering, avoid smoking or drinking alcohol, as these activities can inhibit blood circulation.

How Can Frostbite Be Prevented?

The best way to prevent frostbite of the feet and toes is to exercise common sense. If you’re going to be out in the cold for an extended period, dress warmly so that your body can easily maintain its core temperature.

In particular, wear warm socks (maybe even two pairs) and warm boots. Keep alcohol consumption to a minimum while you’re out there, and don’t hesitate to drink a little extra hot cocoa if the opportunity arises.

If you’re hiking in the wilderness, stick to the trail, and make sure that someone knows where you are.

Medical References:

    The Mayo Clinic The National Institutes of Health/Medicine Plus

This page was last updated on November 15th, 2015

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