Causes of purple feet in the elderly

What causes purple feet in older adults?

If an older person’s feet are purple in colour, this may seem alarming, but there are a number of possible reasons for this symptom, some harmless and some that require urgent attention. Here, we are taking a closer look at what causes purple feet in older adults, how to know when this needs medical attention, managing the associated symptoms, how to support foot health at home, and when to involve loved ones or home carers. 

At Home Instead, our aim is to help people age positively and in place by bringing expert care to their home. For nearly 20 years, we have been providing the highest standard of care, and creating industry-leading training programmes for our Care Professionals that are accredited by nursing and medical professionals. Today, we are the world’s largest global domiciliary care network, supporting over 100,000 older adults with personalised, tailored care at home. So whatever questions you have about foot health in older people, we can help.

Common causes of purple feet in older adults

Circulatory Problems

Circulation issues (sometimes as a result of Peripheral Artery Disease) can affect the feet of older adults, as these are the furthest extremities from the heart. Circulatory problems happen when the arteries narrow or harden, reducing blood flow to certain areas of the body and causing symptoms like swollen legs, sore muscles, shiny skin, a pins-and-needles sensation, cold feet, numbness, and pale or purple/blue skin. 

Older adults may have a higher risk of developing circulation issues, but there may be additional risk for those who smoke, or have diabetes, high blood pressure or other health conditions. If symptoms arise such as dull or cramping leg pain, numbness, or weakness in the legs, this could be a sign of cardiovascular issues and must be checked urgently. 

If circulation issues are present, restricted blood flow to one or both feet could lead to serious issues if tissue in the area begins to die. If this happens, feet can develop a serious condition called gangrene, which sometimes requires amputation if not treated quickly enough. For this reason, any discolouration or numbness should be checked as soon as possible. 

If more general circulation issues are the cause of purple feet, a doctor might suggest moving around more to improve circulation, and avoid sitting or standing for long periods of time. Compression stockings may also be recommended, as well as keeping feet warm and elevated while sitting. 

Circulation issues can also be the cause of upper thigh pain in older adults, which you can read more about in our guide to the causes of upper thigh pain in the elderly.

Deep Vein Thrombosis (DVT) 

Deep vein thrombosis (DVT) can occur when a blood clot develops in a deep vein within the body, and this typically happens in the legs. DVT can cause a number of symptoms in the legs or feet such as pain, swelling, cramping, warmness, or changes in skin colour. Purple skin on the feet could be a sign of this condition. 

DVT can lead to a life-threatening pulmonary embolism, and some of the warning signs that indicate the need for medical help include sudden shortness of breath, chest pain or discomfort (worse when taking a deep breath or coughing), feeling lightheaded or dizzy, fainting, having a rapid pulse or rapid breathing, or coughing up blood.

Purple feet could indicate DVT is the problem, so it is important to have this checked by a doctor before symptoms progress to reach the stage of a pulmonary embolism. 

Vasculitis 

Vasculitis is another vein-related condition causing inflammation of blood vessels, and when this happens to an older person, it can lead to a rash that appears as red or purple dots across the feet or other parts of the body – some people with this condition may experience purple skin on their feet. 

Other symptoms caused by vasculitis include numbness, skin tingling, or loss of strength in the feet, so if these symptoms are present it is important to reach out to a doctor to have this checked. Those most at risk of vasculitis include people with a family history of the condition, those who take certain medications, those who smoke, or those who also have an autoimmune disease like lupus or rheumatoid arthritis. 

Raynaud’s Disease 

Raynaud’s disease is a condition causing blood vessels in the extremities to constrict (specifically the hands and feet), and blood to stop flowing there when a person comes into contact with coldness, such as being in cold weather or holding their hand under a cold tap. This can also happen when the person experiences stress, and it can sometimes lead to fingers and toes turning purple or blue, which is why this condition often causes purple feet. 

Usually this doesn’t pose any health risks, and the symptoms can be treated by keeping warm. However, if symptoms such as pain, numbness, or pins and needles are present, it is important to speak to a doctor so they can check there is nothing more serious underlying, and to provide you with resources and advice on how to live well with Raynaud’s disease. 

Diabetes 

Diabetesis commonly found in older adults, and can cause a number of symptoms and additional health problems, including poor circulation and peripheral neuropathy (nerve damage). This can result in potential discolouration of the feet which is often accompanied by feelings of numbness or pain. 

It is important to keep in mind that those who suffer from diabetes will have an increased risk of things like foot ulcers and infections, so they should regularly be on the lookout for signs of this, such as sores. If you have diabetes and you notice any of the above symptoms, or your feet are turning purple, it is extremely important to see your doctor right away to check for any serious issues that could be developing, and get treated for this as early as possible.

You may find more helpful information in our guides to diabetes and how to avoid diabetes in old age.

Liver Issues 

Liver issues can mean a number of medical problems, such as liver disease or a condition called cirrhosis, which is caused by excessive consumption of alcohol, long-term infection of hepatitis, or non-alcoholic fatty liver disease (NAFLD), which is when the liver is inflamed due to a build-up of excess fat. 

Poor liver function can also lead to circulation issues, which in turn can cause discolouration of the feet and swelling, often causing the feet to turn purple. This is known as acrocyanosis, and some of the other symptomsof this include blue or purple hands, fingers or toes. If you have known liver issues, you should let your doctor know about any discolouration in your limbs, or if you do not know the cause of your purple feet, you should also make sure a doctor checks this to rule out any serious liver problems that could be occurring. 

Lymphatic Obstruction 

Lymphatic obstruction (sometimes developing to become lymphedema) is a blockage within the lymphatic system causing fluid to build up, particularly in the feet. This can lead to swelling and discolouration in this area, which is why some people notice their feet turn purple. 

Some of the symptoms that might arise include swelling in the legs, being unable to see the veins or tendons in hands or feet, noticeably thicker skin, legs differing in size, tight joints, heavy legs, puffy or red skin, or burning or itching skin. If you notice any of these symptoms in yourself or an older loved one, it is important to speak to a doctor about the possibility of lymphatic obstruction to have this treated promptly. If a lymphatic obstruction has developed to become lymphedema, there is no cure for this, but certain treatments can help to relieve symptoms.  

Lymphedema can also lead to swollen legs, so if you are experiencing this you may find more information in our guide to dealing with swollen legs in the elderly.

Skin Infections 

Certain severe skin infections, such as cellulitis, can cause redness, swelling, and purple discolouration in the feet when blood flow to the area is affected. This bacterial infection affects the outer layer of skin as well as the underlying tissue, and it is usually caused by an untreated skin wound where bacteria has entered the body. 

Those with a weakened immune system (such as older adults) have a higher risk of developing cellulitis, and the discolouration from cellulitis can look like red, darker or purple skin, or could appear as a rash. It is important to speak to a doctor or a skin specialist about this as soon as symptoms are noticed, to stop it from spreading. Treatment usually involves a course of antibiotics, and a doctor may recommend a warm compress on the area, as well as elevation and compression to relieve symptoms. 

Chilblains and Cold Exposure

Cold exposure can sometimes cause chilblains, which are small, itchy or painful red or purple patches that appear on toes or fingers. These appear in response to cold, then rewarming. These are common in older adults with poor circulation and are usually harmless, though persistent cases should be reviewed by a GP. Usually, they clear up on their own. 

Around 1 in 10 people in the UK will get chilblains at some point. If you suffer from chilblains, it’s best to avoid being outside when the weather is cold or damp. If you have to go out, make sure you wear warm, waterproof clothing, gloves, and warm socks to protect your toes and fingers. 

Bruising 

Anyone can develop a bruise after a trauma or injury to an area of the body, and this will naturally show up as a purple patch on skin. However, older adults are more prone to bruising than younger age groups due to thinning skin and more fragile blood vessels. Their bruises can also take longer to heal, so any bruising on the foot that appears to be purple may seem abnormal due to the length of time it takes to fade. 

If it is clear where a bruise on the foot has come from, this is usually nothing to worry about unless there is a suspected broken bone or further injury. If you have any concerns about bruising on yourself or on an older loved one, you can speak to your doctor to check there are no other health reasons for this. 

You can learn more about this in our guide to understanding elderly skin bruising.

Skin Breakdown and Pressure Areas 

Prolonged pressure on the heels or toes can lead to discolouration or even pressure ulcers in the feet. If you notice darkened or purple areas that do not blanch (fade) when pressed, or skin that’s broken or weeping, this may indicate pressure damage and should be reviewed urgently, particularly if you have diabetes. 

Medications 

Certain medications can affect functions like the circulatory system, which can lead to less blood flow to the feet and, as a result, purple feet. In particular, anticoagulant medications (also known as blood thinners) are known to cause this symptom. 

These medications are used to treat blood clot issues, but if there are any concerns about symptoms like purple feet since starting this medication, older adults should speak to their doctor to make sure this is the best medication and dosage for them, and ask about switching to an alternative if this could help to avoid these symptoms.

You may also find helpful information in our guide to common elderly foot problems.

How can older adults and their loved ones look after their feet at home? 

Even if the above conditions are present, sometimes purple feet can be alleviated by taking more general care of the feet to improve circulation, hygiene, and keep skin healthy. It is also helpful to maintain good foot health in order to pick up on early signs of foot conditions through regular inspections, either by yourself or with help from a family member or home carer. Some tips for looking after your feet at home include: 

• Have regular checkups with a medical professional or podiatrist who can inspect feet for signs of future problems occurring, as recommended by the Centres for Disease Prevention and Control.
• Perform daily checks on your feet if possible, or if you cannot see or reach your feet, have a caregiver or family member check on your behalf. You can look for changes in skin colour, temperature, swelling or sores. This is especially important if you have diabetes or another condition affecting your feet. 
• Move around regularly and try to include gentle exercise in your day if possible, including foot movements like wiggling toes or ankle rotations to improve blood flow. You may find some helpful advice for this in our guide to fitness and exercise for the elderly.
• Stretch your legs regularly – one 2020 study found simple stretches can help improve vascular function in the legs in around 12 weeks.
• Keep your feet clean and dry to prevent infections from forming.
• Moisturise your feet regularly to reduce dryness and skin cracking.
• Wear comfortable, supportive, well-fitting footwear to help avoid blisters or pressure sores. Age UK recommends footwear to reduce your risk of falls, such as shoes with high sides, low heels, thin soles and good grip. 
• Keep toenails trimmed and healthy to prevent infections or pain. You can read more about this in our guide to hand, foot and nail care for the elderly.
• Elevate the feet when sitting down to reduce swelling.
• If possible, avoid sitting or standing in one position for too long to improve circulation.

If you have a loved one with foot or circulation issues and you want to assist them with foot care, you can help them with regular foot checks, nail trimming, and provide encouragement to do physical activity to promote foot health. 

How can professional home care help with foot care for older adults? 

If you suffer from any of the above conditions, or regularly worry about purple feet, enlisting the help of a professional home carer could be useful in order to manage any health conditions, provide regular check-ups to ensure feet remain healthy, and take action if feet do develop signs of a condition. Home care professionals can provide personalised support to assist with personal care activities such as bathing and dressing, and while doing so, can perform the necessary checks on feet regularly so no signs are missed.  

At Home Instead, we can provide highly trained Care Professionals who are experienced in helping older adults at home. Our Care Professionals are also able to provide a pre-visit risk assessment for conditions such as diabetes, haemophilia, poor circulation and more. We will not carry out certain procedures (such as nail care) on diagnosed diabetic patients or those with certain other conditions as they will require specialist foot care from their GP, however in some cases a GP may be able to offer approval for our team to carry out nail care.  

Keep in mind, you may be able to access free podiatry through the NHS if you have diabetes, circulatory conditions, or foot ulcers. Speak to your GP or practice nurse about eligibility.

We’re an award-winning home care provider and part of a worldwide organisation devoted to providing the highest quality relationship-led care for older people in their own homes. Arranging care for yourself or your loved one shouldn’t be stressful, so whatever questions you would like answered, feel free to reach out to the Home Instead team to discuss your needs.