DEAR DR. GOTT: My left big toe is black 90 percent of the time. I assume this is a circulation problem. My GP said it was no big deal. (He didn’t look at it.) I wonder what your opinion is. I’m a 54-year-old male and very active. Thanks.
DEAR READER: Two hints from the minimal information you gave me — specifically that 10 percent of the time your toe is not black and that you are very active — lead me toward possible stress placed on your feet, primarily the big toe. In essence, you could have impact trauma from pushing your toe to the front of your shoe(s) when walking, running, or engaging in sports activities such as baseball, soccer and football. I must rule out a melanoma under the toenail or a fungal infection, because both conditions would be present 100 percent of the time.
Another consideration might be peripheral vascular disease or another circulatory disorder, but you are young. Do you have a history of smoking? Is there pain involved? Are you a diabetic or have a family history of another disorder? Are you on any medication or herbal supplements? Is it related to cold temperatures?
Not knowing the specific cause of your black toe and because your doctor said it was no big deal without even looking at it, I urge you to be seen by a vascular surgeon for a proper diagnosis. The history you provide, coupled with examination of the toe, should allow him or her to direct you toward the most appropriate next step. I urge you to stop smoking, if you even do so, wear good support footwear depending on your level of activity, and get advice for what could be a health issue.
