Cold Feet: Common Causes and When to Be Concerned

Cold feet are common and are often a normal response to cold temperatures. When the body is exposed to cold, blood vessels near the surface of the skin narrow, reducing blood flow to the extremities and directing more blood toward the body's core. This helps conserve heat and maintain the body's internal temperature. People with less body fat may be more sensitive to cold because they have less insulation.

However, cold feet can have many other causes. In some cases, the feet are actually colder because blood flow to the area is reduced. In other cases, the feet may only feel cold because nerves that sense temperature are not functioning properly. Other conditions can cause a person to be more sensitive to cold throughout the body. Understanding these differences can help identify when cold feet may be related to an underlying health condition.

Raynaud's Phenomenon

One possible cause of cold feet is Raynaud's phenomenon, a condition in which the small blood vessels supplying the skin narrow more than they normally should in response to cold temperatures or stress. This excessive narrowing temporarily reduces blood flow to the fingers and toes, causing them to feel cold and numb. The affected skin may also change color, often becoming white or blue before returning to its usual color as blood flow improves.²

There are two main types of Raynaud's. Primary Raynaud's, also called Raynaud's disease, occurs on its own and is more common than secondary Raynaud's. It often begins between the ages of 15 and 30 and is more common in women. Secondary Raynaud's, also called Raynaud's phenomenon, develops in association with another condition, particularly connective tissue or autoimmune diseases such as scleroderma or lupus. Certain medications, smoking, injuries, and repeated exposure to vibration can also contribute to secondary Raynaud's.

Because Raynaud's directly affects blood vessels in the toes, cold feet can be one of its most noticeable symptoms. Episodes are typically triggered by cold or stress and improve as the affected area warms and blood flow returns.

Peripheral Artery Disease

Another important cause of cold feet is peripheral artery disease (PAD). PAD occurs when arteries that supply the legs and feet become narrowed, most commonly because of atherosclerosis, or the buildup of plaque in the artery walls. As the arteries narrow, less blood can reach the feet and legs. This reduced blood flow can cause the affected foot or leg to feel colder, particularly when compared with the opposite side.

Coldness is only one possible symptom of PAD. People may also experience pain, cramping, or heaviness in the legs during walking that improves with rest, a symptom known as intermittent claudication. Other signs can include numbness or weakness, reduced hair growth on the legs or toes, shiny skin, slow-growing toenails, changes in skin color, weak pulses, or sores that do not heal.

More severe PAD can lead to a significant lack of blood flow to the foot. This may cause pain even while resting, particularly at night, as well as wounds that are slow to heal or tissue damage. Because PAD can affect circulation throughout the body, it is important to have persistent or unexplained symptoms evaluated.

Hypothyroidism

Cold feet can also occur with hypothyroidism, or an underactive thyroid. The thyroid gland produces hormones that help regulate how the body uses energy. When the thyroid does not produce enough of these hormones, many of the body's functions slow down. As a result, people with hypothyroidism commonly have difficulty tolerating cold temperatures.

In this situation, the cold sensation is not necessarily caused by a problem with blood flow specifically to the feet. Instead, hypothyroidism can make a person feel colder overall. Other symptoms may include fatigue, weight gain, dry skin, thinning hair, constipation, muscle or joint pain, a slowed heart rate, depression, and heavy or irregular menstrual periods or fertility problems.

Peripheral Neuropathy

Peripheral neuropathy is another possible explanation for cold feet, particularly when the feet feel cold even though they are not actually cold to the touch. Peripheral neuropathy occurs when nerves outside the brain and spinal cord become damaged. It commonly affects the feet and legs and can interfere with the nerves responsible for detecting temperature.

As a result, a person with neuropathy may experience unusual sensations, including feeling extremely hot or cold, even when the actual temperature of the skin is normal. Numbness, burning, tingling, pins-and-needles sensations, pain, or weakness may occur at the same time.

Diabetes is a common cause of peripheral neuropathy, although neuropathy can have many other causes. Because reduced sensation can make it difficult to notice injuries, burns, blisters, or sores on the feet, people with neuropathy should pay particular attention to changes in their feet.

Anemia

Anemia, particularly iron-deficiency anemia, can also be associated with cold hands and feet. Anemia occurs when the blood does not have enough healthy red blood cells or hemoglobin to adequately carry oxygen throughout the body. Cold hands and feet are a recognized symptom of iron-deficiency anemia, along with fatigue, dizziness, weakness, shortness of breath, and pale skin.

The connection between anemia and cold feet is not the same as that seen with PAD or Raynaud's. Rather than a localized blockage or spasm of the blood vessels in the feet, anemia affects the blood's ability to carry oxygen throughout the body. A person with anemia may therefore feel unusually cold in the hands and feet as well as elsewhere in the body.

Buerger Disease

A less common but more serious cause of cold feet is Buerger disease, also known as thromboangiitis obliterans. This rare disease causes inflammation and blockage of small- and medium-sized blood vessels, particularly those supplying the hands and feet. The resulting reduction in blood flow can cause cold hands or feet, numbness or tingling, changes in skin color, and pain.

Buerger disease is strongly associated with tobacco use. As the disease progresses, reduced blood flow can cause painful sores on the toes or fingers and, in severe cases, tissue death or gangrene.⁷ Because Buerger disease is rare and can resemble other conditions that reduce blood flow, symptoms require medical evaluation.

Autoimmune and Connective Tissue Diseases

Some autoimmune and connective tissue diseases, including lupus and scleroderma, can also be associated with cold feet. One reason is that these conditions can cause secondary Raynaud's phenomenon, in which blood vessels in the fingers and toes constrict excessively in response to cold or stress. This reduces blood flow to the extremities and can make the toes feel cold, numb, or painful.

Some autoimmune or vascular diseases can also directly affect blood vessels, further reducing circulation to the hands and feet. For this reason, cold feet accompanied by significant color changes, numbness, sores, or other unexplained symptoms may warrant medical evaluation.

High Cholesterol

High cholesterol is not usually a direct cause of cold feet by itself. However, elevated cholesterol can contribute to atherosclerosis, in which plaque builds up inside the arteries. When atherosclerosis affects the arteries supplying the legs and feet, it can lead to peripheral artery disease and reduced blood flow. This can cause the affected foot to feel colder than the other foot.

This distinction is important because simply having high cholesterol does not necessarily mean that cold feet are caused by poor circulation. The concern is whether cholesterol-related plaque has narrowed the arteries enough to affect blood flow.

Stress

Finally, stress can temporarily contribute to cold feet. Emotional stress can cause blood vessels to narrow, reducing blood flow to the skin and extremities. Stress can also trigger episodes of Raynaud's phenomenon in people who have the condition.

For someone without an underlying vascular disorder, occasional cold feet during periods of stress are generally not concerning. Persistent symptoms, however, should not automatically be attributed to stress without considering other possible causes.

When Should You Be Concerned About Cold Feet?

For many people, cold feet are simply a normal response to cold temperatures. They may warm up after putting on socks, moving around, or entering a warmer environment.

However, certain patterns are more concerning. A foot that suddenly becomes cold, pale, blue, or significantly different from the other foot can indicate an acute problem with blood flow and requires immediate medical attention. Numbness, weakness, or significant pain occurring with the sudden change can be particularly concerning.

Persistent or unexplained cold feet also deserve attention, especially when accompanied by pain with walking, numbness, weakness, significant color changes, wounds that do not heal, or other symptoms. These findings can sometimes indicate an underlying circulation, nerve, blood, or systemic condition that should be evaluated by a healthcare professional.

References

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Mayo Clinic Staff. Buerger disease: Symptoms and causes. Mayo Clinic. Updated April 19, 2025. Accessed October 4, 2026. https://www.mayoclinic.org/diseases-conditions/buergers-disease/symptoms-causes/syc-20350658

Mayo Clinic Staff. Cold hands. Mayo Clinic. Updated July 23, 2024. Accessed October 1, 2026. https://www.mayoclinic.org/symptoms/cold-hands/basics/causes/sym-20050648

National Heart, Lung, and Blood Institute. Iron-deficiency anemia. National Institutes of Health. Updated September 24, 2025. Accessed October 4, 2026. https://www.nhlbi.nih.gov/health/anemia/iron-deficiency-anemia

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National Institute of Arthritis and Musculoskeletal and Skin Diseases. Raynaud's phenomenon. National Institutes of Health. Last reviewed July 2024. Accessed September 30, 2026. https://www.niams.nih.gov/health-topics/raynauds-phenomenon

National Institute of Diabetes and Digestive and Kidney Diseases. Hypothyroidism (underactive thyroid). National Institutes of Health. Last reviewed March 2021. Accessed October 1, 2026. https://www.niddk.nih.gov/health-information/endocrine-diseases/hypothyroidism

National Institute of Diabetes and Digestive and Kidney Diseases. Peripheral neuropathy. National Institutes of Health. Last reviewed February 2018. Accessed October 4, 2026. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/nerve-damage-diabetic-neuropathies/peripheral-neuropathy

WebMD Editorial Contributors. Cold feet: causes and treatment. WebMD. Accessed October 3, 2026. https://www.webmd.com/a-to-z-guides/cold-feet-reasons

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