My Leg is SO Cold
Polio “cold leg” or “cold limb” is a phenomenon well known to polio survivors,
but little known to many medical practitioners.
As winter approaches for those of us in the northern hemisphere, many polio survivors and their bed partners will deal with “polio cold leg” (or it could also be “polio cold arm” but that is less common). It also can affect polio survivors when they are in an air-conditioned room for several minutes. Back in the summer of 2015, Dr. Fred Maynard answered a question submitted to Post-Polio Health International by a polio survivor who wrote, “My right leg (polio-affected) is always very cold to the touch even though it never feels cold to me unless I touch it. Is there any therapy or anything else I can do to get this atrophied leg warm besides wearing up to two pairs of knee socks?” Dr. Maynard’s reply was “You’re doing the only helpful thing for cold polio-atrophied legs by wearing layers of warm socks in cooler weather. Try putting the socks on when the leg is at its warmest, like after a hot bath or first thing in the morning before getting out of a warm bed. I would reassure you that the persistent coldness will not lead to other problems, nor is it likely a sign of other problems.” *
As time goes on, healthcare providers have less and less experience caring for polio survivors, and there is less information in the medical literature. Polio survivors are encountering physicians who assume that a “cold leg” means ONLY ONE THING - that the leg is not getting adequate blood supply (which is often called “peripheral artery disease” or PAD). Therefore, they believe that a fracture or a wound may not heal properly unless normal arterial blood supply is restored by some invasive procedure. Even if the polio survivor tells them, “My polio leg has always been cold since I had polio 50 or more years ago”, the doctor may not believe them. Before consenting to any invasive vascular procedure, it is important for survivors in this situation, to insist on some kind of non-invasive testing of the blood flow in their leg, that proves there is restricted blood flow in the arteries into the lower leg and foot.
As polio survivors age, some will develop things in addition to, and unrelated to, the residuals of their previous polio, such as diabetes, atherosclerosis (hardening of the arteries), elevated cholesterol, or restricted blood flow in their lower extremities due to smoking. Restricted blood flow in the arteries is less likely if a person has never smoked, does not have diabetes or untreated high cholesterol, has not had untreated high blood pressure or has never had a heart attack or a stroke.
Even if a polio survivor has some of these risk factors, it is reasonable to request some kind of testing to measure the blood flow into the lower leg and/or foot. This testing can be as simple as measuring the blood pressure in the ankle on the affected leg and comparing it to the blood pressure in that person’s upper arm. This is called an ankle/brachial index. Most doctor’s offices do not have the equipment to do this test, but cardiologists, vascular surgeons, and many hospital outpatient departments can do it. The second test that can be done is an arteriogram, sometimes also called an angiogram, either as part of a standard x-ray or as part of computed tomography (CT scan). It does involve the injection into a vein of a dye that will show the column of blood flowing through the blood vessels into whatever part of the body that is being imaged. If the ankle/brachial index is abnormally low, then an angiogram may be ordered to document the slowed blood flow but also identify where any blockage may be. If a blockage or severe narrowing is proven, then it is very important to take steps to increase the blood flow and prevent severe permanent injury to the tissues in the leg/foot.
Why do polio survivors often have “polio cold limb”? I’m going to quote the section on “Cold Intolerance” in the Handbook on Late Effects of Poliomyelitis for Physicians and Survivors, 3rd edition, published by Post-Polio Health International, updated in 2024.
“In nearly all cases, the ‘polio cold limb’ does NOT mean that the arterial circulation is faulty or that healing will take longer than someone with normal circulation. The body’s thermostat, the area of the brain that causes blood vessels to contract, and the hypothalamus, the part that controls the body’s (inner environment) core temperature, may have been affected during the original poliovirus infection. An atrophied extremity will also have less insulation due to less muscle mass and tissue. Additionally, polio often affected motor nerves in the spinal cord of the sympathetic nervous system that send the message to the capillaries of the skin to contract when it is cold (Bodian, 1949). Consequently, as the outside temperature drops, the capillaries do not contract and warm blood flows to the surface of the skin resulting in excessive loss of heat and cooling of the limbs. When the limbs cool, veins narrow, trapping venous (blue) blood in the capillaries. This causes the feet to look blue. The motor nerves of cold limbs conduct more slowly; the muscles contract less efficiently. Cold also chills tendons and ligaments (like putting a rubber band in the freezer), making them stiff and movement of weak muscles more difficult.”
So, what can be done? To add onto Dr. Maynard’s advice, here is what the section on Cold Intolerance in the Handbook says,
“ . . . recommendations related to cold intolerance include dress as if it were 20º F colder, dress in layers and wear heat-retaining socks or undergarments made of polypropylene (e.g., Gortex or Thinsulate) or wool and put on clothes immediately after showering when the skin is warm. Heated blankets may be necessary in the recovery room after surgery (Bruno, 1996).”
Some people use heated mattress pads, electric blankets, or heated throws on their favorite chair or couch. For outside use, there are battery operated heated socks or chemical foot warmers that can be activated and placed inside winter boots. And there are also battery-operated heated vests, coats, and mittens and gloves.
*Post-Polio Health, (Volume 31, Number 3), Summer 2015
More articles from Dr. Eulberg, along with her extensive biography, are available under “Primary Care Perspective”.