Background: Trash feet is a rare, but serious, disorder occuring in patients with advanced atherosclerosis due to cholesterol crystal embolisation. Given the relatively low incidence of the condition, and the lack of evidence, there is no consensus on the optimal management of this condition. We herein describe a patient who presented with trash feet and was successfully treated with anticoagulation.

Aims: We aim to illustrate the importance of promptly recognising the condition, review the literature and discuss the current treatment options available.

Methods: We report here a 78-year old man who presented with acute-onset spontaneous purplish discolouration of multiple toes of bilateral feet. He had a significant medical history of hypertension, dyslipidemia, ischemic heart disease and chronic kidney disease. On examination he had hypertension(BP 167/93 mmHg), intact bilateral femoral and dorsals pedis arterial pulsations. There was evidence of livedo reticularis over his legs with purplish discolouration of multiple toes of both feet. A CT scan abdominal aortogram done in the recent past was suggestive of severe diffuse atherosclerotic plaques involving thoracic-abdominal aorta and an ulcerated atherosclerotic plaque in descending abdominal aorta.

Results: He was initially started on aspirin and enoxaparin, and was subsequently transitioned to warfarin, with which the feet symptoms got better, and serum creatinine improved to baseline. On follow-up at two weeks, serum creatinine had remained stable and the discolouration of the toes had improved significantly.

Conclusions: Trash feet is a rare disorder, which is frequently under-diagnosed. Prompt diagnosis is necessary, and is aided by strong clinical suspicion. Although treatment with anticoagulation has been shown to be controversial, it appears from this report that anticoagulation has a positive role in the management of patients during the acute phase of cholesterol embolisation syndrome.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/trash-feet-is-anticoagulation-therapy-useful/