It might sometimes seem that your feet are the hardest part of your anatomy to keep warm, particularly in the dead of winter, when spring is a myth you tell yourself to keep an iota of hope alive. The rest of you might feel all warm and toasty, but your feet remain persistent little blocks of ice attached to your ankles, making you (and your bedmate) completely uncomfortable. Fortunately, cold feet can usually be attributed to cold weather (or doing something like walking out barefoot in the snow-which, by the way, is probably a bad idea), but you need to be careful. It can also be a symptom of an underlying disease or condition, ones which are often associated with poor circulation.

Some conditions that may cause poor circulation (and thus chilly feet) include diabetes, peripheral vacular disease (which is when your arteries become hardened or blocked), heart disease, and Reynaud’s phenomenon or disease (which is when blood vessels spasm because of cold sensitivity). Your cold feet might also be a result of other diseases, such as multiple sclerosis, peripheral neuropathy (degeneration of the nerves), fibromyalgia, hormonal or glandular problems like hypothyroidism or adrenal insufficiency, or some diseases like lupus or scleroderma (both are problems with the immune system.) In short, there’s a veritable plethora of possible causes.

You should also be aware that some things you might be taking in to your body could be causing your feet to feel the chill. Smoking, for instance, can make your blood vessels constrict and harden, which turns down the temperature on your feet. Some medications may also have this side effect, including beta blockers (typically used to treat hypertension or migraines), ergotamine (used in migraine medication), or pseudoephedrine (used in cold medications). Now, smoking is definitely something worth giving up (and cold feet is hardly the worst side effect), but don’t just stop taking the rest of these meds simply because you don’t like having chilly toes. You can talk with your doctor if you’d like to explore other options, but stopping medication cold turkey (or, cold turkey feet if you will) on your own is not a good idea.

Having cold feet is really a symptom in itself, but there may be other symptoms that appear with it. For instance, if your cold feet are caused by blockage of blood vessels that run to your foot, you may start seeing other problems such as toe discoloration (they start to look red or purple), muscle cramping after brief periods of exercise, and later issues might include ulcers, pain in your limbs while you rest, or gangrene. If your cold feet are caused by extensive exposure to cold weather, you may notice that your toes or other prominent areas of your foot develop chilblains, or red and itchy spots that can become infected. Definitely see your podiatrist if you get these.

If you’re concerned about your cold feet, your podiatrist should be able to offer some insight into what’s going on. He or she will likely ask you about any medications you may be taking, whether or not you’re a smoker, and may inquire about your medical history. Your foot or feet will likely be examined for changes in skin coloration or condition, and if circulation problems are suspected, your podiatrist will probably check the pulse in your feet. Some tests can be done to check your circulation, including arterial Doppler testing (which uses sound waves to see how well blood is flowing-pretty nifty, right?), and an arteriogram (which uses dye to make arteries visible on X-rays).

The treatment of your cold feet will really depend on what is causing them. If your cold feet are due to nothing more than the fact that the exterior temperature is hovering around -15 degrees Fahrenheit, then wearing socks will probably make you a bit more comfortable. The acrylic kind wick moisture away from your skin, which is nice if you’re wearing shoes and moving around a bit, although natural fibers such as wool may also work well for you (unless, of course, wool makes your skin itch like mad). When you’re outdoors in cold weather, wear insulated waterproof shoes, since feet that are wet as well as cold can develop significant problems, such as frostbite. If your feet do get wet, get back inside quickly and dry them off to avoid these problems. (And get some hot chocolate while you’re at it.)

If poor circulation is the problem, your doctor may recommend exercises to increase bloodflow, medications, or both. If the doctor is able to locate a blockage, then surgery might be an effective way to remove it and increase bloodflow to your feet.

Wearing socks can also help warm the feet of those suffering from poor circulation. If you are having circulation problems, then trying things like sticking your foot into a basin of hot water, or using heating creams, might not be a good idea, since the same things that cause poor circulation sometimes also cause nerve damage. You may be scorching your foot and not even notice. Talk to your podiatrist if you’d like other ideas of how to keep your toes nice and toasty.