Buerger’s Disease: How Smoking Affects Foot Health

About 1 in 100,000 Americans develop Buerger's disease each year, and nearly every case is linked to tobacco use. Want to know more? We’ve compiled the most essential facts, symptoms, and insights into Buerger’s disease—what it is, how it’s diagnosed, and how to manage it for better foot health.

What Is Buerger Disease?

Buerger’s disease—also called thromboangiitis obliterans—is a rare, non-atherosclerotic inflammatory disease that affects the small and medium-sized arteries and veins in the arms and legs. The disease leads to inflammation and clotting in blood vessels, cutting off circulation and depriving tissues of oxygen and nutrients. This can eventually lead to pain, ulceration, and even gangrene.

The inflammation usually starts in the hands and feet but can progress to the arms and legs. It tends to affect more than one limb at a time and is almost always linked to tobacco use. Though its exact cause is unknown, experts believe it results from an immune response triggered by the chemicals in tobacco products.

What Causes Buerger’s Disease?

Nearly all individuals diagnosed with Buerger’s disease are current or former tobacco users. The condition is believed to stem from the body’s immune reaction to chemicals in tobacco that damage blood vessels. Genetics may also play a role. According to the National Institutes of Health, this disease primarily affects young to middle-aged men who smoke, although women and non-smokers who use tobacco in other forms (like chewing tobacco or vaping) may also be affected.

How Common Is Buerger’s Disease?

Although rare compared to other vascular diseases, Buerger’s disease carries serious consequences and shows a striking association with tobacco use.

• 8–12 people per 100,000 in the U.S. are diagnosed each year (Cleveland Clinic, 2023)
• About 95% of those diagnosed have a history of tobacco use (Cleveland Clinic, 2023)
• Most commonly found in people under the age of 45 (NIH, 2023)
• Men are up to 4 times more likely to develop it than women (Vascular Specialists of Central Florida, 2018)

What Are the Symptoms of Buerger’s Disease?

Symptoms vary by individual but are typically related to impaired circulation in the hands and feet. They often worsen over time as blood vessels narrow or become blocked.

Common Symptoms:

• Pain in the hands or feet during physical activity (claudication)
• Numbness, tingling, or burning sensations
• Pale, reddish, or bluish skin, especially in response to cold
• Cold hands and feet
• Ulcers or open sores on fingers or toes
• Thrombophlebitis (swelling and redness along a vein)

These symptoms are often confused with other circulatory or neuropathic conditions, such as Raynaud’s phenomenon or peripheral neuropathy.

How Is Buerger’s Disease Diagnosed?

Because Buerger’s disease shares symptoms with other conditions, diagnosis involves excluding other diseases such as atherosclerosis, diabetes, and autoimmune disorders.

Diagnostic Tools and Techniques:

1. Allen Test: Assesses blood flow in the hands by compressing arteries and monitoring how fast blood returns after release.

2. Angiography: Imaging that reveals narrowing or blockages in blood vessels. Buerger’s disease may produce a “corkscrew” appearance of the arteries.

3. Doppler Ultrasound: Evaluates blood flow through arteries and veins.

4. Blood Tests: Used to exclude other inflammatory or clotting disorders such as lupus or diabetes.

Early and accurate diagnosis is crucial to preventing long-term complications, especially tissue death or amputation.

What Are the Stages of Buerger’s Disease?

Buerger’s disease tends to progress in three general stages, each marked by increasingly severe symptoms. Understanding these stages can help with early detection and timely treatment.

1. Early Stage:

During this initial phase, symptoms are mild but noticeable, especially during physical activity. Blood flow begins to decrease in small vessels, leading to discomfort in the extremities.

• Intermittent pain or cramping in hands or feet (especially with exercise)
• Tingling or numbness
• Cold sensitivity or pale/discolored fingers and toes

2. Intermediate Stage:

As inflammation and vessel narrowing increase, symptoms become more frequent and occur even at rest. You may begin to notice persistent pain and visible skin changes.

• Constant or worsening pain, even while at rest
• Changes in skin tone (red, blue, or pale)
• Swelling or inflammation of superficial veins (thrombophlebitis)
• Delayed healing of minor injuries on hands or feet

3. Advanced Stage:

This stage includes serious complications that arise from severe blockages in blood flow. Without intervention, tissue can begin to die.

• Painful, chronic ulcers on fingers or toes
• Infections that are slow to heal
• Tissue death (gangrene)
• Risk of amputation to prevent spread of infection

Is There a Cure for Buerger’s Disease?

Unfortunately, there is no definitive cure for Buerger’s disease. However, quitting all forms of tobacco is the most critical step and can often stop disease progression. In early stages, quitting tobacco may even reverse some symptoms and prevent long-term damage.

Treatment Options:

Tobacco Cessation:
This is the cornerstone of treatment. Without it, other therapies are unlikely to help. Complete abstinence from smoking, vaping, or chewing tobacco is essential.

Medications:

• Vasodilators: Medications like nifedipine help dilate blood vessels and improve circulation.
• Anticoagulants / Antiplatelet drugs: Reduce the risk of clot formation in narrowed vessels.
• Pain relief: NSAIDs or stronger medications to manage chronic discomfort.

Surgical Treatments:

• Sympathectomy: A procedure where nerves controlling blood vessel constriction are cut to improve circulation.
• Amputation: In rare, advanced cases where gangrene develops and threatens surrounding tissues.

Alternative Therapies:

• Hyperbaric oxygen therapy: Enhances oxygen supply to affected tissues, promoting healing.
• Iloprost infusion: A prostacyclin analog that mimics a natural blood vessel dilator and inhibitor of platelet aggregation.

Lifestyle Changes for Managing Buerger’s Disease

In addition to medical treatments, several lifestyle changes can make a meaningful impact on slowing disease progression and improving symptoms.

• Quit all tobacco products permanently. Even small exposures can trigger relapse.
• Exercise regularly. Low-impact activities like walking or swimming help stimulate blood flow.
• Stay warm. Cold can constrict blood vessels—wear gloves and warm socks in chilly climates.
• Avoid standing or sitting too long. Shift positions frequently to support circulation.
• Elevate feet and hands periodically. This helps reduce swelling and discomfort.
• Eat anti-inflammatory foods. A Mediterranean-style diet rich in healthy fats and low in processed foods may improve vascular health.

How to Improve Circulation With Buerger’s Disease

Improving circulation is essential to reduce pain and avoid complications. With your doctor’s guidance, the following strategies may help:

• Foot massage and physical therapy. These can stimulate blood flow and relieve muscle tension.
• Gentle exercise. Swimming, yoga, and walking promote movement without excessive strain.
• Warm soaks or heating pads. Keep extremities warm to avoid vasoconstriction.
• Hydration. Proper fluid intake supports healthy blood volume and flow.
• Compression socks. When recommended by a physician, these can enhance venous return.
• Reduce salt and processed foods. High sodium intake can narrow blood vessels and raise blood pressure.

Consequences of Untreated Buerger’s Disease

Buerger’s disease is progressive and can lead to serious, sometimes irreversible complications—especially when left untreated. Because this condition restricts blood flow to the limbs, the consequences of delayed care or continued tobacco use can be both painful and life-altering.

Without medical intervention or tobacco cessation, Buerger’s disease can rapidly worsen, affecting your mobility, overall quality of life, and in advanced cases, leading to amputation. Below are the most common and severe consequences of ignoring or delaying treatment:

1. Chronic Pain and Nerve Damage

As blood vessels become increasingly blocked, tissues in the affected areas are deprived of oxygen and nutrients. This can cause ongoing pain, burning, or numbness in the hands or feet. Over time, damaged nerves may result in permanent loss of sensation or persistent tingling and discomfort, even during rest.

2. Recurrent and Persistent Infections

Because Buerger’s disease reduces circulation, even minor wounds on fingers or toes can heal slowly or not at all. Poor blood flow limits the body’s ability to fight off bacteria, leading to recurring infections that may require antibiotics, wound care, or surgical intervention.

3. Non-Healing Ulcers and Open Sores

Open sores—particularly on the tips of fingers and toes—are common in mid-to-late stages of the disease. These ulcers are slow to heal due to compromised circulation and often become chronic. Without proper care, these wounds can deepen and expose underlying tissue or bone.

4. Tissue Death (Gangrene)

One of the most severe complications of Buerger’s disease is gangrene—tissue death resulting from prolonged lack of blood supply. Affected areas may turn black, become cold and numb, and emit a foul odor. Gangrene typically requires emergency care and, in many cases, surgical removal of the affected tissue.

5. Amputation of Toes, Fingers, or Limbs

When tissue damage becomes severe and irreversible, amputation may be necessary to prevent the spread of infection and preserve the patient’s overall health. According to Cleveland Clinic, amputation occurs in approximately 30%–40% of Buerger’s disease patients who continue using tobacco.

6. Reduced Mobility and Function

As pain and circulation issues worsen, patients may lose the ability to walk, stand, or use their hands without assistance. In advanced stages, this can mean relying on mobility aids, requiring help with daily activities, or facing long-term disability.

7. Emotional and Psychological Toll

Living with a progressive vascular disease can impact mental health. Chronic pain, physical limitations, and the risk of amputation can contribute to feelings of anxiety, isolation, or depression—especially if the disease results in visible physical changes or loss of independence.

Find Relief With KURU

Now that you’ve learned the serious risks and symptoms of Buerger’s disease, we want to help you stay active and protected.

At KURU, we exist to eliminate foot pain by designing footwear engineered to support healthy movement—especially for those managing chronic foot conditions. Our patented KURUSOLE technology flexes with your stride to protect the heel, reduce impact, and encourage healthy circulation.

From shock-absorbing sneakers to supportive everyday shoes, every pair is built to help reduce foot fatigue and keep you comfortably on your feet—so you can move better, longer.

Sourcing

• Buerger's Disease. Cleveland Clinic (May 2023)
• Buerger Disease. National Institutes of Health (February 2023)
• Buerger's Disease. Vascular Specialists of Central Florida, Inc (October 2018)

About Us

At KURU, we're on a mission to help you Heel Better™ with footwear technology designed to relieve foot pain, so you can live a life you love. Since launching our innovative technology in 2008, we’ve received more than 39,000 five-star reviews from thousands of customers who tell us their KURU shoes helped them get back to doing what they love.

For all media inquiries, please contact us at pr@kurufootwear.com.