COVID-19 can affect your legs and feet in ways that range from mildly uncomfortable skin changes to limb-threatening blood clots. The virus triggers widespread inflammation and disrupts blood vessels, nerves, and muscles throughout the body, and the lower extremities are often where those effects show up first or most visibly. Some leg and foot symptoms appear during an active infection, while others surface weeks or months later as part of long COVID.
COVID Toes and Chilblain-Like Lesions
The most widely discussed foot symptom of COVID-19 goes by the informal name “COVID toes.” These are red, purple, or bluish swollen patches on the toes (and sometimes the fingers) that look a lot like chilblains, the painful bumps people get from cold exposure. Early in the pandemic, dermatologists noticed a spike in pernio-like eruptions on the feet of young, otherwise healthy patients who had no history of cold injury and had not been exposed to freezing temperatures. That unusual pattern, along with skin biopsies that sometimes showed the virus in tissue, pointed toward COVID-19 as a probable trigger.1PubMed Central. Pernio (Chilblains), SARS-CoV-2, and COVID Toes Unified Through Cutaneous and Systemic Mechanisms
The connection has never been fully nailed down, though. Many patients with COVID toes tested negative for the virus on standard swabs, and after more than 300 publications on the topic, the association remains controversial.2PubMed Central. “COVID toes”: A true viral phenomenon or a diagnosis without a leg to stand on? One leading theory is that the lesions result from an exaggerated interferon response, the body’s antiviral alarm system, rather than direct viral damage to the skin. That idea gained support when similar toe lesions appeared in some people after COVID vaccination and worsened after treatment with a drug that suppresses certain immune cells, suggesting the immune response itself drives the skin reaction.3PubMed Central. Post-vaccination COVID Toes (Chilblains) Exacerbated by Rituximab Infusion Suggests Interferon Activation as Mechanism
For many people, COVID toes resolve on their own within a few weeks. But a follow-up study of 82 patients found that only about a third experienced complete recovery. Roughly 40% had recurrences after their hands and feet initially returned to normal, and about a quarter developed persistent discoloration or other lasting changes to their fingers and toes over the following ten months.4PubMed Central. Long-term Outcome of Chilblains Associated with SARS-CoV-2 So while COVID toes are not dangerous in the way that blood clots are, they can be annoyingly persistent.
Blood Clots in the Legs
The most medically serious way COVID-19 affects the legs is by driving blood clot formation. The virus damages the lining of blood vessels and throws the clotting system into overdrive, creating conditions ripe for deep vein thrombosis, where a clot forms in the deep veins of the leg.5Journal of Vascular Surgery Cases, Innovations and Techniques. Persistent hypercoagulability and acute limb ischemia post COVID-19 A large Swedish study that tracked over a million COVID-19 patients found that the risk of deep vein thrombosis was roughly five times higher than normal in the first 30 days after infection, and the elevated risk persisted for about 70 days.6PubMed Central. Risks of deep vein thrombosis, pulmonary embolism, and bleeding after covid-19: nationwide self-controlled cases series and matched cohort study The risk was highest in people with severe infections who needed intensive care, but even patients with milder illness could develop clots.
Classic symptoms of a deep vein thrombosis include swelling in one leg, cramping or soreness in the calf, warmth and redness over the affected area, and pain that worsens when you flex your foot upward. Case reports from the pandemic describe patients showing up with leg cramps and swelling as their main complaint, only for imaging to reveal extensive clotting in the deep veins.7Jurnal Respirologi Indonesia. Non-Severe COVID-19 Complicated by Deep Vein Thrombosis (DVT) Beyond the risk of the clot itself, the bigger danger is that a piece can break free and travel to the lungs, causing a pulmonary embolism. That same Swedish study found the risk of pulmonary embolism was more than 30 times higher in the first month after COVID-19.6PubMed Central. Risks of deep vein thrombosis, pulmonary embolism, and bleeding after covid-19: nationwide self-controlled cases series and matched cohort study
The thrombotic risk doesn’t disappear once you recover from the acute infection. Data show that the risk of blood clots remains elevated for months afterward, which is a particular concern for people who had severe illness or who already had risk factors like obesity, immobility, or prior clotting disorders.8PubMed Central. Risk of Thrombosis during and after a SARS-CoV-2 Infection: Pathogenesis, Diagnostic Approach, and Management
Acute Limb Ischemia
A rarer but more dramatic vascular complication is acute limb ischemia, where a clot or sudden arterial blockage cuts off blood flow to an arm or leg. Your leg or foot may suddenly become pale, cold, painful, and numb, and you might lose the ability to move it. This is a surgical emergency. Even young, otherwise healthy patients with COVID-19 have developed this complication despite being on preventive blood thinners, because the virus creates such an intensely pro-clotting state.9PubMed Central. Acute limb ischemia in a COVID-19 patient
Outcomes for COVID-associated acute limb ischemia are sobering. One study identified 36 patients with 40 affected limbs and found that overall mortality was 50%. Among those who underwent surgery to restore blood flow, the rate of major amputation was 25%, compared with just 3% in a pre-pandemic comparison group.10Journal of Vascular Surgery. COVID-associated acute limb ischemia during the Delta surge and the effect of vaccines Part of the problem is timing: during pandemic waves, patients often delayed seeking help because they were isolating at home, were anxious about going to a hospital, or could not get into overcrowded facilities.11Vascular Disease Management. Acute Limb Ischemia as a Complication of COVID-19 Late presentation makes salvaging the limb much harder.
Nerve-Related Symptoms in the Legs and Feet
COVID-19 doesn’t only affect blood vessels. It can also damage peripheral nerves, the wiring that carries sensation and movement signals to and from your extremities. Peripheral neuropathy after COVID-19 can show up as tingling, numbness, burning pain, or a “pins and needles” feeling in the feet and lower legs.12PubMed Central. Peripheral Neuropathies Derived from COVID-19: New Perspectives for Treatment These sensations may start during the acute illness or emerge weeks later, which can be confusing for people who thought they were past the worst of it.
In rare cases, COVID-19 triggers Guillain-Barré syndrome, an autoimmune condition in which the body’s immune system attacks its own peripheral nerves. It typically begins with weakness and tingling in the legs that spreads upward, and it can progress to paralysis. One case report describes a previously healthy man who developed bilateral leg pain and loss of sensation in his feet 53 days after having COVID pneumonia. His weakness progressed rapidly to involve all four limbs, his face, and his breathing muscles, requiring a ventilator.13BMJ Case Reports. Late onset of Guillain-Barré syndrome following SARS-CoV-2 infection: part of ‘long COVID-19 syndrome’? The condition is uncommon, but it can have serious consequences when it progresses to severe muscle weakness or the loss of reflexes entirely.14PubMed Central. The Impact of COVID-19 on the Guillain-Barré Syndrome Incidence
A milder but more common nerve-related complaint is restless legs syndrome, that uncontrollable urge to move your legs, especially at night. An international survey found that new-onset restless legs symptoms appeared in about 5.6% of participants who had had COVID-19, compared with about 1.1% of those who had not.15Sleep Medicine. Restless legs symptoms increased during COVID-19 pandemic. International ICOSS-survey That fivefold difference is striking, though the researchers noted that younger age, social restrictions, and insomnia severity also contributed. Case reports have also documented new-onset restless legs in COVID patients with no prior history of the condition.16PubMed Central. New-onset restless leg syndrome in a COVID-19 patient: a case report with literature review
Muscle Weakness and Breakdown
Leg pain and muscle fatigue are among the most common complaints during and after COVID-19, and sometimes the damage goes deeper than ordinary soreness. Rhabdomyolysis, a condition in which muscle fibers break down and release their contents into the bloodstream, has been reported as a complication of severe COVID-19.17PubMed Central. Rhabdomyolysis secondary to COVID-19 infection and vaccination: a review of literature One of the earliest documented cases involved a patient in Wuhan whose main symptoms were lower limb pain and fatigue, along with worsening lung disease.18Emerging Infectious Diseases. Rhabdomyolysis as Potential Late Complication Associated with COVID-19 Rhabdomyolysis can lead to kidney damage if untreated, so unexplained severe muscle pain, weakness, and dark-colored urine after COVID should prompt urgent medical evaluation.
Patients who spend time in intensive care face an additional risk: ICU-acquired weakness. Prolonged mechanical ventilation, heavy sedation, and the inflammation of severe COVID can strip away muscle mass and nerve function. One case report describes a man who developed bilateral foot drop, the inability to lift the front of the foot, after a prolonged ICU stay for severe COVID. With customized ankle-foot braces and months of rehabilitation, he was back at work within seven months and had returned to his pre-illness activity level by 18 months.19PubMed Central. ICU-Acquired Weakness Complicated With Bilateral Foot Drop After Severe COVID-19: Successful Rehabilitation Approach and Long-Term Follow-Up Another case documented severe, symmetric limb weakness that developed after ten days on a ventilator, with testing confirming acute muscle inflammation.20PubMed Central. Severe acute myopathy following SARS-CoV-2 infection: a case report and review of recent literature These outcomes underscore the importance of early physical therapy in severe COVID cases.
Skin Discoloration on the Lower Legs
Beyond COVID toes, a separate skin finding can appear on the lower legs: livedo reticularis, a lace-like pattern of reddish or purplish mottling that results from reduced blood flow in tiny skin capillaries. In COVID-19 patients, this pattern tends to show up on the lower limbs and reflects the microvascular damage the virus can cause. It has been reported in a small percentage of COVID patients with skin symptoms, with estimates ranging from less than 1% to about 3.5% of all COVID-related skin findings.21PubMed Central. COVID-19 Skin Manifestations in Skin of Colour While the mottling itself is usually harmless and often resolves, it signals that the virus is affecting the blood supply to the skin. In darker skin tones, livedo may appear as areas of deeper pigmentation rather than the reddish-violet color described in lighter skin, so it can be easy to miss.
Long COVID and Lasting Leg Problems
Many of the leg and foot symptoms described above don’t neatly resolve when the acute infection ends. Long COVID can leave people dealing with persistent muscle weakness, reduced physical performance, and difficulty with everyday activities. Research has shown that skeletal muscle is one of the systems hit hard by long COVID, contributing to fatigue, lower mobility, and poor quality of life that lasts weeks or months beyond the initial diagnosis.22PubMed Central. The Impact of Long COVID-19 on Muscle Health
Some people with long COVID develop dysautonomia, a malfunction of the involuntary nervous system that controls things like heart rate and blood pressure. One common form is postural orthostatic tachycardia syndrome, where your heart rate spikes when you stand up, leaving you dizzy, lightheaded, and sometimes unable to stand for long. In a study of 22 patients with long COVID or the related condition myalgic encephalomyelitis/chronic fatigue syndrome, over 90% met the diagnostic criteria for this type of orthostatic intolerance during a standing test.23PubMed Central. Testing a Personalised Dysautonomia Management Protocol in Patients with Orthostatic Intolerance and a Diagnosis of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome or Long COVID Blood pooling in the legs upon standing is a hallmark feature. People often describe heavy, aching legs, swelling in the lower extremities, and a sense that their legs simply won’t cooperate when they try to stand or walk for any length of time.
When Leg and Foot Symptoms Need Urgent Attention
Not every ache in your legs after COVID demands a trip to the emergency room, but certain red flags should not be ignored. Sudden swelling in one leg, especially if accompanied by calf pain, warmth, or redness, could indicate a deep vein thrombosis and warrants immediate evaluation. A leg or foot that suddenly becomes cold, pale, numb, or painful may signal acute limb ischemia and requires emergency care. Rapidly progressing weakness that starts in the feet and moves upward, particularly if your reflexes feel dulled and your grip weakens, could be Guillain-Barré syndrome. And severe muscle pain with dark urine after COVID raises concern for rhabdomyolysis and potential kidney damage.
Milder symptoms like tingling in the feet, general leg fatigue, restless legs at night, or lingering COVID toes are worth bringing up with your doctor, especially if they persist for more than a few weeks. These are treatable, and in many cases they resolve with time, physical therapy, or targeted management. The overarching pattern is that COVID-19 can affect virtually every tissue in the lower extremities, from the skin surface all the way down to the blood vessels, nerves, and muscle fibers, through overlapping mechanisms of inflammation, clotting, and immune dysregulation.
Vaccine-Related Leg Symptoms
A small number of reports have also linked COVID-19 vaccination to lower-extremity symptoms, though these cases are rare and the connection is less well established than for the infection itself. Case reports describe patients, particularly people with a prior history of cancer treatment affecting their lymph nodes, who developed significant one-sided leg swelling after receiving a COVID booster shot. In two such cases involving women with a history of cervical cancer, imaging confirmed lymphedema with abnormal fluid drainage in the affected leg. Intensive treatment improved their symptoms but did not fully resolve the swelling, suggesting progression to chronic lymphedema.24Journal of Yeungnam Medical Science. Unilateral lower extremity lymphedema followed by COVID-19 vaccination in patients with cervical cancer history: two case reports COVID toes have also been reported after vaccination, as noted earlier, likely driven by the same interferon-mediated immune response that the virus itself provokes. These vaccine-related findings are uncommon enough that they don’t change the risk-benefit calculation for most people, but they are worth knowing about if you have a history of lymph node surgery, radiation to the pelvis, or prior episodes of limb swelling.