Persistent Pain in the Toes After Hiking

A 22-year-old young woman presents with complaints of severe pain in all the toes on both feet. She reported going hiking and camping with some friends over the weekend. The daytime temperature during the trip had unexpectedly dropped as low as 4.4°C (40°F). She admits she had only sneakers to hike in and her feet had gotten very cold and uncomfortable during the day while hiking but felt better when she warmed them by the fire at night.

The patient describes persistent pain and mild pruritus in her toes.  Examination reveals moderate erythema of most of her toes with some trace edema.  The skin is intact without lesions, blisters or ulcerations.  The patient’s vital signs are normal and she has no contributory past medical or surgical history.  She takes no medications and has no drug allergies.

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• What is the cause of this condition?
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