Abstract: There is a lack of scientific evidence about the severe acute respiratory syndrome coronavirus
2 (SARS-CoV-2). The clinical manifestations are not thoroughly understood; classically, the
virus manifests itself at the pulmonary level but can manifest at other levels. To the best of our
knowledge, systematic reviews and non-systematic reviews about COVID-19 symptoms in the feet
have not been published. The aim of this review of reviews was to analyze and synthesize the
published reviews on manifestations of COVID-19 at the foot level. Methods: a review of reviews
was conducted; the eligibility criteria included studies published in English or Spanish, involving
children and adults with COVID-19, and reporting foot manifestations. PubMed, SciELO, Science
Direct, Cochrane Database of Systematic Review, and Google Scholar were analyzed. Two authors
independently performed the screening and quality assessment of the studies with AMSTAR 1,
and finally, nine reviews were analyzed (one systematic and eight narratives studies). The main
clinical manifestations at the foot level in patients with COVID-19 were vascular (edema, exanthems,
chilblains, ischemia, and distal necrosis), dermatological (vesicular, maculopapular, papulosquamous,
urticarial skin breakouts, and recurrent herpes), and neurological (muscular weakness in lower limbs,
paresis, areflexias, ataxia, and difficulty walking). Erythema pernio or “COVID toes” was shown as
the most characteristic lesion of this disease, especially in asymptomatic children and young people,
so this typical manifestation may be considered important in patients who are positive for COVID-19.
This finding does not allow for strong conclusions due to the scarce literature and methodological
quality in this regard. Future studies are necessary.
