Peripheral neuropathy: the most common cause
Peripheral neuropathy is damage to the nerves outside the brain and spinal cord. In the feet, it typically causes burning, tingling, pins and needles, sharp or stabbing pains, numbness and loss of balance, starting in the toes of both feet and slowly spreading upwards in a “stocking” pattern.
See tingling in feet.
Common causes of neuropathy
- Diabetes: the leading cause, related to high blood glucose over time.
- Vitamin B12 deficiency: common with vegan diets, older age, metformin and acid-suppressing medicines.
- Alcohol: heavy, long-term drinking.
- Underactive thyroid and kidney disease.
- Medicines: some chemotherapy and other drugs.
- Infections such as HIV and shingles.
- Inherited neuropathies.
Burning in one foot
- Tarsal tunnel syndrome: compression of the tibial nerve on the inside of the ankle, causing burning in the sole.
- Morton’s neuroma: irritated nerve between the toes, causing burning in the ball of the foot.
- Sciatica: a trapped nerve in the lower back can cause burning and numbness in one foot.
Other causes
- Athlete’s foot, which causes itching and burning between the toes.
- Tight or poorly fitting shoes.
- Standing for long periods.
- Erythromelalgia, a rare condition with red, hot, burning feet.
- Circulation problems.
- Menopause-related hot flushes affecting the feet.
Why burning feet are worse at night
Nerve pain often feels worse at night, when there are fewer distractions, temperature changes under the covers and the body is still. Many people find relief by uncovering their feet or cooling them.
Tests
- Examination of sensation, reflexes, strength and the skin of the feet.
- Blood tests: glucose and HbA1c, B12 and folate, thyroid function, kidney and liver function, full blood count.
- Nerve conduction studies and electromyography to measure nerve function.
- Occasionally a skin biopsy for small fibre neuropathy.
Treatment
Treatment depends on the cause: improving blood sugar control in diabetes, B12 injections or tablets for deficiency, reducing alcohol, treating thyroid problems or changing medicines. Nerve pain medicines such as amitriptyline, duloxetine, gabapentin or pregabalin may help; ordinary painkillers usually do not. Capsaicin cream can help localised pain.
Vitamin B12 deficiency is worth checking early, because nerve damage can become permanent if treatment is delayed.
Practical relief
- Soak your feet in cool (not ice-cold) water for a few minutes.
- Keep feet uncovered at night or use a bed cradle.
- Wear comfortable, well-fitting, breathable shoes and socks.
- Stay active; walking and balance exercises help.
- Avoid alcohol and stop smoking.
Protecting numb feet
- Check your feet daily for cuts, blisters or redness.
- Test bath water with your elbow.
- Never walk barefoot.
- Moisturise dry skin, but not between the toes.
- See a podiatrist regularly if you have diabetes.
How physiotherapy helps
Neuropathy can affect balance and strength, increasing the risk of falls. Physiotherapy provides balance training, strengthening and advice on footwear and walking aids. For entrapment problems such as tarsal tunnel or sciatica, specific treatment of the source helps.
Exercise with neuropathy
- Walking: on even ground, in supportive shoes.
- Balance: standing with feet together, then heel-to-toe, holding a counter.
- Calf raises: to strengthen the lower leg.
- Cycling or swimming: low-impact options if walking is painful.
Regular exercise improves blood sugar control in diabetes, may reduce nerve pain and lowers the risk of falls. Check your feet after exercise.
Keeping track of symptoms
Noting when burning occurs, what makes it better or worse, which areas are affected and any new numbness or weakness helps your doctor. A pattern affecting both feet symmetrically points to neuropathy, while one foot suggests a local nerve problem or a back issue.
When to seek urgent help
- Weakness or numbness spreading quickly up the legs over days.
- Loss of bladder or bowel control or saddle numbness.
- A foot wound that is not healing, especially with diabetes.
- A red, hot, swollen foot.
- Burning feet with unexplained weight loss.
Key points to remember
- Burning feet are usually caused by peripheral neuropathy.
- Diabetes, B12 deficiency and alcohol are common causes.
- Blood tests can find treatable causes.
- Check numb feet daily and seek urgent help for spreading weakness.
Questions about burning feet
These answers are general information and do not replace an examination or individual medical advice.
What causes burning feet at night?
Usually peripheral neuropathy, which feels worse when the body is still.
Is burning feet a sign of diabetes?
It can be; diabetes is the commonest cause of neuropathy.
Can vitamin deficiency cause burning feet?
Yes, especially vitamin B12 deficiency.
What causes numbness in the feet?
Neuropathy, trapped nerves such as sciatica, and circulation problems.
How do I stop my feet burning?
Cool water, uncovering the feet and treating the cause help.
Can burning feet be cured?
It depends on the cause; some, like B12 deficiency, improve with treatment.
Which doctor should I see for burning feet?
Start with your GP, who can arrange tests and referral.
Can tight shoes cause burning feet?
Yes, they can compress nerves and cause burning, especially in the ball of the foot.
Is burning feet linked to menopause?
Hot flushes can affect the feet, but other causes should be checked.
Sources
This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.