Burning feet at night: causes and what can help

Many people find that their feet feel fine all day and then start to burn when they lie down. The sensation can be maddening, and it can also be an early sign of something that deserves attention.

What burning feet feels like

People describe a hot, prickling or stinging feeling in the soles or toes, sometimes with tingling or numbness. It may be worse at night, and some people are soothed by cool surfaces. In many, the feet look normal even though the sensation is distressing.^[1] Nerve pain from neuropathy has been described as superficial or deep-seated, and severe and unremitting pain that is worse at night is a recognized feature.^[5]

Why it happens

There is no single cause. Burning feet syndrome can occur as an isolated symptom or as part of a variety of conditions, and the physical examination often shows few objective signs.^[1] Common explanations fall into a few groups.

Neuropathy in both feet. Peripheral neuropathy is usually length-dependent: the longest nerves, which reach the toes, are affected first, so symptoms start at the toes and creep upward, on both sides at once. Diabetes is the most common cause in Western countries, and other causes include vitamin deficiencies such as B12, alcohol, and toxic effects of medicines such as some chemotherapy drugs. In up to 27% of adults with neuropathy no cause is found even after testing.^[2] Damage to the smallest nerve fibers, called small fiber neuropathy, commonly causes neuropathic pain along with autonomic disturbances.^[6] See small fiber neuropathy: burning feet with normal tests and vitamin B12 and neuropathy.

A pinched nerve (usually one foot). Morton’s neuroma causes burning pain in the ball of the foot that can reach the toes, and tarsal tunnel syndrome can burn in the sole.^[3,7] These usually affect one foot and are triggered by standing, walking or particular shoes.

Other causes. A pinched nerve in the lower back can send burning pain into the foot. Reduced circulation (peripheral artery disease) can cause leg and foot pain and a cold or pale foot.^[8] Skin problems such as athlete’s foot can burn and itch too.

How it is worked out

A good evaluation looks at your whole health, not just your feet: when it began, which parts burn, one foot or both, what you take, your alcohol use and other conditions, followed by an examination of sensation, reflexes, strength, circulation, skin and footwear.

• Blood tests, usually arranged with your primary care physician. Recommended first tests in neuropathy include blood sugar, vitamin B12 with related markers, and protein testing for certain blood disorders.^[2]
• Nerve studies and skin biopsy, arranged with a neurologist when they would change the plan. A skin biopsy can help diagnose small fiber neuropathy.^[6] See nerve testing for foot pain.

What can help

• Treat the cause where one is found. Treatment of burning feet syndrome varies depending on the cause.^[1]
• Medicines for nerve pain. First-line choices include tricyclic antidepressants, serotonin-noradrenaline reuptake inhibitors such as duloxetine, pregabalin and gabapentin. Their effect is modest on average, so a first medicine may not work and another may be tried. They are prescribed and monitored by your physician.^[4]
• Simple steps. Wear roomy shoes and clean, dry, breathable socks. Cool your feet with a room-temperature bath or a cool floor, and avoid ice or very hot water, which can injure skin that does not feel well. Check your feet daily, especially if you have diabetes, because numb skin is easy to injure.
• Keep a short diary of when the burning is worst. It helps with the evaluation. Our guide to how to describe nerve pain shows what to note.

For the full overview, see burning feet.

When to see a specialist

Consider an evaluation if burning in your feet lasts more than a few weeks, is getting worse, keeps you from sleeping, or is spreading upward. If you have diabetes, have new burning or numbness checked promptly.