Numb toes: when to worry and when not to

Toes are at the far end of the longest nerves in your body, which is why they are often the first place a nerve problem announces itself. Most of the time numb toes turn out to be harmless. Sometimes they are the first sign of something that deserves attention. This guide helps you tell which is which.

Which toes, and how many, are the biggest clue

Doctors pay close attention to the pattern:

• Two neighboring toes, usually the third and fourth, with burning in the ball of the foot. This is the classic picture of a Morton’s neuroma, a thickened nerve between the toes.^[2]
• All the toes on both feet, starting at the tips and slowly creeping upward. Peripheral neuropathy typically works this way. Because the longest nerves are affected first, symptoms show up in the toes and progress upward over time, and they are usually symmetric.^[1]
• The toes and sole of one foot, spreading from the inner ankle. This can be a nerve squeezed at the ankle, as in tarsal tunnel syndrome.^[3]
• The web space between the big toe and second toe, with an ache on top of the foot. This can be the deep peroneal nerve, as in anterior tarsal tunnel syndrome.^[4]
• The top of the foot and toes, reaching the outer lower leg. The superficial peroneal nerve may be involved.^[5]
• Numbness that comes with pain from the back or buttock. A pinched nerve in the lower back can do this.^[6,7] We cover that pattern in sciatica or a foot nerve problem?

These patterns overlap, and more than one cause can be present at once, so they are clues and not a diagnosis.

Everyday causes that usually pass

• Position. Sitting with your legs crossed or kneeling for a long time can briefly press on a nerve. If the numbness clears within a few minutes of changing position, it is usually harmless.
• Tight shoes. Narrow toe boxes and high heels squeeze the front of the foot. Shoes that are broad in the toe box, flat in the heel and not too flexible are recommended to help prevent or delay a Morton’s neuroma.^[8]
• Cold. Cold weather can dull feeling in your toes for a while.
• Medicines, alcohol and vitamin shortages. Several medications, heavy alcohol use and low vitamin B12 are known causes of neuropathy.^[1] See vitamin B12 and neuropathy.

Signs that it is more than a passing problem

Have your toes checked if numbness:

• lasts more than a few weeks or keeps returning
• is slowly spreading up the foot or into the other foot
• comes with burning, shooting pain, or extreme sensitivity to touch
• affects your balance, or makes you trip or shuffle
• follows an injury or an operation

If you have diabetes, do not wait: new numbness deserves a prompt visit. Loss of feeling is what puts feet at risk of injuries you don’t notice.^[9,10]

What might be behind it

Peripheral neuropathy is damage to nerves outside the brain and spinal cord. Diabetes is the most common cause in Western countries, and more than 200 causes exist. In up to 27% of adults with neuropathy, no cause is found even after testing.^[1] A single nerve squeezed in one spot, such as a Morton’s neuroma or a nerve trapped at the ankle, is different from a body-wide neuropathy. The two are treated differently, which is why sorting them out matters. You can read about both in numb toes and peripheral neuropathy.

Poor circulation can also make toes numb, cold or pale. Reduced blood flow in the legs (peripheral artery disease) has its own evaluation and treatment.^[11]

How numb toes are checked

The first steps are your story and an examination: which toes, one foot or both, how it began, what brings it on, your shoes, your back, injuries, medicines and other health conditions. The examination tests feeling with a fine filament and vibration, strength, reflexes, circulation, foot shape, and tapping along the nerves that commonly cause trouble.

When a body-wide neuropathy is suspected, a JAMA review recommends starting with blood tests for blood sugar, vitamin B12 and related markers, and a protein test for certain blood disorders.^[1] These are arranged with your primary care physician. Nerve studies, if needed, are performed by another specialist that we coordinate with. See nerve testing for foot pain.

What you can do in the meantime

• Wear roomy shoes with a wide toe box and a low heel.
• Look at your feet every day for cuts, blisters or color changes, especially if you have diabetes.
• Jot down which toes are numb and what makes them better or worse. A few notes save time at your visit.

Our sister practice explains the daily check in the diabetes daily foot check (external site).

When to see a specialist

Consider an evaluation if toe numbness lasts more than a few weeks, keeps returning, is spreading, or affects your balance or walking.