Burning feet: causes, evaluation and when to get help

What burning feet can feel like

People describe burning feet in different ways: a hot, prickling or stinging feeling in the soles or toes, sometimes with tingling or numbness. It may be worse at night, when you’re lying still, and some people find cool surfaces soothing. In many people, the feet look normal, even though the sensation is distressing.^[1]

Burning feet is not a disease on its own. It is a symptom, and treatment depends on what is causing it.^[1]

Common causes

Peripheral neuropathy (both feet)

Peripheral neuropathy means damage to the nerves outside the brain and spinal cord. It is usually length-dependent: the longest nerves, which reach the toes, are affected first, so symptoms typically start in the toes and creep upward, in both feet at the same time.^[2] Causes include:

• Diabetes, which accounts for more than half of neuropathy in Western populations
• Vitamin deficiencies, especially vitamin B12
• Alcohol
• Medicines, including some chemotherapy drugs
• Inherited conditions, and, less often, blood disorders
• Unknown causes: in up to about a quarter of people, no cause is found even after testing^[2]

Damage to the smallest nerve fibers, called small fiber neuropathy, often causes burning pain along with changes in sweating or skin temperature.^[3] Read more in peripheral neuropathy in the feet.

A pinched nerve in the foot (usually one foot)

• Tarsal tunnel syndrome: burning in the sole, often spreading from the inner ankle and worse with standing or walking. See tarsal tunnel syndrome.
• Morton’s neuroma: burning in the ball of the foot that may reach the toes, often between the third and fourth toes.^[4] See Morton’s neuroma.
• Nerve irritation after an injury or an operation. See nerve pain after surgery or injury.

Other causes

• The lower back. A pinched nerve root can send burning pain into the foot. See back or foot?
• Skin problems such as athlete’s foot, which can burn and itch.
• Reduced circulation. Peripheral artery disease can cause leg and foot pain, and a cold or pale foot. It needs its own evaluation.^[5]
• Everyday factors, such as tight shoes, sweaty synthetic socks, or very hot feet after long days on hard floors.

How burning feet are evaluated

A careful evaluation looks at your whole health, not only your feet.

• History: when it began, what makes it better or worse, which parts of the foot are affected, one foot or both, what medicines you take, alcohol use, and health conditions.
• Examination: sensation with a fine filament and a tuning fork, reflexes, strength, skin and nails, pulses and circulation, foot shape and footwear. We also tap along the nerves that commonly cause trouble.
• Blood tests, usually arranged with your primary care physician. Recommended first tests include blood sugar, vitamin B12 with related markers, and protein testing for certain blood disorders.^[2]
• Nerve studies and other tests, such as a skin biopsy for small fiber neuropathy, are arranged with a neurologist when they would change the plan.^[3] We coordinate these and review the results with you. See nerve testing for foot pain.

Treatment and self-care

Treat the cause where one is found. For diabetes, that means blood-sugar control with your medical team. For a B12 shortage, it means correcting it. A pinched nerve in the foot is treated on its own merits, starting with non-surgical care whenever that’s appropriate. See non-surgical treatment for foot nerve pain.

Medicines for nerve pain. First-line choices include gabapentin and pregabalin, medicines such as duloxetine and venlafaxine, and tricyclic antidepressants such as amitriptyline.^[2] They help some people, but the effect is modest on average. In pooled trials, roughly one in six to eight people taking them got at least 50% pain relief beyond what a placebo gave, so a trial of one medicine may not work and another may be needed.^[6] These are prescribed and monitored by your physician.

Simple steps that help many people:

• Wear roomy shoes and clean, dry, breathable socks.
• Check your feet every day, especially if you have diabetes or numb feet.
• Cool your feet with a room-temperature bath or cool floor. Avoid ice and very hot or cold water, which can injure skin you can’t feel well.
• Keep a short diary of when the burning is worst; it helps in the evaluation.

When to seek care

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 in your feet checked promptly.