Health guide · Podiatry
Nerve pain in the feet: neuropathy, pinched nerves and what helps
What burning, tingling, numbness and shooting pain in the feet mean, what causes neuropathy and pinched nerves, and how they’re treated.
The short answer
Burning, tingling, numbness or electric, shooting pain in your feet usually means a nerve is irritated or damaged. The most common cause is peripheral neuropathy, damage to the nerves in both feet, and diabetes is its leading cause. Other causes include low vitamin B12, heavy drinking, some medicines, and kidney or thyroid disease. A pinched nerve, such as Morton’s neuroma or tarsal tunnel syndrome, usually affects one foot.
Nerve damage can’t always be reversed, but finding the cause early can stop it getting worse, and treatment can ease the pain. If your feet are numb, check them every day, because you may not feel a cut or blister. Get emergency care for sudden weakness, numbness that spreads quickly, or new bladder or bowel problems.
Want it checked? Find an Evolve Health podiatrist near you
This guide is for general information and is not a diagnosis. Some services may not be offered at every office; your provider will go over your treatment options at your appointment.
Signs of nerve damage in the feet
Nerves carry feeling from your feet to your brain, and signals from your brain to your foot muscles. When they’re damaged, you may notice:
- Changes in feeling: burning, tingling or pins and needles, numbness, or feeling like you’re wearing socks when you aren’t
- Pain: sharp, shooting or electric jolts, or pain from light touch such as bedsheets
- Weakness: trouble lifting the front of your foot, curled toes or weak ankles
- Balance problems: feeling unsteady, especially in the dark
- Skin changes: very dry or cracked skin, or unusual sweating
Symptoms of neuropathy usually start in the toes and spread slowly up the feet, often in both feet at once.
Neuropathy or a pinched nerve?
| Pattern | Likely cause |
|---|---|
| Both feet, starting in the toes and creeping up, often worse at night | Peripheral neuropathy |
| Burning or a “pebble” feeling in the ball of the foot, often between the third and fourth toes | Morton’s neuroma, a thickened nerve between the toes |
| Burning, tingling or shooting pain along the sole and inner ankle, worse after standing | Tarsal tunnel syndrome, a squeezed nerve at the inner ankle |
| Sharp pain at the inside of the heel that doesn’t fit plantar fasciitis | An irritated heel nerve (Baxter’s nerve) |
| Numbness or tingling that runs down the leg from the back or buttock | A pinched nerve in the lower back (sciatica) |
| Numbness or pain near a scar or old injury | A nerve damaged by injury or surgery |
Our guide to sharp pain in the foot covers these and other causes by location.
What causes peripheral neuropathy in the feet?
- Diabetes. Years of high blood sugar damage the nerves and the tiny blood vessels that feed them. It’s the most common cause.
- Low vitamin B12, which is more common with age, a vegan diet, weight-loss surgery and some medicines, such as metformin and acid reducers.
- Heavy alcohol use.
- Medicines, including some chemotherapy drugs.
- Kidney disease, liver disease and an underactive thyroid.
- Autoimmune conditions such as lupus, rheumatoid arthritis and Sjögren’s syndrome.
- Infections such as shingles, Lyme disease and HIV.
- Inherited nerve conditions, which often run in families.
Sometimes no cause is found even after a full workup. Treatment then focuses on easing symptoms and protecting the feet.
Why nerve pain is often worse at night
Many people with neuropathy notice burning or tingling most when they lie down. There’s less to distract you, the touch of sheets can set nerves off, and changes in skin temperature play a part. Cool, loose bedding, a regular bedtime routine and taking any prescribed nerve pain medicine at the time your doctor suggests can help.
How nerve pain in the feet is diagnosed
Your podiatrist or doctor will ask how your symptoms started, where they are and what makes them worse, and examine your feet. Common checks include:
- Feeling tests: a thin nylon filament pressed on the sole, a tuning fork for vibration, and checks for sharp, dull, warm and cold
- Reflexes, strength and balance
- Blood tests for blood sugar (A1c), vitamin B12, thyroid and kidney function, and sometimes others
- Nerve tests (nerve conduction studies and EMG) to measure how well the nerves carry signals
- Imaging such as ultrasound or MRI if a pinched nerve, cyst or other structural problem is suspected
Treatment for nerve pain in the feet
Treat the cause
- Keep blood sugar in range if you have diabetes.
- Replace vitamin B12 or other vitamins if you’re low.
- Cut back on or stop alcohol.
- Ask whether any of your medicines could be involved. Don’t stop them on your own.
Medicines for nerve pain
Regular pain relievers such as ibuprofen often don’t help nerve pain much. Medicines that calm overactive nerves work better. Your doctor may prescribe duloxetine, pregabalin, gabapentin or amitriptyline. They take a few weeks to work and can cause side effects such as drowsiness or dizziness, so the dose is usually started low and raised slowly. For pain in one area, lidocaine cream or patches, or capsaicin cream, can help.
Physical therapy and exercise
Physical therapy builds strength and balance, improves how you walk and lowers your risk of falling. Gentle, regular walking, cycling or swimming also helps circulation and blood sugar. Learn about gait and balance training at Evolve Health, and see our guide to fall risk.
Treating a pinched nerve
- Shoes and padding: wider shoes with a low heel, metatarsal pads and orthotics take pressure off a squeezed nerve.
- Injections: a steroid injection can calm an irritated nerve.
- Surgery: when other treatment hasn’t helped, a surgeon can free a trapped nerve or remove a painful neuroma.
Other options
Some people find a TENS unit, which sends a mild electrical current through the skin, helpful for pain. Evidence for acupuncture and supplements is mixed. Check with your doctor before trying supplements, as some interact with medicines.
How to protect numb feet
Numb feet can’t warn you about injuries, and a small blister can turn into a serious wound, especially with diabetes. Make these daily habits:
- Check your feet every day, including the soles and between the toes. Use a mirror or ask for help.
- Don’t walk barefoot, even at home.
- Test bath water with your hand or elbow, not your foot, and avoid heating pads, hot water bottles and hot soaks.
- Wear well-fitting shoes and seamless socks, and check inside shoes for stones or rough spots before putting them on.
- Moisturize dry skin, but not between the toes.
- Don’t cut corns or calluses yourself, and have your nails trimmed by a podiatrist if you can’t see or reach them well.
- See a podiatrist regularly. People with diabetes and neuropathy should have a foot exam at least once a year, often more. See our guide to diabetic foot care.
Complications of neuropathy
- Foot ulcers and infections that go unnoticed because they don’t hurt
- Charcot foot, a rare but serious weakening of the bones in a numb foot that can collapse the arch. A warm, red, swollen foot in someone with neuropathy needs to be seen promptly. See Charcot foot.
- Falls from poor balance
- Amputation, in the most serious cases, usually after an infected wound. Daily foot checks and regular podiatry visits greatly lower this risk.
When to see a doctor
Get emergency care for:
- sudden weakness in your legs or feet
- numbness that spreads quickly over hours or days
- new problems controlling your bladder or bowels
See a podiatrist promptly for:
- a wound, blister or sore you didn’t feel happen
- a foot that’s red, hot or swollen, especially if you have diabetes
- a change in the shape of your foot
Book a visit if burning, tingling or numbness lasts more than a few weeks, keeps getting worse, disturbs your sleep or affects your balance. Evolve Health offers diabetic foot care and treats nerve pain in the feet. You can find a podiatrist near you and book online.
Everyday habits that support nerve health
- Keep blood sugar, blood pressure and cholesterol in range.
- Eat a balanced diet with enough B12 from fish, meat, eggs, dairy or fortified foods. If you’re vegan or take metformin, ask about having your B12 checked.
- Limit alcohol and don’t smoke. Both damage nerves and blood vessels.
- Stay active most days.
Questions, answered
Common feelings are burning, tingling or pins and needles, electric or shooting pain, and numbness, as if you’re wearing socks when you aren’t. Some people become very sensitive to light touch, such as bedsheets. Nerve damage can also cause weak foot muscles, poor balance, and very dry or sweaty skin.
Diabetes is the most common cause. Others include low vitamin B12, heavy alcohol use, some medicines such as chemotherapy, kidney disease, an underactive thyroid, autoimmune conditions, some infections and inherited nerve conditions. In some people, no cause is found even after testing.
Sometimes. When the cause is found and treated early, such as low vitamin B12, a medicine side effect or heavy drinking, symptoms can improve. Long-standing nerve damage often doesn’t fully reverse, but treatment can stop it getting worse and make the pain much more manageable.
At night there’s less to distract you, so you notice nerve signals more. Changes in body temperature and the touch of bedsheets can also set off burning or tingling. Cool, loose bedding and taking prescribed nerve pain medicine at the right time of day can help.
It depends on the cause. Treating the cause comes first, such as controlling blood sugar or correcting a vitamin deficiency. For the pain itself, prescription nerve pain medicines work better than regular pain relievers, and lidocaine or capsaicin creams can help one area. Physical therapy helps balance and strength. A pinched nerve may need different shoes, padding, an injection or, rarely, surgery.
Usually, yes. Regular, gentle walking helps circulation, strength and balance, and it helps control blood sugar. Build up slowly, wear well-fitting shoes and socks, and check your feet for blisters afterward. If walking is painful or you’re unsteady, a physical therapist can suggest safer exercises.
It usually causes burning, tingling or sharp, electric pain in one area, such as between the toes or along the sole, often worse in tight shoes or after standing. Numbness in the toes the nerve supplies is common. It usually affects one foot rather than both.
The sciatic nerve splits behind the knee into the tibial nerve and the common peroneal (fibular) nerve. The tibial nerve runs behind the inner ankle and branches into the nerves that supply the sole of the foot. Branches of the peroneal nerve supply the top of the foot and the muscles that lift the foot and toes.
See a doctor if burning, tingling or numbness lasts more than a few weeks, is getting worse, disturbs your sleep or affects your balance. See a podiatrist promptly for a wound you can’t feel, or a red, hot, swollen foot, especially if you have diabetes. Get emergency care for sudden weakness, fast-spreading numbness or new bladder or bowel problems.
This guide is for general education and doesn’t replace advice from your own doctor. Everyone’s situation is different, so talk to a healthcare provider about symptoms that are new, getting worse or worrying you. If you think you may have a medical emergency, call 911. Reading this guide doesn’t make you a patient of Evolve Health.
Want a specialist to take a look?
A guide can explain, but it can’t examine you. Evolve Health providers see patients across Florida and Texas, and you can book online any time.
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