Burning feet

What are burning feet, and how common are they?

Burning feet (a burning sensation) are a disturbed feeling in the feet, often described as burning, tingling or sharp pain, sometimes with numbness¹. It's common, and the feet are the most usual place for it¹. Nerve damage (peripheral neuropathy) is often behind it, but that label fits only some people with these symptoms¹.

The nearest figure is that pain with nerve-pain features affects an estimated 6.9% to 10% of people in general². Diabetes plays a big part: its nerve damage usually affects the feet and lower legs, though some people have no symptoms at all³.

What causes burning feet?

Nerve damage is the most common cause, and diabetes is its leading cause⁴⁵. Nerve damage usually starts in the toes and affects both feet⁴. With diabetes, the burning may be worse at night and when touched, often with tingling⁶.

Other causes include:

• Small-fibre neuropathy (damage to the finest nerves), mostly in middle-aged and older people. The cause is often never found⁷.
• Vitamin B12 deficiency, too much vitamin B6, alcohol, toxins and some medicines⁵.
• Poor blood supply to the nerves, from narrowed arteries or smoking⁵.
• Tarsal tunnel syndrome, where a nerve is squeezed near the inner ankle, causing burning, numbness or tingling along that nerve's area⁸.
• Erythromelalgia, a rare condition with episodes of burning pain, redness and heat⁹.

Burning that follows the path of one nerve, or comes with a lump or swelling near the inner ankle, can point to a squeezed nerve rather than general nerve damage¹⁰. If you have diabetes, more than one cause can be present at once, which makes the cause harder to sort out⁸.

How do you find out what's causing it?

Mostly by talking and examining: the diagnosis is clinical¹. A GP or podiatrist asks about your symptoms and your family and medical history, then does a physical exam that includes a foot and nerve exam¹¹. They often test your sense of touch, vibration and temperature, and look for conditions that can damage nerves, such as diabetes⁵. They may also consider whether poor circulation could explain it¹². Your GP can arrange blood tests to look for other causes of nerve damage¹.

Erythromelalgia is recognised from your history and the pattern of burning, redness and warmth, as there's no test for it⁹. For tarsal tunnel syndrome, tapping over the nerve is the usual check, but there's no standard approach, and results need careful reading if you have diabetes⁸.

What can I do first?

Many people with nerve damage can manage their symptoms without medicine⁵. If your doctor suggests one, nerve pain is often treated with medicines more commonly used for depression or epilepsy⁵. They help some people but not everyone: any one treatment gives worthwhile relief to only 10% to 25% more people than a dummy treatment¹³. Side effects often limit their use¹⁴. Opioids aren't recommended as first- or second-line treatment for painful diabetic nerve damage¹⁵. Lidocaine patches or capsaicin cream may help small painful areas⁵.

These medicines can cause drowsiness and dizziness, which raises the risk of falls⁵¹⁶. Talk to your GP or pharmacist before starting or stopping any medicine.

For erythromelalgia, it can help to avoid your triggers, wear loose shoes and clothing, drink plenty of fluids, and manage stress. During a flare-up, raise your feet and cool them briefly with a fan or a cool (not cold) gel pack¹⁷.

What if that isn't enough?

If the first medicine hasn't helped enough or causes side effects, go back to the prescriber. They can review it, switch it or add options, so don't change doses yourself. It's reasonable to ask whether a referral to a pain service or a podiatrist would suit you. Tricyclic antidepressants can work for diabetic nerve pain but need caution because of serious side effects¹⁶.

Will it go away, and can I stop it coming back?

How it goes depends on the cause, so ask your GP or podiatrist what to expect for yours. As nerves heal, many people can reduce or stop their medicines, but talk with a doctor before stopping any⁵.

If you have reduced feeling in your feet, for example from diabetes, you can lower the chance of unnoticed injuries turning into hard-to-heal sores¹¹:

• Check both feet every day for cuts, blisters, colour change, warmth or swelling.
• Wear shoes and socks at all times, including indoors¹⁸.
• Avoid hot water bottles and heating pads, and test bath water with your elbow or ask someone else¹⁸.
• Leave hard skin and corns to a podiatrist³.