Tingling in the foot

What is tingling in the foot, and how common is it?

Tingling in the foot is a "pins and needles" feeling, also called paraesthesia. It can feel like pricking, burning, itching, tingling or numbness, and it doesn't usually cause pain¹. Most people get it from time to time, usually when you sit or sleep on your foot and pressure cuts off the blood supply to the nerves. It typically lasts only a few minutes¹², though it can sometimes be long-lasting¹.

What can cause tingling in the foot?

The commonest cause is short-lived: pressure from kneeling, sitting on your foot, or tight shoes or socks¹. Tingling that lasts or keeps returning has other causes:

• Diabetes. Diabetic neuropathy (nerve damage) usually starts in the toes and feet and moves upwards³. It can bring tingling, burning or sharp pains, and numbness⁴. Estimates of how many people with diabetes are affected range from about one third to about two thirds⁵⁶, and some have no symptoms⁵.
• Small fibre neuropathy. This usually starts in both feet and slowly climbs the legs. Diabetes is the commonest identifiable cause, but up to half of cases have no cause found⁷.
• Morton's neuroma. This is a pinched nerve between the toes, with pain, burning and numbness there, worse with walking, standing or tight shoes⁸. It often occurs with metatarsalgia (pain in the ball of the foot), and the two are hard to tell apart yourself⁸.
• Alcohol, some medicines and low vitamin B12. Alcohol, some medicines (including some chemotherapy) and low vitamin B12 can contribute to nerve problems⁷.

Where it is gives clues. Tingling in both feet that creeps upwards suggests a nerve disease, while tingling between particular toes that comes on with walking or tight shoes suggests a local problem³⁸.

How is the cause found?

Mostly by asking about your symptoms and examining you, with tests added only where needed⁹¹⁰. A health professional will ask how long the tingling has lasted, whether it's one foot or both, and about alcohol, medicines and any family history of nerve problems⁷. They may check your ankle reflexes, look for weakness and suggest blood tests⁹.

If you have diabetes, they'll also test feeling in your feet (light touch, vibration, temperature and pin-prick)¹⁰ and check the pulses in your feet¹¹. Nerve conduction studies are kept for unusual cases¹⁰. Morton's neuroma is diagnosed mainly from your history and an examination, with ultrasound or MRI used to confirm it⁸.

What can I do first?

For brief tingling, take the pressure off, change position and check your shoes and socks aren't too tight¹.

If tingling is constant or keeps coming back, see your GP rather than guessing the cause¹². Treatment depends on the cause. Medicines for nerve pain help only nerve pain, and only in some cases; no medicine helps numbness or tingling itself⁹. It's fair to ask what any medicine is meant to treat.

What helps if that isn't enough?

Options mostly ease nerve pain rather than tingling or numbness⁹. If pain is the main problem, a doctor can talk through local treatments such as lidocaine patches or capsaicin, which may help small painful areas⁶¹⁰. Opioids aren't recommended for nerve pain⁶. Talk with a doctor before starting or stopping any medicine.

If you're having chemotherapy, tell your cancer care team promptly about troublesome foot tingling or numbness. When it becomes intolerable or limits what you can do, they can consider delaying, reducing, changing or stopping the chemotherapy¹².

Will it get better, and how can I stop it coming back?

It depends on the cause. Tingling from pressure settles once the pressure is off¹. Nerve problems from chemotherapy may continue long after treatment stops⁶. Tingling that keeps returning is worth having reviewed.

If you have diabetes or are at high risk, check your feet every day, including the tops, soles, heels and between the toes, for cuts, cracks, blisters, new redness or swelling, hot or painful areas and colour changes. Attend your foot screening too⁴. Changes can be slow and easy to miss, and reduced feeling can hide injuries⁴¹³.