If your feet are burning, tingling or prickling and this discomfort keeps you awake at night, it is important to see a specialist. There are a variety of conditions that cause this symptom, the most common being diabetes and nerve damage.

Nerve damage can be caused by diabetes, alcohol overuse, dietary deficiencies and certain B vitamins. Diagnosing the root cause is essential for finding the best treatment plan.

Diabetes

Having diabetes can cause several problems that may lead to burning feet, including sores that don’t heal, poor circulation in the legs and feet, and nerve damage. This type of nerve damage is called peripheral neuropathy and it often develops gradually as a result of high blood sugar levels. Symptoms include a burning sensation in your feet that can feel like prickling, tingling or pain and it is typically worse at night. Diabetic neuropathy can also cause foot deformities, including clawing of the toes, hammertoes and bunions, which can make it difficult to wear comfortable shoes. Taking good care of your feet, wearing well-fitting shoes, practicing relaxation techniques, using cold or warm compresses on your feet and making sure to get enough sleep may help manage symptoms. Over-the-counter pain relievers can also be used to manage the pain. A podiatrist can take a mold of your feet and insert custom orthotic inserts into your shoes to reduce diabetic neuropathy pain.

If your doctor suspects that your burning feet are due to neuropathy, they will conduct a physical examination and order some tests, such as an electromyography (EMG) test or a nerve conduction study (NCS). They will also ask about your medical history, how much alcohol you drink, and whether you’ve experienced any other symptoms. They will also perform imaging tests if tarsal tunnel syndrome is suspected or a biopsy to confirm the diagnosis of small fiber sensory neuropathy.

Tarsal Tunnel Syndrome

Tarsal Tunnel Syndrome (TTS) is a condition that occurs when the posterior tibial nerve or one of its two branches, the lateral or medial plantar nerve, are compressed within the tarsal tunnel in the ankle can cause burning feet symptoms. TTS results in pain, tingling, and weakness in the foot and heel. It usually develops insidiously over months or years, but sometimes has a sudden onset.

The tibial nerve runs through the tarsal tunnel, which is a passage in your ankle made of bones and ligaments. You might develop TTS if you have a medical condition that causes nerve damage, such as diabetes or low thyroid function (hypothyroidism). It may also occur from participating in sports that involve rapid movement, such as hockey, running, or ballet dancing.

Your health care provider will examine your feet and ankle and ask about your symptoms. They may order blood tests to look for medical conditions that cause nerve damage, such as diabetes or nutritional deficiencies. They may also order an electrodiagnostic test to measure the ability of your nerves to transmit signals by inserting a needle electrode into muscles and observing their response. A nerve conduction test can help determine the location of nerve damage and identify a specific cause, such as compression or trauma. They might also recommend an imaging test to view your ankle and foot structure.

Peripheral Artery Disease (PAD)

Arteries are blood vessels that transport oxygen-rich and nutrient-rich blood from the heart to organs and tissues throughout the body. When these arteries are narrowed or blocked, it causes pain in the legs and feet. This happens when a build-up of fatty deposits (atheroma) in the wall of your artery restricts blood flow. The condition is called peripheral artery disease or PAD.

Over time, this process—called atherosclerosis—can lead to serious and sometimes life-threatening problems, including amputation. In some cases, if the blockage is severe, the arteries can stop supplying blood to the leg or foot and cause it to die, which is called critical limb ischaemia (CLI).

Symptoms of PAD may include a dull ache or sharp, stabbing pain, especially when walking. It’s also common to have coldness or numbness in the legs and feet. Pain is worse at night and when lying down. It’s also possible to have sores on the skin that won’t heal.

You can diagnose PAD by having a simple noninvasive test called the ankle-brachial index (ABI), which measures your blood pressure in your legs and arms while you’re at rest. If you have PAD, your ABI will be lower than 0.9. You can also have CT scans or magnetic resonance imaging (MRI) to get more detailed information about your arteries and help plan for a procedure.

Neuropathy

Many people with burning feet have a condition that causes nerve damage, such as diabetic neuropathy or small fiber sensory neuropathy (also called SFSN). Neuropathy affects the longest and most distal parts of your nerves, including your feet. It can lead to a burning, painful or tingling sensation that starts in the balls of your feet, wraps around the top of your foot and up your leg. It can also cause weakness, a loss of balance and muscle wasting.

To diagnose neuropathy, your doctor will examine you and ask about when your symptoms started and how long they have lasted. They may order blood tests to look for signs of diabetes, vitamin B12 deficiency or hypothyroidism. They might also perform an NCS, which measures the ability of your nerves to send impulses.

Treating the underlying condition is usually enough to control your symptoms. For example, controlling your blood sugar will relieve the nerve damage from diabetes. If you have other causes, like vitamin B12 deficiency, you can take vitamin supplements or get treated for a health problem that caused the problem, such as anemia, hepatitis or HIV. Over-the-counter pain medications, such as acetaminophen or non-steroidal anti-inflammatory drugs, and topical anesthetics can help with the pain. In more severe cases, your doctor might prescribe SNRIs or tricyclic antidepressants or a drug that reduces seizures, such as acarbose or gabapentin.