Burning Feet: Why Your Feet Burn and What Helps

What burning feet feel like

People describe it as heat, stinging, prickling, pins and needles, or feet that feel "on fire". It can be constant or come and go. Nerve-related burning is typically:

• in both feet, starting in the toes and soles
• worse at night or when the feet are warm under bedcovers
• accompanied by numbness, tingling or sensitivity to touch, so even bedsheets hurt

Skin causes, such as athlete's foot, feel more superficial and come with a rash, itching or peeling.

Common causes of burning feet

Peripheral neuropathy

Damage to the small nerve fibers that carry pain and temperature signals is the leading cause. Peripheral neuropathy usually starts in the longest nerves, so it begins in the toes and spreads up in a "stocking" pattern. Causes include:

• Diabetes: diabetic neuropathy affects up to half of people with long-standing diabetes. Burning feet can also be one of the first signs of prediabetes.
• Alcohol: heavy drinking damages nerves directly and through poor nutrition.
• Vitamin deficiencies: vitamin B12 deficiency is common in older adults, vegans, and people taking metformin or acid-suppressing medicines. Low B1, B6 or folate can also contribute. Too much B6 from supplements can also cause neuropathy.
• Kidney failure: waste products build up and damage nerves.
• Underactive thyroid.
• Medicines: chemotherapy drugs, some HIV drugs, metronidazole, isoniazid and long courses of certain antibiotics.
• Infections: HIV, hepatitis C, Lyme disease, shingles.
• Autoimmune and inherited causes: Sjögren's syndrome, sarcoidosis, celiac disease, and rare conditions such as Fabry disease and hereditary amyloidosis.
• Small fiber neuropathy where no cause is found (idiopathic).

Athlete's foot

Athlete's foot, a fungal skin infection, causes burning, itching, peeling and cracking between the toes or on the soles. It responds to antifungal creams.

Nerve entrapment

Tarsal tunnel syndrome is compression of the tibial nerve on the inside of the ankle, causing burning and tingling in the sole, often on one side only. Morton's neuroma causes burning between the third and fourth toes.

Other causes

• Contact dermatitis from shoe materials or dyes
• Tired or overworked feet, from standing all day or poorly fitting shoes
• Poor circulation: peripheral artery disease can cause burning pain at rest in severe cases, usually with cold feet
• Erythromelalgia: a rare condition where the feet become red, hot and burning in episodes, triggered by warmth or exercise and relieved by cooling
• Complex regional pain syndrome after an injury
• Menopause: hot flashes can make the feet feel hot

Hot, red feet and a red face in older adults

Sudden heat and redness in the face, head and feet together usually reflect flushing: blood vessels in the skin widening. In older adults, common triggers are:

• fever from an infection
• medicines such as calcium channel blockers (amlodipine, nifedipine), nitrates, niacin, and some diabetes or erectile dysfunction drugs
• alcohol, spicy food, hot drinks or a warm room
• high blood pressure readings during anxiety or pain

Erythromelalgia and, rarely, blood disorders that raise platelet or red cell counts can also cause episodes of hot, red, burning hands and feet. A doctor should check new, unexplained episodes, especially with dizziness, palpitations, rash or confusion.

How doctors find the cause

Your doctor will ask when the burning started, whether it is one or both feet, your diabetes and alcohol history, your diet and medicines. They will examine your feet for skin changes, wounds and pulses, and test sensation, reflexes, vibration sense and balance.

Common tests include:

• blood sugar and HbA1c
• vitamin B12 (sometimes with methylmalonic acid), folate and thyroid tests
• kidney and liver function, blood count
• protein electrophoresis to check for an abnormal antibody (paraprotein)
• skin scraping for fungus if there is a rash
• nerve conduction studies and electromyography for larger nerve damage
• skin biopsy to count small nerve fibers when small fiber neuropathy is suspected

Treatment

Treat the cause

• Tight blood-sugar control in diabetes slows nerve damage.
• B12 replacement by injection or tablets.
• Stop or reduce alcohol.
• Switch medicines that damage nerves, if possible.
• Antifungal creams or powders for athlete's foot.
• Treat thyroid or kidney problems.

Relieve the burning

• Prescription nerve pain medicines: gabapentinoids (pregabalin, gabapentin), duloxetine, or tricyclic antidepressants such as amitriptyline. These are different from regular painkillers, which work poorly for nerve pain.
• Topical treatments: capsaicin cream or high-strength patches, and lidocaine patches.
• Cooling: soak feet in cool (not icy) water for 15 minutes, or use a fan. Avoid ice directly on the skin, especially if sensation is reduced.

Foot care

Numb, burning feet are prone to unnoticed injuries. Check your feet every day for cuts, blisters or redness, wear well-fitting shoes and moisture-wicking socks, keep feet clean and dry, and never walk barefoot outdoors. People with diabetes should have a foot exam at least once a year.

Frequently asked questions

Why do my feet burn at night?

Nerve-related burning tends to feel worse at night because there are fewer distractions, the feet are warm under bedcovers, and body temperature changes. It is a classic sign of peripheral neuropathy, often from diabetes, and should be checked by a doctor.

What deficiency causes burning feet?

Vitamin B12 deficiency is the most common nutritional cause. Low levels of vitamin B1 (thiamine), B6 or folate can also contribute, as can heavy alcohol use, which depletes B vitamins. A simple blood test can check your B12 level.

Is burning feet a sign of diabetes?

It can be. Burning, tingling or numb feet are common symptoms of diabetic neuropathy and sometimes appear before diabetes is diagnosed. If you also have increased thirst, frequent urination or tiredness, ask your doctor for a blood sugar test.

How do I stop my feet from burning?

Short-term relief comes from cooling the feet, raising them, wearing breathable shoes and socks, and topical capsaicin or lidocaine. Lasting relief depends on treating the cause, such as diabetes or B12 deficiency, and sometimes prescription nerve pain medicines.

Can burning feet be serious?

Usually it is a long-term nuisance rather than an emergency, but it can signal diabetes, kidney disease or nutritional deficiency. Burning that spreads quickly up the legs with weakness, or a red, hot, swollen foot with fever, needs urgent care.