Tingling in Feet: Why Your Feet Feel Pins and Needles

What the pattern of tingling suggests

Peripheral neuropathy

Peripheral neuropathy is damage to the long nerves that run to the hands and feet. The longest nerves are affected first, so symptoms start in the toes and soles of both feet, then creep up toward the ankles and later the hands. Along with tingling, people feel burning, numbness, sharp pains, a "walking on cotton wool" sensation, and sensitivity to bed sheets at night.

Diabetes

Diabetic neuropathy affects about half of people with diabetes over time. Tingling is often the first sign. Loss of feeling means cuts and blisters go unnoticed, which can lead to ulcers and infection. Prediabetes can cause it too.

Vitamin B12 deficiency

Vitamin B12 deficiency damages nerves and the spinal cord, causing tingling in feet and hands, balance problems, fatigue and sometimes a sore tongue. It is common in older adults, vegans, people taking metformin or long-term acid-reducing medicines, and after stomach surgery. Caught early, it is reversible.

Alcohol

Heavy alcohol use causes alcoholic neuropathy through direct toxicity and poor nutrition (especially thiamine deficiency).

Other causes of neuropathy

• chemotherapy (such as platinum drugs, taxanes) and some antibiotics (metronidazole, fluoroquinolones)
• chronic kidney disease and an underactive thyroid
• autoimmune diseases, HIV, hepatitis C, Lyme disease
• inherited neuropathies such as Charcot-Marie-Tooth disease
• too much vitamin B6 from supplements

Pinched nerves

• Sciatica: a slipped disc or narrowing in the lower spine compresses a nerve root, causing tingling in one foot along with back and leg pain. See lumbar radiculopathy.
• Tarsal tunnel syndrome: compression of the tibial nerve behind the inner ankle causes tingling and burning in the sole.
• Morton's neuroma: a thickened nerve between the toes, worse in tight or high-heeled shoes.

Other causes

• Guillain-Barré syndrome: rapidly ascending tingling and weakness, often after an infection. An emergency.
• Multiple sclerosis: tingling episodes lasting days to weeks, sometimes with vision or balance problems.
• Peripheral artery disease: poor blood flow causes cold, tingling feet and calf pain when walking.
• Anxiety and hyperventilation: tingling in hands, feet and around the mouth during panic.

Tingling in feet at night

Neuropathy symptoms often feel worse at night when there are fewer distractions and the feet are at rest. Restless legs syndrome causes an urge to move with uncomfortable sensations at night, relieved by walking. Sleeping positions that press on the knee can briefly compress the peroneal nerve.

How doctors find the cause

Your doctor will ask when it started, whether both feet are affected, about diabetes, alcohol, diet, medicines and family history. They will test sensation to light touch, pin, vibration (with a tuning fork) and a monofilament, check reflexes and strength, and look at the feet for wounds and pulses.

Tests often include:

• Blood tests: fasting glucose or HbA1c, vitamin B12 (sometimes with methylmalonic acid), thyroid function, kidney and liver function, complete blood count, and sometimes protein electrophoresis
• Nerve conduction studies and EMG to confirm and classify neuropathy
• MRI of the lower back for suspected nerve root compression

Treatment

Treat the cause

• Control blood sugar to slow diabetic neuropathy.
• Replace vitamin B12 by injections or tablets.
• Stop alcohol, and take thiamine if advised.
• Change medicines that damage nerves, if possible.
• Physical therapy, and sometimes injections or surgery, for pinched nerves.
• Wider shoes, padding and injections for Morton's neuroma.

Relieve symptoms

For painful neuropathy, doctors may prescribe duloxetine, pregabalin, gabapentin or amitriptyline. Capsaicin cream or patches and lidocaine patches help some people. Standard painkillers often help little.

Protect your feet

• Check your feet daily for cuts, blisters and redness, using a mirror if needed.
• Wear well-fitting shoes and socks, and never walk barefoot if feeling is reduced.
• Test bath water with your elbow, not your feet.
• Keep skin moisturized but dry between toes.
• See a podiatrist for nail and callus care if you have diabetes or neuropathy.

Frequently asked questions

What causes tingling in the feet?

Brief tingling is usually from pressure on a nerve, such as sitting cross-legged. Ongoing tingling is most often peripheral neuropathy from diabetes, vitamin B12 deficiency, alcohol or certain medicines, or a pinched nerve in the lower back, ankle or between the toes.

Is tingling in the feet a sign of diabetes?

It can be. Tingling, burning or numbness in both feet, starting in the toes, is a common early sign of diabetic neuropathy, and can occur in prediabetes. A blood sugar or HbA1c test checks for diabetes.

When should I worry about tingling in my feet?

Seek emergency care if tingling spreads up the legs quickly with weakness, comes with numbness in the groin area or loss of bladder control, or appears suddenly on one side with face or speech changes. See a doctor for tingling that lasts more than 2 weeks.

Can vitamin deficiency cause tingling feet?

Yes. Vitamin B12 deficiency is the most common vitamin cause. Low thiamine (B1), B6, folate, vitamin E and copper can also cause neuropathy. Too much vitamin B6 from supplements can also damage nerves.

Can tingling in feet be cured?

It depends on the cause. Tingling from pressure, B12 deficiency caught early, or a pinched nerve often resolves with treatment. Nerve damage from long-standing diabetes or alcohol may be permanent, but its progression can be slowed and symptoms eased.