Neuropathy in Feet: Symptoms, Causes & When to See a Neurologist

Are your feet constantly numb, tingling, or burning? Do you feel like you're walking on pebbles or cotton, even when you're not? These sensations could be signs of neuropathy in the feet—a condition where the nerves that supply your feet become damaged.

Foot neuropathy is one of the most common forms of peripheral neuropathy, affecting millions of people. Because the nerves to your feet are the longest in your body, they're often the first to show signs of damage. In this comprehensive guide, we'll explore what causes neuropathy in the feet, when to be concerned, and what you can do about it.

Common Symptoms of Neuropathy in Feet

Foot neuropathy can cause a wide range of sensations, from mildly annoying to severely debilitating. Symptoms often start subtly and progress over time.

Sensory Symptoms

• Numbness: Reduced ability to feel touch, pressure, or temperature
• Tingling: "Pins and needles" sensations that may come and go or be constant
• Burning pain: A hot, burning sensation often worse at night
• Sharp or stabbing pain: Electric shock-like sensations
• Hypersensitivity: Even light touch feels painful (allodynia)
• Strange sensations: Feeling like you're wearing socks when you're not, or walking on sand

Motor Symptoms

• Weakness: Difficulty lifting the front of your foot (foot drop)
• Muscle wasting: Thinning of muscles in the feet
• Difficulty walking: Unsteady gait or trouble with balance
• Foot deformities: High arches or hammer toes (in some hereditary neuropathies)

Autonomic Symptoms

• Dry feet: Reduced sweating in the feet
• Temperature changes: Feet that feel unusually cold or hot
• Skin changes: Shiny, thin skin or color changes
• Slow wound healing: Cuts and blisters take longer to heal

Common Causes of Foot Neuropathy

Many conditions can damage the nerves in your feet. Identifying the underlying cause is essential for effective treatment.

Diabetes and Prediabetes

Diabetes is the leading cause of peripheral neuropathy in developed countries. High blood sugar damages nerves over time, particularly affecting the feet.

Key facts:

• Approximately 50% of people with diabetes develop neuropathy
• Symptoms can appear before diabetes is diagnosed (prediabetes neuropathy)
• Tight glucose control can slow or prevent progression

Vitamin Deficiencies

Certain vitamins are essential for nerve health, and deficiencies can cause neuropathy:

• Vitamin B12: Most common vitamin-related cause; can be fully reversible with treatment
• Vitamin B1 (thiamine): Often related to alcohol use or poor nutrition
• Vitamin B6: Can cause neuropathy from both deficiency AND excess
• Vitamin E: Rare but can cause sensory neuropathy

Alcohol Use

Chronic alcohol consumption can damage nerves through both direct toxicity and associated nutritional deficiencies. Alcoholic neuropathy typically affects the feet first and may improve with abstinence.

Autoimmune Conditions

Several autoimmune diseases can cause foot neuropathy:

• Guillain-Barré syndrome: Acute inflammatory neuropathy (can be severe)
• Chronic inflammatory demyelinating polyneuropathy (CIDP): Treatable with immunotherapy
• Vasculitic neuropathy: Related to blood vessel inflammation
• Sjögren's syndrome: Often causes small fiber neuropathy

Chemotherapy

Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of many cancer treatments. It often starts in the feet and may persist after treatment ends.

Hereditary Conditions

Genetic disorders like Charcot-Marie-Tooth disease cause progressive neuropathy that typically begins in the feet during adolescence or early adulthood.

Kidney Disease

Uremic neuropathy occurs when kidney failure leads to toxin buildup that damages nerves.

Infections

Certain infections can cause or trigger neuropathy:

• Shingles (post-herpetic neuralgia)
• HIV
• Lyme disease
• Hepatitis C

Idiopathic (Unknown Cause)

In approximately 25-30% of cases, no specific cause is found despite thorough evaluation. This is called idiopathic neuropathy.

Small Fiber Neuropathy in the Feet

Small fiber neuropathy (SFN)deserves special attention because it often causes intense symptoms in the feet but doesn't show up on standard nerve tests.

Characteristics of SFN in the feet:

• Burning, stabbing, or electric-shock pain
• Symptoms often worse at night
• Normal EMG and nerve conduction studies
• May be associated with autonomic symptoms

If you have significant foot symptoms but normal standard testing, a small fiber skin biopsy can provide a definitive diagnosis.

Warning Signs That Need Immediate Attention

While most foot neuropathy develops gradually, certain symptoms require urgent evaluation:

• Rapid onset: Symptoms developing over days rather than weeks or months
• Severe weakness: Sudden inability to lift your foot or walk
• Spreading symptoms: Numbness rapidly moving up your legs
• Associated fever or illness: Could indicate infection or inflammatory condition
• Foot wounds that won't heal: Especially in diabetics
• Signs of infection: Redness, warmth, swelling around wounds

Diagnosing Foot Neuropathy

A comprehensive evaluation for foot neuropathy includes several components:

Medical History and Physical Exam

Your neurologist will ask detailed questions about:

• When symptoms started and how they've progressed
• Specific sensations you're experiencing
• Medical conditions, medications, and family history
• Alcohol use and nutritional factors

The neurological examination assesses:

• Sensation (light touch, vibration, temperature, pain)
• Reflexes (often reduced in neuropathy)
• Muscle strength
• Coordination and balance

Nerve Conduction Studies and EMG

These tests measure how well nerves conduct electrical signals:

• Can identify large fiber damage
• Help determine the type and severity of neuropathy
• May be normal in pure small fiber neuropathy

Small Fiber Skin Biopsy

The gold standard for diagnosing small fiber neuropathy:

• Minimally invasive procedure
• Measures nerve fiber density in the skin
• Important when EMG is normal but symptoms persist

Blood Tests

Screens for common causes:

• Blood sugar and HbA1c (diabetes)
• Vitamin B12 and other B vitamins
• Thyroid function
• Kidney and liver function
• Inflammatory markers
• Specific autoimmune antibodies

Additional Testing

Depending on findings:

• Genetic testing for hereditary neuropathies
• Lumbar puncture for inflammatory conditions
• Autonomic function testing
• Nerve ultrasound

Treatment Options

Treating the Underlying Cause

The most important step is addressing what's causing the neuropathy:

Managing Neuropathic Pain

Several medications can help control foot pain:

First-line options:

• Gabapentin (Neurontin)
• Pregabalin (Lyrica)
• Duloxetine (Cymbalta)

Additional options:

• Tricyclic antidepressants (amitriptyline, nortriptyline)
• Topical lidocaine patches or cream
• Capsaicin cream (for localized pain)

Physical Therapy and Rehabilitation

• Balance training to prevent falls
• Strengthening exercises
• Gait training
• Assistive devices when needed

Lifestyle Modifications

• Foot care: Daily inspection, proper footwear, avoiding injury
• Exercise: Improves circulation and overall nerve health
• Nutrition: Balanced diet with adequate B vitamins
• Avoid toxins: Limit alcohol, stop smoking

Foot Care Tips for Neuropathy

When you can't feel your feet well, extra care is essential:

Daily Foot Inspection

• Check feet every day for cuts, blisters, or sores
• Use a mirror or ask someone to help check the bottoms
• Look for redness, swelling, or skin changes

Proper Footwear

• Wear well-fitting shoes with good support
• Avoid going barefoot, even indoors
• Check shoes for objects before putting them on
• Consider diabetic-specific footwear

Temperature Awareness

• Test bathwater with your elbow before stepping in
• Avoid heating pads or hot water bottles on feet
• Protect feet from cold temperatures

Moisturizing

• Keep skin moisturized to prevent cracking (not between toes)
• Use gentle, fragrance-free lotions

Professional Foot Care

• See a podiatrist regularly, especially with diabetes
• Have calluses and nails professionally trimmed
• Don't treat corns or calluses yourself

When to See a Neurologist

Consider scheduling an evaluation if you have:

• Persistent numbness, tingling, or burning in your feet
• Symptoms that are worsening over time
• Unexplained weakness or difficulty walking
• Foot symptoms with normal results from your primary doctor
• Known risk factors for neuropathy (diabetes, autoimmune disease, family history)
• Symptoms affecting your quality of life

At Achilles Neurology Clinic in Beverly Hills, we provide comprehensive evaluation for all types of foot neuropathy. Our thorough approach helps identify treatable causes and develops personalized management plans.

Frequently Asked Questions

What does neuropathy in feet feel like?

Neuropathy in the feet can cause various sensations including numbness, tingling ("pins and needles"), burning, stabbing pain, or feeling like you're walking on pebbles or cotton. Symptoms are often worse at night and may be accompanied by sensitivity to touch.

What causes neuropathy in feet?

The most common causes include diabetes, vitamin B12 deficiency, alcohol use, autoimmune conditions, chemotherapy, and hereditary disorders. In about 25-30% of cases, no cause is found (idiopathic neuropathy). A thorough evaluation can identify treatable causes.

Can neuropathy in feet be reversed?

It depends on the cause. Neuropathy from vitamin deficiencies, early diabetes, and some autoimmune conditions can often improve with treatment. Long-standing or hereditary neuropathies may not fully reverse, but symptoms can usually be managed effectively. Learn more about neuropathy reversibility.

Is walking good for neuropathy in feet?

Yes, generally. Regular walking and exercise can improve circulation, help with blood sugar control, and support overall nerve health. However, if you have significant numbness, proper footwear is essential to prevent injuries. Check with your doctor about appropriate exercise for your situation.

When should I see a doctor for numb feet?

See a doctor if numbness persists for more than a few days, is worsening, is accompanied by weakness or difficulty walking, or if you have risk factors for neuropathy like diabetes. Seek immediate care if symptoms develop rapidly or are accompanied by severe weakness.

Does neuropathy in feet get worse?

Progression depends on the cause. Neuropathy from ongoing damage (uncontrolled diabetes, continued alcohol use) typically worsens. Neuropathy from a treated cause may stabilize or improve. Hereditary neuropathies usually progress slowly over years. Early diagnosis and treatment offer the best chance of preventing progression.

What is the life expectancy with foot neuropathy?

Foot neuropathy itself does not typically affect life expectancy. Most people with neuropathy in their feet live normal lifespans. The key is managing the underlying cause, preventing complications (especially foot injuries), and controlling symptoms effectively. Read more about neuropathy life expectancy.

Take the First Step

If you're experiencing numbness, tingling, burning, or pain in your feet, getting an accurate diagnosis is the most important step you can take. Many causes of foot neuropathy are treatable, and early intervention offers the best outcomes.

About the Author

Dr. Achillefs Ntranos MD

Board-Certified Neurologist
Achilles Neurology Clinic

Dr. Achillefs Ntranos MD is a board-certified neurologist and MS specialist known for his thorough evaluations and compassionate approach. Originally from Greece, he trained at Johns Hopkins University and Mount Sinai Hospital before founding Achilles Neurology Clinic in Beverly Hills to deliver comprehensive, patient-centered neurological care. He specializes in MS, autoimmune neurology, neuropathy, headaches, and other neurological disorders, blending research-driven insights with personalized treatment plans.

Learn More About Dr. Ntranos(310) 774-7025