Most people don't think much about their feet until they hurt or give you trouble. Burning and tingling in the feet usually signals nerve irritation that may be due to injury, infection or other medical disorders. Chronic nerve damage, known as peripheral neuropathy, commonly causes a pins-and-needles sensation in the feet that can make it tough to walk. Depending on the cause, potential complications of peripheral neuropathy include foot ulcers, muscle loss and paralysis, in rare cases.
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A host of metabolic conditions can lead to burning and tingling in the feet. Diabetes is among the most frequent causes. People with diabetes who have peripheral neuropathy are prone to foot injuries, ulcers and infections. Without appropriate medical care and regular foot exams, these foot infections can progress to gangrene and ultimately require amputation. Chronic kidney and liver diseases are other potential causes of peripheral neuropathy. Damage to either of these organs can result in a buildup of metabolic waste products that may irritate the nerves in the legs and feet. Disorders of the thyroid gland can also cause burning and tingling in the feet, often accompanied by muscle cramps in the legs.
Many infections can lead to inflammation of the nerves in the legs and feet. The viruses that cause chickenpox and mononucleosis are common culprits. Cytomegalovirus, human immunodeficiency virus, hepatitis B and hepatitis C viruses can trigger intense burning and tingling in the legs and feet as well. Borrelia burgdorferi, the bacterium that causes Lyme disease, can also irritate nerves in the lower extremities. A rash usually precedes joint pain and peripheral neuropathy symptoms due to Lyme disease.
Toxins and Medications
Many toxins and medications can irritate nerves and lead to burning and tingling in the feet. Alcohol is one of the most common. Chronic exposure to large amounts of alcohol is thought to lead to nerve damage. Long-term alcohol abuse is also associated with nutritional deficiencies, such as deficiencies in vitamin B12, folate and thiamine. These vitamin deficiencies can result in burning, tingling, pain or numbness in the legs and feet. Heavy metals, including lead and mercury, can cause peripheral neuropathy as well. Medications used to treat seizure disorders, certain antibiotics and antiviral drugs are also associated with peripheral neuropathy. Chemotherapy drugs used for certain cancers frequently cause burning and tingling in the feet. Common offenders include platinum-based medications, thalidomide (Thalomid) and vincristine (Vincasar).
Autoimmune and Inflammatory Conditions
In some cases, the body's response to an infection rather than the infection itself leads to nerve damage. A condition called Guillain-Barré syndrome causes abrupt weakness and tingling in the lower extremities. Guillain-Barré syndrome occurs due to an autoimmune response wherein the body inadvertently attacks nerve tissue following a bacterial or viral infection. Left untreated, the disorder can progress to temporary paralysis and be life-threatening. Lupus, rheumatoid arthritis and Sjögren syndrome are other autoimmune disorders that can cause peripheral neuropathy. Symptoms tend to develop gradually with these conditions. Burning and tingling in the legs and feet can also sometimes occur with multiple sclerosis, an inflammatory disorder. Additional symptoms such as visual difficulties, bladder problems and muscle spasms are common with multiple sclerosis.
Cancerous and noncancerous tumors can invade nerve tissue, resulting in peripheral neuropathy symptoms. Inflammation due to tumors that arise on or near nerves in the lower extremities can lead to burning and tingling in the feet. In some cases, cancer does not directly affect the nerves but can cause a condition known as a paraneoplastic syndrome. Paraneoplastic syndromes can result in a variety of symptoms, including muscle weakness and a burning sensation in the limbs.
When to Seek Medical Attention
In most cases, peripheral neuropathy symptoms begin gradually. If you abruptly develop burning and tingling in the feet, contact your healthcare provider without delay. If burning and tingling arise in association with muscle weakness or other nervous system symptoms -- such as visual problems, dizziness or loss of bladder or bowel control -- seek medical attention immediately. If you have an underlying medical condition, including diabetes, HIV or lupus, discuss your symptoms with your provider. Blood tests can be performed to check for nutritional deficiencies, and medications can be prescribed to ease symptoms.
Reviewed by: Tina M. St. John, M.D.
REFERENCES & RESOURCES
- British Medical Journal: Peripheral Neuropathy
- American Family Physician: Peripheral Neuropathy: Differential Diagnosis and Management
- Journal of Neurology, Neurosurgery and Psychiatry: Clinical Evaluation and Investigation of Neuropathy
- Hepatology: Autonomic and Peripheral (Sensorimotor) Neuropathy in Chronic Liver Disease -- A Clinical and Electrophysiologic Study
- Journal of the American Medical Association Patient Page: Peripheral Neuropathy
- National Institute of Neurological Disorders and Stroke: Peripheral Neuropathy Fact Sheet