“Doctor, my feet feel normal during the day, but as soon as I lie down at night, they start burning. Why does this happen?”
This is a common complaint I hear from patients. A burning sensation in the feet may feel like heat, pins and needles, prickling, or even a sensation that the feet are “on fire.”
Sometimes it is temporary and harmless. But if it happens repeatedly, especially at night, it is worth finding out why it is happening.
Here are some common causes I consider when evaluating burning feet.
1. Diabetes-Related Nerve Damage
One of the important causes is diabetic peripheral neuropathy.
When blood sugar remains high for a long time, it can gradually affect the nerves supplying the feet. You can also read about the long-term effects of high blood sugar on the body and why prolonged glucose elevation should not be ignored.
Diabetes-related nerve damage, known as diabetic neuropathy, can cause burning, tingling, numbness and pain in the feet. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) provides further information about this complication.
I particularly advise people with diabetes not to ignore new or worsening sensations in their feet.
2. Vitamin B12 Deficiency
Vitamin B12 is important for healthy nerve function. When the body does not have enough B12, neurological symptoms can develop.
These may include burning, tingling, numbness or unusual sensations in the feet, sometimes along with weakness or fatigue.
If the symptoms suggest a deficiency, a blood test can help determine whether B12 is actually low.
3. Peripheral Neuropathy
Not every case of burning feet is caused by diabetes.
Peripheral neuropathy means that the peripheral nerves are damaged or not functioning normally. Diabetes, nutritional deficiencies, alcohol-related nerve damage, certain medicines and several other conditions can contribute to it.
Peripheral neuropathy can have several underlying causes and may produce symptoms such as burning, tingling and numbness. The NHS guide to peripheral neuropathy explains these symptoms and some of their possible causes.
The pattern of symptoms and the patient’s medical history help determine the possible cause.
4. Fungal Infection or Other Skin Problems
Sometimes the problem isn’t coming from the nerves at all.
A fungal infection such as athlete’s foot can cause burning, itching, redness, peeling or cracked skin, particularly between the toes.
So when a patient tells me their feet are burning, I also look at the skin—not just the nerves.
5. Certain Medicines or Alcohol
Some medicines can affect nerve function and produce unusual sensations in the feet.
Long-term excessive alcohol consumption can also damage peripheral nerves.
If you think a medicine may be responsible, don’t stop it yourself. Discuss the possible side effect with your doctor.
6. Circulation Problems
Problems affecting blood flow can sometimes cause discomfort in the feet or legs.
Other symptoms may include cold feet, changes in skin colour, swelling or pain while walking.
People with diabetes, high blood pressure or cholesterol problems should take persistent foot symptoms seriously.
7. Other Medical Conditions
Burning feet can occasionally be associated with other conditions, including thyroid disorders, kidney problems, nerve compression and certain neurological conditions.
This is why I would not recommend assuming that burning feet automatically mean diabetes or vitamin B12 deficiency.
When Should You See a Doctor?
I recommend getting the symptom evaluated if the burning:
- Happens frequently or is getting worse
- Regularly disturbs your sleep
- Is accompanied by numbness or weakness
- Causes significant pain
- Affects your balance or walking
- Occurs with swelling or skin colour changes
- Is associated with a wound or ulcer on the foot
If you have diabetes, regular foot examination is particularly important because reduced sensation can make small injuries difficult to notice.
My Advice as a Physician
Burning feet are a symptom, not a diagnosis.
The important question is not simply, “How do I stop the burning?” but “Why are my feet burning?”
Depending on your symptoms and medical history, your physician may consider tests such as blood glucose/HbA1c, vitamin B12 and other investigations to identify the underlying cause.
If burning feet repeatedly disturb your sleep, don’t simply ignore them or start supplements on your own. Get the cause evaluated and treat the underlying problem.
About Dr. Dileep Verma
Dr. Dileep Verma is a Diabetologist & Physician at Safal Clinic & Wellness Center, Lucknow, with over two decades of clinical experience. He focuses on comprehensive management of diabetes and other general medical conditions.
đź“Ť Safal Clinic & Wellness Center, Ashiyana, Lucknow
đź“ž 9454926668 | 9555362630
