Most of the time it is because the nerves in your feet are damaged. The medical name is peripheral neuropathy. Patients describe it to me in different ways: burning, pins and needles, numbness. Different words, usually the same problem. The nerves are sending the wrong message to the brain, or no message at all.
Think of your nerves as wires. MedlinePlus uses the same picture: nerves carry messages back and forth between your brain and your body, so you can feel pain, heat and cold. When the wires are damaged, the messages get scrambled or stop.
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), this kind of nerve damage typically affects the feet and legs first. The feet may burn, tingle, feel numb, hurt, or feel weak. The symptoms are often worse at night, and some people feel real pain from something as light as a bedsheet.
Diabetes is the most common cause. High blood sugar over time damages the nerves and the small blood vessels that feed them, as the NIDDK explains. But it is not the only cause. MedlinePlus lists others, including low vitamin B12, kidney disease, heavy alcohol use, some cancer treatments and other medicines, infections and injury. Sometimes no cause is found.
So numb feet are not something to write off as age. There is a reason, and the reason matters, because some causes can be treated.
The burning gets your attention. The numbness is the part that worries me.
If you cannot feel a blister or a cut, you keep walking on it. It rubs inside the shoe. It gets deeper and deeper and you do not know it is there. I have written about how this turns into the wounds that will not heal, and I tell every diabetic patient the same thing: any wound on a diabetic foot is dangerous.
The NIDDK puts it plainly. Sores and infections in a foot that has lost feeling can lead to the loss of a toe, a foot or part of a leg. Neuropathy also throws off your balance, so falls and fractures become more likely.
First, I want to know why it is happening. That means a nerve and foot exam, a look at how you walk and stand, and questions about your health history, your medicines and your blood sugar if you are diabetic. Feeling in the foot is tested with simple tools; the NIDDK describes the standard ones, a thin nylon filament touched to the skin and a tuning fork to check for vibration.
I also check circulation, because nerves need a blood supply like every other tissue. When we need more detail, the office has C-MAT testing, a painless test that looks at circulation and nerve function together. And as with my wound patients, I ask what you eat. A body that is not getting the right nutrition does not repair itself well.
If there is a cause we can treat, we treat it. MedlinePlus notes that treating the underlying condition can, in some cases, let the nerves heal over time. For diabetics, that means getting the blood sugar under control.
Then we protect the foot and work on the symptoms. Depending on the patient, that can include better shoes and TCS devices to take pressure off the spots that are at risk, balance and gait training, vitamin supplementation when it is appropriate, and topical medicines. The NIDDK points out that pain medicines can help with the pain but do not change the nerve damage itself.
For patients whose symptoms keep going, I use NeuroGenix therapy. Electrodes are placed on the skin and a gentle electrical stimulation targets the nerve pathways. There are no needles, no drugs and no downtime, and it is done as a series of sessions. How much it helps depends on how severe the damage is and how long it has been there, so it is something we decide on after an evaluation.
Make an appointment if your feet burn, tingle or feel numb and it is not going away, if it keeps you up at night, or if your balance is getting worse. Come in promptly if you find a blister, cut or sore you did not feel, or if a toe or foot is red, swollen, warm, draining or you have a fever. If you have diabetes, do not wait on any of these.
Numbness or weakness that comes on suddenly, especially on one side of the body, is different. MedlinePlus lists it as a warning sign of stroke. Call 911.
If you have diabetes, the NIDDK advises checking your feet every day and having a foot exam at least once a year. Take your socks off at every doctor visit so your feet get looked at.
This article is for education and cannot tell you what is causing your own symptoms. An exam can. Learn more about our neuropathy and nerve pain treatment and diabetic foot care, or request an appointment at our Scarsdale office.