Hormonal imbalances can disrupt the body’s normal functions, leading to some swelling of tissues that can press on nerves.
Peripheral Neuropathy
Peripheral neuropathy is a type of nerve damage that typically affects the feet and legs and sometimes affects the hands and arms.
This type of neuropathy is very common. Up to one-half of people with diabetes have peripheral neuropathy. 1,2
What causes peripheral neuropathy?
Over time, high blood glucose, also called blood sugar, and high levels of fats, such as triglycerides, in the blood from diabetes can damage your nerves and the small blood vessels that nourish your nerves, leading to peripheral neuropathy.
What are the symptoms of peripheral neuropathy?
If you have peripheral neuropathy, your feet, legs, hands, or arms may feel
- burning
- tingling, like “pins and needles”
- numb
- painful
- weak
You may feel extreme pain in your feet, legs, hands, and arms, even when they are touched lightly. You may also have problems sensing pain or temperature in these parts of your body.
If you have peripheral neuropathy, you may feel burning or tingling, like “pins and needles,” in your feet.
Symptoms are often worse at night. Most of the time, you will have symptoms on both sides of your body. However, you may have symptoms only on one side.
If you have peripheral neuropathy, you might experience:
- changes in the way you walk
- loss of balance, which could make you fall more often
- loss of muscle tone in your hands and feet
- pain when you walk
- problems sensing movement or position
- swollen feet
What problems does peripheral neuropathy cause?
Peripheral neuropathy can cause foot problems that lead to blisters and sores. If peripheral neuropathy causes you to lose feeling in your feet, you may not notice pressure or injuries that lead to blisters and sores. Diabetes can make these wounds difficult to heal and increase the chance of infections. These sores and infections can lead to the loss of a toe, foot, or part of your leg. Finding and treating foot problems early can lower the chances that you will develop serious infections.
This type of diabetes-related nerve damage can also cause changes to the shape of your feet and toes. A rare condition that can occur in some people with diabetes is Charcot’s foot, a problem in which the bones and tissue in your foot are damaged.
Peripheral neuropathy can make you more likely to lose your balance and fall, which can increase your chance of fractures and other injuries. The chronic pain of peripheral neuropathy can also lead to grief, anxiety, and depression.
How do doctors diagnose peripheral neuropathy?
Doctors diagnose peripheral neuropathy based on your symptoms, family and medical history, a physical exam, and tests. A physical exam will include a neurological exam and a foot exam.
Examination for neuropathy
If you have diabetes, you should get a thorough exam to test how you feel in your feet and legs at least once a year. During this exam, your doctor will look at your feet for signs of problems and check the blood flow and feeling, or sensation, in your feet by
- placing a tuning fork against your great toes and higher on your feet to check whether you can feel vibration
- touching each foot and some toes with a nylon strand to see if you can feel it—a procedure called a monofilament test
- reviewing your gait, or the patterns you make when you walk
- testing your balance
Your doctor may also check if you can feel temperature changes in your feet.
What tests do doctors use to diagnose peripheral neuropathy?
Your doctor may perform tests to rule out other causes of nerve damage, such as a blood test to check for thyroid problems, kidney disease, or low vitamin B12 levels. If low B12 levels are found, your doctor will do additional tests to determine the cause. Metformin use is among several causes of low vitamin B12 levels. If B12 deficiency is due to metformin, metformin can be continued with B12 supplementation.
How can I prevent the problems caused by peripheral neuropathy?
You can prevent the problems caused by peripheral neuropathy by managing your diabetes, which means managing your blood glucose, blood pressure, and cholesterol. Staying close to your goal numbers can keep nerve damage from getting worse.
If you have diabetes, check your feet for problems every day and take good care of your feet. If you notice any foot problems, call or see your doctor right away.
Remove your socks and shoes in the exam room to remind your doctor to check your feet at every office visit. See your doctor for a foot exam at least once a year—more often if you have foot problems. Your doctor may send you to a podiatrist.
How do doctors treat peripheral neuropathy?
Doctors may prescribe medicine and other treatments for pain.
Medicines for nerve pain
Your doctor may prescribe medicines to help with pain, such as certain types of
- antidepressants, including
- tricyclic antidepressants, such as nortriptyline, desipramine, imipramine, and amitriptyline
- other types of antidepressants, such as duloxetine, venlafaxine, paroxetine, and citalopram
Although these medicines can help with the pain, they do not change the nerve damage. Therefore, if there is no improvement with a medicine to treat pain, there is no benefit to continuing to take it and another medication may be tried.
All medicines have side effects. Ask your doctor about the side effects of any medicines you take. Doctors don’t recommend some medicines for older adults or for people with other health problems, such as heart disease.
Some doctors recommend avoiding over-the-counter pain medicines, such as acetaminophen and ibuprofen. These medicines may not work well for treating most nerve pain and can have side effects.
Other treatments for nerve pain
Your doctor may recommend other treatments for pain, including
- physical therapy to improve your strength and balance
- a bed cradle, a device that keeps sheets and blankets off your legs and feet while you sleep
Diabetes experts have not made special recommendations about supplements for people with diabetes. For safety reasons, talk with your doctor before using supplements or any complementary or alternative medicines or medical practices.
References
[1] Pop-Busui R, Boulton AJ, Feldman EL, et al. Diabetic neuropathy: a position statement by the American Diabetes Association. Diabetes Care. 2017;40(1):136–154.
[2] Izenberg A, Perkins BA, Bril V. Diabetic neuropathies. Seminars in Neurology. 2015;35(4):424–430.
Last Reviewed February 2018
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Previous: What Is Diabetic Neuropathy?
Next: Autonomic NeuropathyThis content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank:
Rodica Pop-Busui, M.D., Ph.D., University of MichiganWhat Causes Hot Feet? All You Need to Know
Feet that feel hot or burning, especially at night, can be caused by several medical conditions.
Sometimes the heat feels like tingling, numbness, stabbing, or a “pins and needles” sensation.
In this article, we discuss what can be causing your feet to feel hot. Then, read on to learn how your primary care clinician can diagnose and treat the problem.
Lastly, check out the most commonly asked questions about hot feet.
Causes
There is a wide range of possibilities for what’s causing your feet to feel hot.
Some of them include neuropathy, infections, and vitamin insufficiencies.
Vitamin deficiencies
Healthy nerves require specific vitamins and minerals to function correctly.
For example, low levels of vitamin B12 and folate can lead to neuropathy, which can cause your feet to feel hot.
According to research, reasons why you may be deficient in these vitamins include:
- Poor diet
- Stomach conditions preventing absorption
- Intestinal conditions preventing absorption
- Certain medications
- Pregnancy
- Cancer
- Sickle-cell anemia
Nerve damage
Nerve damage, also called neuropathy, is a common problem with many causes.
Neuropathy is a disruption of the nerve’s ability to communicate with the rest of your body due to:
- Physical injury
- Diabetes
- Blood flow problems
- Autoimmune diseases
- Hormonal imbalances
- Kidney and liver problems
- Vitamin B12 deficiency
- Certain cancers or chemotherapy drugs
- Certain infections
Fungal infection
Athlete’s foot is a common fungal infection. It likes to grow in warm, moist areas of the skin.
Symptoms are red and itchy skin with burning hot pain.
Diabetic neuropathy
Diabetes is a leading cause of neuropathy in the United States.
Having high levels of sugar in your blood leads to nerve damage. This nerve damage in your feet can lead to pain, feelings of them being hot or “on fire”, and, in some cases, it makes your feet feel numb.
In addition, this neuropathy can lead to further issues with your feet because it’s difficult to discern when there is a problem, like an injury, which may result in chronic foot wounds and infections.
Kidney disease
Your kidneys filter toxins from your blood and balance levels of electrolytes.
People with chronic kidney disease tend to have electrolyte imbalances in their blood because their kidneys aren’t working as well, which can lead to nerve damage.
Hypothyroidism
Hypothyroidism is when your thyroid gland cannot produce enough thyroid hormone.
Not having the right levels of thyroid hormone in your body can lead to a burning or tingling sensation in your feet, weight gain, thinning hair, and dry skin.
Hormonal changes
Hormonal imbalances can disrupt the body’s normal functions, leading to some swelling of tissues that can press on nerves.
In the long term, this pressure on the nerves damages them and causes hot feet, numbness, and tingling.
Pregnancy: During pregnancy, the body goes through significant hormonal changes, leading to changes in body temperature and swollen, hot feet. These changes are generally temporary and resolve as hormone levels gradually go back to normal after giving birth.
Menopause: It’s common to hear about people going through menopause experiencing hot flashes. These hot flashes happen because of the hormonal shifts occurring in their bodies and resolve within a few years.
Guillain-Barré syndrome (GBS)
Guillain-Barré is a rare syndrome when the immune system attacks the nerves.
It causes weakness, tingling, and burning sensations starting in the feet and legs and progressing up the body over a few hours to days.
Guillain-Barré is a medical emergency, as it can cause paralysis of the diaphragm—the muscle that helps you breathe—and should be evaluated by a doctor right away.
Erythromelalgia
Erythromelalgia is a very rare condition in which people experience burning pain, warmth, redness, and swelling, particularly in the hands and feet.
In many cases, the cause of the disease is never found; in some cases, the reason is genetic.
Lifestyle factors
Smoking: Smoking causes the blood vessels to constrict. This constriction can lead to the nerves not getting enough blood flow, which can cause long-term damage.
Alcoholism: Drinking too much alcohol leads to decreased vitamins in the body, particularly folic acid, B6, and B12 (also known as thiamine). When your body doesn’t get these needed vitamins, it can lead to chronic nerve pain
Improper Footwear: Improper footwear, especially when worn for long periods of standing or walking, can lead to burning pain in the feet.
Stress: Chronic stress can impact the blood flow to the nerves. When nerves get decreased blood flow, they become damaged.
Certain medications
Some chemotherapy medications cause neuropathy. Radiation can also have the same effect.
Other medications used to treat seizures or high blood pressure have also caused peripheral neuropathy.
