A burning, tingling, or “hot” sensation in your feet can be hard to ignore—especially when it strikes at night or after a long day on your feet. For some, it’s a mild nuisance; for others, it disrupts sleep, exercise, and everyday activities. While fatigue or a skin irritation may explain occasional symptoms, persistent burning feet can signal a nerve problem, a pinched nerve, a fungal infection, circulation issues, or even a vitamin imbalance or medication side effect. Knowing which signs matter helps you decide what to do next.
This guide breaks down five of the most common causes of burning feet—peripheral neuropathy (often diabetes-related), tarsal tunnel syndrome, athlete’s foot and skin causes, vitamin deficiencies/medication effects, and peripheral artery disease (PAD). You’ll learn the hallmark symptoms, how doctors make a diagnosis, proven treatments and smart self-care, and when it’s time to see a podiatrist. We’ll also explain how Achilles Foot and Ankle Center helps patients find lasting relief.
1. Peripheral neuropathy (often diabetes-related) — evaluation and care at Achilles Foot and Ankle Center
Among the most common causes of burning feet is peripheral neuropathy. It happens when damaged peripheral nerves misfire pain signals, often from long-standing high blood sugar in diabetes, but also from alcohol use, certain medications (including some chemotherapy), vitamin B deficiencies, thyroid disease, kidney disease, or infections.
What it is
Peripheral neuropathy is nerve damage that typically starts in the toes and feet and can climb up the legs. Damaged sensory fibers can create burning, tingling, numbness, or painful hypersensitivity—even without an external injury.
Typical symptoms
Burning neuropathic pain often worsens at night and may coexist with pins-and-needles or loss of feeling. Some people notice oversensitivity to touch; others feel “deadness” that affects balance and gait.
- Burning, tingling, or numbness in toes and soles
- Hypersensitivity to touch (hyperesthesia) or electric-shock zaps
- Worse at night; can disturb sleep
- Muscle weakness or unsteadiness in advanced cases
How doctors diagnose it
Your provider starts with your story and a focused nerve exam. If the cause isn’t obvious or symptoms progress quickly, tests help confirm nerve involvement and uncover contributing conditions.
- Neurologic foot exam: sensation, strength, reflexes, skin integrity
- Electrodiagnostics: nerve conduction studies and/or EMG
- Laboratory tests: blood sugar/A1c, vitamin levels (B12), thyroid, kidney function
- Medication review: drugs linked to neuropathy
Treatment and self-care options
Treat the cause and calm the nerves. For diabetes, keeping blood sugar in range is essential. Vitamin deficiencies need replacement; alcohol-related damage improves with abstinence; thyroid or kidney issues require medical management.
- Glycemic control (diabetes) to halt ongoing nerve damage
- Vitamin B12 replacement when low; nutrition support
- Address contributors: alcohol cessation; thyroid or kidney treatment
- Neuropathic pain medicines: duloxetine, gabapentin, pregabalin, amitriptyline, venlafaxine
- Topicals and comfort care: lidocaine or capsaicin creams; 15-minute cool-water soaks; breathable socks; supportive footwear; cool bedroom
When to see a podiatrist
Seek care if burning feet persist more than two weeks, wake you at night, or come with numbness, weakness, open sores, color changes, or rapidly worsening pain—especially if you have diabetes.
How Achilles Foot and Ankle Center can help
Our team provides comprehensive diabetic and neuropathy-focused foot care—thorough exams, risk reduction, and individualized plans. We offer protective footwear and custom orthotics, diabetic shoes, advanced wound care and limb salvage when needed, and coordination with your primary care or endocrinology team. With multiple Central Virginia locations, same-day appointments, state-of-the-art facilities, and a convenient patient portal, we make timely, expert relief accessible close to home.
2. Tarsal tunnel syndrome (pinched tibial nerve)
When the tibial nerve gets compressed as it travels along the inside of the ankle (the “tarsal tunnel”), it can spark burning, tingling, and numbness in the sole—one of the overlooked causes of burning feet. Because this is a mechanical nerve entrapment, targeted treatment can be very effective.
What it is
Tarsal tunnel syndrome is a compression neuropathy of the tibial nerve where it passes behind the inner ankle bone. Irritation or swelling in this space makes the nerve misfire, creating pain and heat-like sensations.
Typical symptoms
Symptoms often spread from the inner ankle into the arch, heel, or toes. Many patients notice symptoms after standing or walking and at night.
- Burning, tingling, or electric shocks in the sole or toes
- Numb spots or cramping in the foot
- Worse with activity or tight footwear; may improve with rest
- Occasional weakness or instability if prolonged
How doctors diagnose it
Clinicians combine your history with a focused foot and nerve exam. If needed, nerve testing helps confirm involvement and gauge severity.
- Targeted exam of sensation, strength, and tenderness along the tunnel
- Nerve conduction studies/EMG to assess tibial nerve function
- Review of contributors (diabetes, thyroid, medications) that can worsen nerve symptoms
Treatment and self-care options
The goal is to reduce pressure on the nerve and quiet pain. Many cases improve without surgery.
- Activity and footwear changes: supportive shoes, avoid tight laces/straps
- Arch support/orthotics and ankle bracing to offload the tunnel
- Anti-inflammatory strategies: rest, ice, OTC analgesics as directed
- Neuropathic pain medications and topical lidocaine/capsaicin
- Image-guided corticosteroid injections when appropriate
- Surgical decompression for persistent, severe, or progressive cases
When to see a podiatrist
Book a visit if symptoms last more than two weeks, wake you at night, limit activity, or if you notice numbness, weakness, color/temperature changes, or rapidly worsening pain.
How Achilles Foot and Ankle Center can help
We pinpoint nerve compression with a thorough exam and, when indicated, electrodiagnostics. Care plans may include custom orthotics, bracing, physical therapy, and ultrasound‑guided injections; if needed, our Foot and Ankle Surgery Center offers definitive decompression. With multiple Central Virginia locations and same-day availability, you can get expert relief quickly.
3. Athlete’s foot (tinea pedis) and skin causes
Fungal and skin conditions are common, fixable causes of burning feet. Athlete’s foot (tinea pedis) is the usual suspect, thriving in warm, sweaty shoes and between the toes. Contact dermatitis from soaps, detergents, or shoe materials can also trigger burning, redness, and peeling.
What it is
Athlete’s foot is a contagious fungal infection of the skin of the feet, most often between the toes and on the soles. It irritates the skin and nerves, leading to itching, stinging, and a burning sensation. Irritant or allergic contact dermatitis can mimic or accompany it.
Typical symptoms
Symptoms vary by severity but often include classic skin changes plus the “hot” or burning feel.
- Itching, stinging, burning between toes or on soles
- Peeling, cracking, scaling, or soggy white skin between toes
- Redness or small blisters; sometimes noticeable odor
- After new product/shoes: red, burning rash consistent with dermatitis
How doctors diagnose it
Clinicians rely on your history and a focused skin exam. When needed, simple tests confirm fungus and rule out look-alikes.
- Skin scraping/KOH test to identify fungal elements
- Assessment for dermatitis triggers and secondary bacterial infection
- Consider neuropathy or circulation issues if symptoms are atypical or persistent
Treatment and self-care options
Most cases respond to diligent hygiene and topical antifungals; stubborn infections may need prescriptions.
- OTC antifungals: miconazole or terbinafine as directed
- Keep feet dry: change socks, breathable shoes, rotate pairs
- Dry between toes; use foot powder or antiperspirant for sweat
- Disinfect footwear and shower surfaces
- Prescription options for severe/recurrent cases: fluconazole, itraconazole, or naftifine
- For dermatitis: avoid the trigger, moisturize; use doctor‑directed topicals
When to see a podiatrist
Seek care if symptoms last beyond two weeks, keep recurring, or you notice severe cracking, blisters, drainage, spreading redness, or fever. If you have diabetes, neuropathy, or poor circulation, don’t wait—get evaluated promptly.
How Achilles Foot and Ankle Center can help
We distinguish fungus from dermatitis and neuropathic causes of burning feet, perform in‑office testing, and tailor treatment—topical or oral antifungals, management of secondary infection, debridement of macerated skin, footwear and moisture‑control strategies, and prevention plans. Same‑day appointments and multiple Central Virginia locations make relief convenient.
4. Vitamin deficiencies and medication effects
Among the common causes of burning feet are nutrient problems and drug side effects. Low vitamin B12 can damage nerves, metformin may lower B12 over time, and too much vitamin B6 can also trigger neuropathy. Certain medicines—like some chemotherapy agents, statins, amiodarone, and specific antibiotics or antifungals—are known contributors.
What it is
When the body lacks key vitamins (especially B12) or a medication irritates peripheral nerves, the result can be neuropathy—misfiring nerves that create burning, tingling, and numbness in the feet.
Typical symptoms
Symptoms often resemble other neuropathies and can fluctuate with medication timing or diet changes.
- Burning, tingling, or numbness in toes and soles
- Sensitivity to touch or night-time worsening
How doctors diagnose it
Your clinician will connect the timeline of symptoms with diet and prescriptions, then confirm potential contributors.
- Medication and nutrition review (including metformin use)
- Blood tests for vitamin levels; nerve studies if unclear or worsening
Treatment and self-care options
Address the cause and calm the nerves while preventing ongoing damage.
- Replace deficiencies: vitamin B12 by mouth or injection, as directed
- Adjust offending drugs with your prescribing clinician
- Neuropathic pain relief: duloxetine, gabapentin/pregabalin, or topical lidocaine/capsaicin
- Nutrition support: add B12‑rich foods (eggs, dairy, fish, poultry)
When to see a podiatrist
If burning feet persist beyond two weeks, worsen, or affect balance or sleep—especially if you have diabetes or take multiple medications—get evaluated.
How Achilles Foot and Ankle Center can help
We identify vitamin- or medication‑related neuropathy with targeted exams and labs, coordinate safe medication changes with your providers, and tailor symptom relief—topicals, orthotics, footwear guidance, and, when appropriate, neuropathic pain medications—across our convenient Central Virginia locations.
5. Peripheral artery disease (PAD)
Poor circulation can also cause a burning sensation in the feet. With PAD, narrowed leg arteries limit oxygen‑rich blood to your feet. When blood flow can’t meet tissue demand—especially at night when legs are elevated—you may feel intense burning or “hot” soles called ischemic rest pain.
What it is
PAD is hardening and narrowing of the arteries that supply your legs and feet. Reduced blood flow starves nerves and skin, which can trigger burning, aching, and slow healing. Diabetes, smoking, high cholesterol, and high blood pressure are major risk factors.
Typical symptoms
Burning from PAD often pairs with other circulation clues. Symptoms may worsen at night and improve when you dangle the foot over the bed (gravity helps flow).
- Burning or severe aching in the soles at rest (nighttime)
- Cramping with walking (claudication) that eases with rest
- Cold, pale, or bluish feet; weak or absent pulses
- Shiny skin, hair loss on legs/toes, thickened nails
- Slow‑healing cuts or ulcers, especially in people with diabetes
How doctors diagnose it
Your clinician will look for circulation deficits and skin changes and rule out purely nerve‑related causes. If PAD is suspected, we coordinate vascular testing.
- Focused vascular exam: pulses, temperature, color, capillary refill, wound check
- Referral for noninvasive vascular studies and specialist evaluation when indicated
Treatment and self-care options
Improving blood flow and protecting skin are key. Many patients improve with risk‑factor control and activity; advanced disease may need vascular procedures.
- Risk‑factor management: stop smoking, optimize diabetes, cholesterol, and blood pressure
- Supervised/walking programs as advised by your providers
- Medication management (e.g., antiplatelet and lipid‑lowering therapy per your prescribers)
- Meticulous foot care: daily checks, moisturize (not between toes), protective socks/shoes
- Wound care and offloading for any sores to prevent infection
- Vascular referral for revascularization if rest pain, nonhealing wounds, or severe disease
When to see a podiatrist
Get prompt care if you have burning feet with color change, coldness, weak pulses, or sores. Seek urgent help for a suddenly cold, blue, or severely painful foot, spreading redness, or fever.
How Achilles Foot and Ankle Center can help
We differentiate PAD from neuropathy, perform thorough vascular and skin checks, and protect your feet with footwear guidance, custom offloading, and advanced wound care and limb‑salvage services. When circulation is the driver, we coordinate quickly with vascular specialists. With multiple Central Virginia locations and same‑day availability, you can be seen fast and start a targeted plan right away.
Next steps for relief
If your feet burn, start with simple, safe steps while you arrange care: cool-water soaks for 10–15 minutes, breathable socks and supportive shoes, rotate footwear to stay dry, and try an OTC antifungal if there’s scaling between the toes. For nerve-type discomfort, doctor‑approved lidocaine or capsaicin topicals may help; keep diabetes numbers in range and jot down all medications and supplements to review.
- See a podiatrist if symptoms last beyond two weeks or worsen.
- Night/rest pain in the soles suggests circulation issues—don’t wait.
- Numbness, weakness, or balance problems raise fall and ulcer risk.
- Cold, pale/blue feet or open sores need prompt evaluation.
- Diabetes or kidney disease warrants earlier, proactive care.
At Achilles Foot and Ankle Center, we pinpoint the cause—nerve, skin, or circulation—then tailor treatment, from antifungals and orthotics to neuropathic pain relief, wound care, and surgical options when needed. Same-day visits and multiple Central Virginia locations make it easy to get help. Start now at Achilles Foot and Ankle Center.
