Burning Feet Syndrome
Causes, Treatment, and Why It’s Worse at Night
Medically reviewed by Adam H. Kaplan, DPM
Burning feet at night or any time of day is a sign of neuropathy. Neuropathy, or nerve damage in the legs and feet, is commonly caused by diabetes. However, many other conditions can lead to the sensation of burning feet.
Burning feet syndrome, also known as Grierson-Gopalan syndrome, causes sensations of heat or burning in the feet that are often worse at night. It can also cause numbness, sharp or stabbing pain, a dull ache, skin redness, or pins-and-needles sensations in the feet.
This article discusses the causes of burning feet. It explains why burning feet syndrome is often worse at night and how to relieve the burning pain.
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Why Are Burning Feet Worse at Night?
Burning feet syndrome is often worst at night. Scientists aren’t sure why, but there are a few theories.
At night there are fewer distractions to help take your mind off the pain. You may also have more stress at the end of the day, and stress is a well-documented contributor to pain.
Cooler temperatures may also play a role. The peripheral nerves activated in burning feet syndrome are responsible for sending temperature signals to the brain. However, the brain misinterprets the message from the damaged nerves, mistakenly translating cooler temperatures into "burning foot pain." Cooler evening temperatures can also slow your heart rate and circulation, which may contribute to the pain.
Causes of Burning Feet
There are various health conditions and procedures that can cause burning feet.
Diabetic Neuropathy
High blood sugar damages nerves over time. As many as 50% of people with diabetes will develop nerve damage at some point. This is called diabetic neuropathy.
When a person with diabetes develops nerve damage, the symptoms begin in the feet and can include pain, tingling, and burning. Some people describe the sensation as similar to walking on bubble wrap. The type of nerve damage that affects the extremities, like hands and feet, is peripheral neuropathy.
What Is the Peripheral Nervous System?
The nervous system acts as a messenger highway to and from the brain and the rest of the body. It uses nerves to communicate. The peripheral nervous system exists outside of the brain and spinal cord. Parts of the body in the peripheral nervous system include the spine, the roots and branches of spinal nerves, and cranial nerves.
Learn More: Understanding Peripheral Neuropathy
Heavy Alcohol Use
People who use alcohol in excess are at risk of developing nerve damage that can lead to the sensation of burning in the feet. This is called alcoholic neuropathy. The reasons why this happens are unclear, but some researchers think oxidative stress may be to blame.
"Oxidative stress" is the term used to describe an overload of free radicals in the body. These molecules can react with other molecules and cause damage to the nerves.
Heavy alcohol use may also activate a type of immune cell in the spinal cord. When these cells are activated without cause, they can damage the nerves, leading to burning and painful sensations in the feet.
Amyloid Neuropathy
Amyloid neuropathy is a type of nerve disorder that develops when amyloid, a type of protein, is deposited into nerves. The affected nerves become damaged, and symptoms develop, such as numbness and balance problems, pins and needles, and nighttime feet burning.
Anemia
Anemia occurs when the body doesn’t have enough healthy red blood cells. These are the cells that deliver oxygen throughout the body. Anemia is often caused by an iron deficiency.
While burning feet isn’t one of the most common symptoms of anemia, studies show that iron deficiency can lead to peripheral neuropathy, which causes the burning feet sensation.
Is Anemia Serious?
Anemia is usually mild and highly treatable, but if left untreated it can sometimes lead to serious and life-threatening consequences. This is because all cells in the body will die without oxygen. This can lead to severe weakness, a poorly functioning immune system, and heart failure.
Athlete’s Foot
Athlete’s foot is a type of fungal infection that affects the feet. Typical symptoms include dry, flaky skin or whiteness on the soles of the feet and between the toes. It can also feel like burning.
Athlete’s foot is highly treatable and does not typically cause any serious health consequences.
Charcot-Marie-Tooth Disease (CMT)
CMT is a hereditary nerve disease that affects nerves involved in muscle control. The disease progresses over time, leading to worsening symptoms.
One of the very first signs of CMT is burning in the feet. CMT can also lead to an extremely high arch over time due to the muscular imbalance or neuropathy.
Chemotherapy
Chemotherapy is a type of cancer treatment. According to research, between 19% and 85% of people who undergo chemotherapy will experience the common side effect of peripheral neuropathy, which causes burning sensations throughout the body, including the feet.
Learn More: Side Effects of Chemotherapy
Medication Use
Many medications can lead to peripheral neuropathy and burning feet. Medications that have been implicated in the development of peripheral neuropathy include:
Certain heart medications, such as amiodarone
Chemotherapy drugs
Medications used to treat HIV, such as NRTIs (nucleoside reverse transcriptase inhibitors)
Some antibiotics, such as isoniazid
Anticonvulsant medications designed to stop seizures from occurring
Certain psychotropic medications that are used to treat mental health disorders
Immunosuppressant drugs that hinder the overreaction of the immune system
Levodopa, which is used to treat Parkinson’s disease
Metformin and Peripheral Neuropathy
While the drug metformin is used to help people with diabetes manage their disease, some research has found that it can lead to a deficiency in vitamin B12. Certain vitamin deficiencies can cause nerve damage, and that can lead to peripheral neuropathy and burning feet. That being said, if your healthcare provider has recommended metformin, follow their instructions unless directed otherwise.
Chronic Inflammatory Demyelinating Polyneuropathy (CIPD)
CIPD is a neurological disorder that develops when the roots of nerves become inflamed. The disorder is rare. Only about five to seven people in every 100,000 will develop CIPD.
In CIPD (and neuropathy as well), the protective coating of nerves, known as myelin, becomes damaged. This hinders proper communication between nerves. Symptoms typically develop on both sides of the body at the same time, so both feet are often affected.
Complex Regional Pain Syndrome (CRPS)
CRPS is a chronic pain condition that usually develops after an injury that causes nerve damage. It can also develop following surgery if the nerves are injured during the procedure.
CRPS is an extremely painful condition that requires early diagnosis, intervention, and physical therapy. The pain is typically described as burning, tingling, or as if the area of the body is being tightly squeezed. It can happen to any part of the body, including the feet.
Other Causes of CRPS
Although 90% of all CRPS cases are caused by some sort of physical trauma or injury, 10% have no clear cause. It’s often thought that people with CRPS without any known injury have undiagnosed internal nerve trauma that causes symptoms. These issues could include infections, a new tumor, or blood clots.
Erythromelalgia
Erythromelalgia is a condition that is caused by a gene mutation in the body. When it develops, erythromelalgia causes episodic pain, redness, and swelling in the hands, feet, and other parts of the body.
Because the condition leads to damage of the nerves in the peripheral nervous system, it can be characterized as a type of peripheral neuropathy.
Gastric Bypass Complication
In some cases, complications from surgery can lead to peripheral neuropathy and the sensation of burning feet. Research has shown that the weight loss surgery gastric bypass is associated with peripheral neuropathy.
Learn More: What to Expect 10 Years After Gastric Sleeve
Guillain-Barre Syndrome
Guillain-Barre syndrome is an autoimmune disease and neurological disorder. It develops when a person’s immune cells attack the peripheral nervous system by mistake.
The cause of the syndrome is not clear, but some researchers believe when certain substances that resemble nerves enter the body, the immune system reacts by attacking the nerves instead of the substances.
What Triggers Guillain-Barre Syndrome?
While the cause of the syndrome is unclear, it is often developed after a person experiences a viral infection. In some other cases, surgery can also trigger Guillain-Barre.
Heavy Metal Poisoning
When heavy metals build up in the tissues of the body, it can lead to toxicity. When this happens, symptoms begin to develop. The type of symptoms that occur differ depending on the type of metal that is causing the toxic response.
Peripheral neuropathy, which leads to burning feet, is most associated with arsenic, lead, and mercury.
Hypothyroidism
Hypothyroidism is a condition that develops when the thyroid, the gland in the neck responsible for producing certain key hormones, is underactive.
While symptoms aren’t always present at the beginning stages of the disorder, they can include burning feet. This is because hypothyroidism has the ability to cause peripheral neuropathy.
Infectious Diseases
There are various infectious diseases that can lead to the development of burning feet. They include:
Kidney Disease
The kidneys are designed to filter toxins out of the body. When they begin to malfunction, toxins build-up, which can cause damage to the body.
When nerve damage develops because of kidney disease, it is referred to as uremic neuropathy and can lead to burning sensations in the feet.
Nutritional Deficiency
Peripheral neuropathy and the sensation of burning feet that goes along with it can be caused by various vitamin deficiencies such as:
Vitamin B12
Vitamin B6
Copper
Vitamin E
Vitamin B1
Can Too Much of a Vitamin Cause Burning Feet?
Having too much of a good thing can also lead to nerve damage that causes burning feet, as is the case with vitamin B6. Research has shown that people who have too high levels of the vitamin in their system may develop neuropathy that leads to burning, itching, or stinging in the limbs and feet.
Peripheral Artery Disease (PAD)
Peripheral artery disease is characterized by narrow or blocked blood vessels that run from the legs to the heart. The cause of PAD is typically plaque build-up in the arteries. The deprivation of oxygen to lower limb tissue is what can lead to pain and other burning sensations in the feet.
Sarcoidosis
Sarcoidosis is an inflammatory disease. It develops when inflammatory cells known as granulomas form in the organs of the body. The cause of the disease is unknown and some people that develop it may not exhibit any symptoms at all.
For people that do show symptoms, one can be burning feet because of how the disease affects the neurological system and the nerves of the peripheral nervous system.
Related: Granuloma Symptoms and Related Conditions
Small Fiber Neuropathy
Small fiber neuropathy is a type of disorder that affects only small sensory nerves. It usually develops in the feet and makes its way throughout the body by working its way up. Although the cause isn’t highly understood, it is most often developed because of diabetes or pre-diabetes.
Tarsal Tunnel Syndrome
Tarsal tunnel syndrome develops when the posterior tibial nerve, which is the nerve that runs from just above the knee in the back of the leg down to the heel of the foot, gets damaged due to an injury or swelling. It can lead to pain and burning in the foot that radiates up the leg.
Home Remedies for Burning Feet
To reduce pain and burning sensations in your feet, you can take steps at home to improve circulation and blood flow.
Exercise regularly
Soak feet in a warm saltwater bath
Manage blood sugar if you are diabetic
Try supplements that improve circulation such as turmeric, ginger, and fish oil
Apply topical lidocaine or capsaicin
Massage your feet
Before you try these home remedies, talk to your healthcare provider to ensure they are safe for your condition.
When to See a Healthcare Provider for Burning Feet
If you have burning feet and are unsure of the cause, make an appointment with your healthcare provider. This symptom is often caused by a condition that requires medical treatment.
Signs of an Emergency
Seek emergency care if the pain is excruciating, comes on suddenly, or if you have diabetes and there is an infected wound on your foot.
Diagnosing Burning Feet
Burning pain in the feet can have several causes, which is why it's important to seek a diagnosis as soon as possible.
What a Physical Exam Can Indicate
Getting a physical exam can help to identify several things, such as:
Possible infection
Issues with the structural integrity of your feet or legs
Whether or not your reflexes are functioning as they should
During the physical exam, a complete medical history, your alcohol use history, and a medication list will also be gathered, along with all present symptoms and how long they have been going on.
Tests
Certain tests can be used to help identify the cause of burning feet. They include:
Electromyography: Electromyography is a form of test that measures how the muscle responds to nerve stimulation.
Nerve conduction study (NCS): A nerve conduction study assesses nerve damage in a particular area of the body.
Blood tests: Blood tests check for diabetes, thyroid function, kidney function, infections such as HIV, and vitamin deficiencies.
Spinal tests: A spinal tap collects cerebral spinal fluid, which is the fluid that collects around the spine and brain, for testing purposes.
Urine analysis: A urine analysis checks for kidney disease.
Nerve biopsy: A nerve biopsy involves removing a piece of a nerve to examine it.
Other tests can be conducted to test nerve functionality, including a tuning fork vibration test and the Semmes–Weinstein monofilaments test.
Learn More: Getting a Biopsy: How to Prepare
Medical Treatments for Burning Feet
There is no specific treatment for burning feet. Instead, healthcare providers will aim to treat the underlying cause, including nerve damage.
Stop Ongoing Nerve Damage
If nerve damage is to blame, as is the case with diabetes or heavy alcohol consumption, the goal is to manage the conditions and refrain from damaging the nerves further.
Commonly Prescribed Medications for Burning Feet
Medications are sometimes used to treat the underlying cause of the symptoms. Some of these medications include:
Vitamin supplements may be used to treat vitamin deficiencies.
Antimicrobials like antibiotics and antifungals can be used to treat infections.
Antidepressants, such as the serotonin-norepinephrine reuptake inhibitors (SNRIs) Cymbalta (duloxetine), and Effexor (venlafaxine) alter pain signals to relieve neuropathy symptoms.
Anti-seizure medications such as gabapentin, pregabalin, and topiramate, are also used to relieve chronic neuropathic pain.
Learn More: What Type of Nerve Pain Medication Is Right for Me?
Related: Best Home Remedies for Neuropathy in Feet
Outlook
Burning feet caused by diabetes can be treated with proper disease management. Many other causes of burning feet are also highly treatable, so it’s important to see your healthcare provider and develop a plan once you receive a diagnosis.
Many of the causes involve nerve damage, which can be permanent. However, the right treatment plan can prevent further nerve damage from occurring.
Summary
The sensation of burning in your feet can be both mild or severe. In some cases, it can disrupt your life and become chronic. The most common cause of burning feet is diabetes; however, several others require their own types of medical intervention.
If you experience burning in your feet that comes and goes, seek out your healthcare provider. They will help identify the cause and provide you with the proper treatment plan.
Read the original article on Verywell Health.
