Burning feet is most often a sign that the small nerves in your feet are irritated or damaged, rather than a problem with your skin or your circulation. That is why it tends to be worse at night, and why cooling helps for a while and then stops. Most causes can be identified, and several are treatable.

If you are reading this at 1am with your feet uncovered, here is why the burning gets louder after dark, what sits behind it, and which home remedies for burning feet help tonight.

Why are my feet burning at night?

Four things stack up after dark.

Quiet. By day your brain filters a constant stream of input. At night nothing competes with the signal from your feet, so what sat in the background at 4pm is now the loudest thing in the room.

Warmth. Bedding traps heat, and irritated small nerves fire more readily as the skin warms. It is why a hot shower can set the burning off.

Stillness. Walking floods your feet with pressure and movement signals that partly drown out the burning. Lying still removes them.

Rest itself. Pain from damaged nerves, called neuropathic pain, is more active at rest than during activity, the opposite of a mechanical injury. Feet that burn once you lie down point at the nerves.

What causes burning feet?

Peripheral neuropathy. Damage to the small nerves furthest from the spine, and the most common explanation. In Canada, diabetes is the usual cause. The pattern is recognisable: both feet, starting in the toes, creeping upward over months, burning as well as numbness, worse at night. See our peripheral neuropathy page.

Vitamin B12 deficiency. Low B12 damages nerves, is genuinely treatable, and is often missed. It is more common with long term metformin use, in people who eat little or no animal produce, and after some stomach surgery. Ask your doctor to test for it.

Chemotherapy induced neuropathy. Several chemotherapy drugs irritate the small nerves. Burning in the hands and feet can begin during treatment and sometimes persists afterwards. Tell the treating team.

Thyroid problems and heavy alcohol use. An underactive thyroid can produce nerve symptoms and shows on a routine blood test. Sustained heavy drinking damages small nerves directly.

Nerve compression at the ankle or lower back. A nerve squeezed near the ankle, or a root compressed in the lower spine, burns along the path it supplies, usually in one foot. Our post on numbness in toes covers those compression points.

Small fibre neuropathy. Standard nerve tests measure the large fibres. The tiny fibres carrying heat and pain can be damaged while those tests read normal, so a normal result does not mean nothing is wrong.

Erythromelalgia. Uncommon but distinctive: episodes of red, hot, burning feet, set off by warmth or exercise and eased by cooling.

Is burning feet a circulation problem?

Usually not, and this one is worth getting straight.

Reduced arterial blood flow tends to make feet cold and pale, and its signature symptom is calf cramping that starts after walking a set distance and eases on stopping. Burning behaves differently: present at rest, worse in bed, often with tingling. That points at nerves, not blood vessels. Circulation still deserves checking if your feet are also cold, pale or slow to heal.

Home remedies for burning feet

These do not treat the cause, but they take the edge off tonight.

• Keep your feet cool and uncovered. Let them hang out from under the duvet.
• Cool the room, or use a fan. A fan at the foot of the bed helps more than most things applied to the skin.
• Try a cool foot soak. Cool tap water, not ice water, for about ten minutes before bed.
• Lift the bedding off your feet. A blanket lift, a cushion or a loose top sheet keeps weight off sensitive skin.
• Wear breathable footwear and moisture wicking socks. Rotate shoes so they dry fully between wears.
• Check your shoes for pressure points. A tight toe box, worn seams or a flattened insole add irritation on top of the nerve problem.
• Walk gently earlier in the day. Light activity helps nerve health, and doing it early avoids stirring the feet up at bedtime.
• Manage blood sugar where that applies. With diabetes or prediabetes, this is the most useful thing you can do for these nerves.

Two things to avoid: ice directly on the skin, and very hot water, which settles the burning briefly and leaves it worse.

One important safety point. With diabetes, or any reduced sensation in your feet, never use a hot water bottle, an electric heating pad or a very hot soak. A burn can happen without you feeling it. Test water with your hand or elbow first.

What home measures cannot do

They manage the sensation. They do nothing about what is irritating the nerves. Burning that has lasted more than a couple of weeks, or that is spreading upward, deserves an assessment: several causes are reversible, and those respond better when caught early.

What does an assessment involve?

It starts with the story: when it began, which part of the foot, one foot or both, and what else has changed. Then an examination of sensation, reflexes, strength and the pulses in your feet. Blood work follows, for the treatable causes: blood sugar and HbA1c, vitamin B12 and thyroid function. Nerve conduction studies are used selectively, when the result would change the plan.

What an interventional pain clinic adds

Where burning has lasted months and the common causes have been checked, a pain clinic focuses on the pain itself. That starts with a medication review, since the medications that work best for neuropathic pain are not the ones most people have tried from a pharmacy shelf. Where a specific nerve is involved, nerve blocks can interrupt the signal from it. For difficult neuropathic pain in selected patients, we also offer ketamine and lidocaine infusions and peripheral nerve stimulator therapy, which uses a small device to alter the signals a nerve sends.

Warning signs that need urgent care

Seek same day or emergency care if you have:

• A foot that turns cold, pale or blue with sudden severe pain
• Any wound, blister, ulcer or spreading redness on the foot, especially with diabetes
• Burning with weakness in both legs, worsening over hours or days
• New numbness in the groin or saddle area with bladder or bowel changes
• A fever alongside a hot, swollen foot
• Burning that started suddenly after an injury

Frequently asked questions

Why do my feet burn at night but feel fine during the day?
Because nerve pain is more active at rest. By day, walking and pressure partly mask the signal, and plenty competes for attention. At night your feet are still, warm under bedding, and nothing else is going on. The signal is simply easier to hear.

What vitamin deficiency causes burning feet?
Vitamin B12 is the main one. Low levels damage nerves and cause burning, tingling and numbness in the feet. It is more common with long term metformin use, in people who eat little or no animal produce, and after some stomach surgeries.

Does burning in the feet always mean diabetes?
No. Diabetes is the most common cause of nerve damage in the feet in Canada, but B12 deficiency, thyroid problems, heavy alcohol use, chemotherapy and nerve compression all cause the same sensation. Plenty of people burn without diabetes. Blood work is what separates them.

My nerve tests were normal, so why do my feet still burn?
Standard nerve conduction studies test the large nerve fibres. The small fibres that carry heat and pain can be damaged while those tests read normal, which is called small fibre neuropathy. A normal result does not rule out a nerve problem.

This article is general information, not medical advice. It cannot diagnose your pain. If your symptoms are new, worsening, or worrying you, speak with your family doctor or contact us for an assessment.

Talk to us about burning feet

If your feet have been burning for months and the usual causes have been checked, an assessment can work out which nerves are involved and what can be done about the pain. Silver Pain Centre in Toronto offers assessment and management of neuropathic pain, and most services are covered by OHIP with a physician referral.

Ask your family doctor to send a physician referral, or use our self referral form to start without one.