Nerve pain, numbness and neuromas

Symptoms that suggest a nerve

• Burning or “pins and needles” in the toes, sole or ankle.
• Numbness, or a feeling of walking on cotton.
• Sharp, shooting or electric-shock pain.
• Pain between the toes, like a pebble in the shoe.
• Symptoms that are worse at night or after standing.^[1,4]

Common nerve problems of the foot and ankle

Morton’s neuroma is a thickening of the nerve between the toes, usually the third and fourth. It causes burning or sharp pain in the ball of the foot, often with a feeling of a pebble in the shoe.^[2] Wider shoes, pads and inserts help many people; a Cochrane review found that injections and surgery are also options, with evidence that is still limited.^[6]

Tarsal tunnel syndrome is compression of the tibial nerve as it passes behind the inside ankle bone, causing burning, tingling and numbness in the sole.^[3]

Peripheral neuropathy, most often from diabetes, typically starts as numbness, tingling or burning in both feet. It also removes the warning sign of pain, which is why protective foot care matters so much.^[4,5] See diabetic foot care.

Nerve pain after surgery or injury, from a nerve that was stretched, cut or caught in scar tissue.

How we evaluate it

We map where the symptoms are, examine sensation, strength and reflexes, and tap along nerves to find points of irritation. Because back problems, circulation and other conditions can cause foot symptoms, we look at the whole picture, and arrange nerve testing or imaging when it will change the plan.^[1]

Common questions

Is burning in the feet always neuropathy?

No. A single nerve under pressure, such as in tarsal tunnel syndrome or a Morton’s neuroma, can cause burning and tingling too, and it is often treatable directly.^[3,2] A pinched nerve in the lower back can also send symptoms into the foot, which is why we examine more than the foot.^[1]

What causes neuropathy besides diabetes?

Kidney and liver disease, vitamin imbalances (vitamin B12 deficiency and too much vitamin B6 are well-known examples), heavy alcohol use, toxins, some medications and chemotherapy can all damage nerves.^[1] Finding the cause matters, because some of them can be corrected.

Will I need a nerve test?

Sometimes. Nerve conduction studies and electromyography (EMG) measure how well nerves and muscles are working, and can help show where a nerve is damaged and what kind of damage it is.^[1] We arrange them when the result will change the treatment.

Can the pain be treated?

Yes, in several ways. For diabetic neuropathy, managing blood sugar, blood pressure and cholesterol helps prevent the problems it causes, and medications (certain antidepressants and anticonvulsants, and numbing creams or patches) can ease the pain.^[4] Pressure on a single nerve can often be relieved directly, which is the work of our nerve specialty practice.

When to seek care