Burning Feet at Night — What Is Causing It?
Feet that feel like they are on fire at night. Cannot tolerate the weight of a bedsheet. This is a classic symptom of peripheral neuropathy — and it is treatable.
Burning, hot, or fire-like sensation in the feet — particularly at night — is one of the most characteristic symptoms of peripheral neuropathy. It is extremely common in Hyderabad given the high prevalence of diabetes and nutritional deficiencies. Many patients suffer for years without seeking help, assuming it is 'just diabetes'. The cause determines the treatment — and some causes are completely reversible.
Seek Emergency Care Immediately If You Have:
- 1Burning feet with complete numbness — risk of undetected foot wounds (diabetic emergency)
- 2Burning feet with rapidly progressive weakness in the legs
- 3Burning feet in a person not known to be diabetic — check blood sugar
- 4Burning feet with systemic symptoms: rash, weight loss, night sweats
- 5Burning sensation extending up the legs or into the hands
Possible Causes of This Symptom
Diabetic Peripheral Neuropathy
The most common cause in India. Chronic high blood sugar damages small nerve fibres, causing burning, tingling, and loss of sensation — predominantly in the feet, worse at night. NCS and blood sugar optimisation are the key steps.
Vitamin B12 Deficiency
B12 is essential for myelin sheath maintenance. Deficiency — extremely common in vegetarians, vegans, and those on metformin or PPIs — causes a burning, tingling neuropathy. Correctable with B12 injections.
Medication-Induced Neuropathy
Several common drugs cause neuropathy: isoniazid (TB treatment), metronidazole, some chemotherapy agents, nitrofurantoin, and statins. A medication review is always important.
Hypothyroidism
Underactive thyroid can cause a peripheral neuropathy with burning, tingling, and numbness — typically also associated with other hypothyroid features (weight gain, fatigue, hair loss, cold intolerance).
Erythromelalgia
A rare but distinctive condition — intense burning, redness, and heat in the feet triggered by warmth and exercise, relieved by cooling. Requires specific investigation and management.
How We Diagnose the Cause
NCS (Nerve Conduction Study)
Objectively measures which nerves are affected and to what degree — small fibre neuropathy may have normal NCS but abnormal skin biopsy.
Blood Tests Panel
HbA1c (diabetes), B12, folate, TSH, FBC, renal function — the most cost-effective initial investigation panel for peripheral neuropathy.
Foot Examination
Detailed foot examination: monofilament test, vibration, temperature, and inspection for wounds — particularly critical in diabetic patients.
Your Treating Specialist
Sri Anand Child and Neuro Center, Chanda Nagar, Hyderabad
In-house EEG and NCS — same-visit diagnosis, no referral delays
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Sri Anand Child & Neuro Hospital · Open 24/7 · Chanda Nagar, Hyderabad