Why do my feet tingle at night?

Tingling, prickling, or a “pins and needles” feeling in the feet that shows up or gets worse at night is a common complaint. This article covers what the National Institutes of Health and MedlinePlus say about why it can feel worse at night, the usual causes, and when to get it checked.

Why tingling can feel worse at night

Night is when many people first notice nerve symptoms in their feet. The National Institute of Diabetes and Digestive and Kidney Diseases describes peripheral neuropathy this way: you may feel “burning or tingling, like ‘pins and needles,’ in your feet,” and “symptoms are often worse at night.” The National Institute of Neurological Disorders and Stroke (NINDS) adds that these symptoms can be “worse at night, disrupting sleep.”

The feet are often affected first. NINDS explains that most neuropathies are “length-dependent,” meaning the nerve endings farthest from the brain “(those in the feet) are where the symptoms develop first or are worse.”

Common causes of tingling feet at night

Pressure and position

Not all tingling points to a problem. MedlinePlus lists staying in one position for a long time, or putting pressure on a body part, among the common causes of numbness and tingling.

Peripheral neuropathy

Peripheral neuropathy is damage to the nerves outside the brain and spinal cord. NINDS calls diabetes “the leading cause of peripheral neuropathy in the U.S.” and notes that about two thirds of people with diabetes have nerve problems that “can cause numb, tingling, or burning feet.” NIDDK puts it at up to one-half of people with diabetes.

Diabetes is not the only cause. NINDS also names nutritional or vitamin imbalances, alcoholism, exposure to toxins, and some medications. In its words, “Vitamin B12 deficiency and excess vitamin B6 are the best-known vitamin-related causes.”

Restless legs syndrome

Some night-time leg sensations are not nerve damage at all. NINDS describes restless legs syndrome (RLS) as an urge to move the legs along with uncomfortable sensations that “may feel like aching, throbbing, pulling, itching, crawling, or creeping.” People with RLS “commonly feel symptoms in the late afternoon or evening hours,” and moving or walking “typically provides temporary relief.” NINDS notes that low iron levels in the brain may play a role.

When to see a doctor

MedlinePlus advises contacting your health care provider if numbness or tingling has no obvious cause, if leg numbness or tingling gets worse when you walk, or if it comes with other unusual symptoms such as dizziness or muscle spasms.

Get emergency care right away if numbness or tingling comes with weakness or trouble moving, follows a head, neck, or back injury, or comes with loss of bladder or bowel control, confusion, slurred speech, or vision changes. MedlinePlus lists these as reasons to call 911.

If you have diabetes, NIDDK recommends a thorough exam of the feeling in your feet and legs “at least once a year.”

What your doctor may ask and check

NINDS says a doctor will usually start by asking about:

• Your symptoms, and what makes them better or worse through the day
• Your work environment, habits, and alcohol use
• Exposure to toxins and risk of infection
• Family history of neurological conditions

Blood tests can show whether diabetes, a vitamin deficiency, or a liver or kidney problem is involved. Before your visit, write down when the tingling starts, how long it lasts, and what you were doing, and bring a list of every medicine and supplement you take. MedlinePlus also cautions against stopping or changing medicines, or taking large doses of vitamins or supplements, without talking to your provider first.

Sources

• National Institute of Neurological Disorders and Stroke, “Peripheral Neuropathy”
• National Institute of Diabetes and Digestive and Kidney Diseases, “Peripheral Neuropathy”
• National Institute of Neurological Disorders and Stroke, “Restless Legs Syndrome”
• MedlinePlus, “Numbness and tingling”