Telling the common causes apart
Diabetes nerve damage
Both feet, starting in the toes and creeping up, like a sock. Burning, pins and needles or numbness, often worse at night. Later the hands can be affected too.
Pressed nerve in the back
Usually one leg. Pain runs from the back or buttock down the leg, often below the knee, with tingling in part of the foot. Often worse on sitting, bending or coughing.
Narrow spinal canal
Both legs feel heavy, painful or tingly after walking a short distance, and ease on sitting or bending forward.
Other causes
Low vitamin B12 (more common on long-term metformin and in vegetarians), thyroid problems, kidney disease, alcohol, some medicines and, rarely, others.
Go to hospital the same day if
- numbness between the legs, or trouble passing urine or stool
- numbness or weakness spreading quickly over days, especially up both legs
- weakness with trouble breathing or swallowing: call 108
See a doctor soon if
- weakness in the legs, a foot that drags, or falls: within days
- a wound, blister, colour change or swelling on a numb foot: the same day
Tests
- Foot sensation test with a monofilament and tuning fork, at the clinic
- Nerve conduction study (NCS): measures how well the nerves carry signals. Helps tell diabetes nerve damage from a pressed nerve. Done at Caspian
- Blood tests: sugar, HbA1c, vitamin B12, thyroid and kidney tests, done 24 hours by Caspian Diagnostic Centre in the same building
- MRI of the spine if a pressed nerve is suspected. Arranged at Vijaya Diagnostic
Looking after numb feet
- Look at your feet every day, including the soles and between the toes. Use a mirror or ask someone.
- Never walk barefoot, even at home or in a place of worship if you can avoid it.
- Test bath water with your elbow, not your foot.
- Wear soft, well-fitting footwear and check inside for stones before putting it on.
- Keep your sugar in your target range.
Check your own risk with our free foot risk tool, and read about the diabetic foot. For back and leg pain, read back pain and sciatica.
At Caspian, Dr. Mohammed Imran sees the spine and nerve side, and our diabetes team sees the sugar and foot side, in the same building.
See Dr. Imran at Caspian
Dr. Mohammed Imran, Neurosurgeon & Spine Surgeon. MBBS, MS (General Surgery), MCh (Neurosurgery), Gandhi Medical College. Telangana Medical Council 60634.
Monday to Saturday, 4 to 5 pm. Walk in, no appointment needed. Consultation ₹600, valid for 6 days or 2 visits, whichever comes first.
Bring any MRI, CT or X-ray you have had (the films or CD and the written report), and the list of every medicine you take.
Common questions
Can diabetic nerve damage be reversed?
Damage that has already happened usually cannot be fully reversed, but good sugar control slows or stops it getting worse, and medicines can ease burning pain. Early nerve changes improve more than late ones.
Which medicines help burning feet?
Several medicines made for nerve pain help, such as pregabalin, duloxetine and amitriptyline. They are started at a low dose and adjusted. Ordinary painkillers help little. Your doctor will choose based on your other conditions.
Can I have both diabetes nerve damage and a back problem?
Yes, and it is common in older people with diabetes. The pattern of symptoms, the examination and a nerve conduction study help work out how much each one is adding.
Does metformin cause B12 deficiency?
Long-term metformin can lower vitamin B12, which can cause or worsen tingling and numbness. People on metformin for several years should have B12 checked from time to time. Do not stop metformin on your own.
Why should I check my feet every day?
Numb feet cannot feel a stone in the shoe, a burn from hot water or a blister. Small injuries can turn into ulcers and infections. A daily look at the soles, between the toes and the heels catches problems early.
Medically reviewed by Dr. Mohammed Imran, Neurosurgeon & Spine Surgeon, Telangana Medical Council 60634. Last reviewed 13 November 2026. General information for patients of Caspian Healthcare: your own doctor’s advice comes first.