What causes paresthesia of the foot?

From the Guidelines

Foot tingling can occur due to various causes, but the most concerning cause is peripheral neuropathy, particularly in diabetic patients, as it can lead to significant morbidity and mortality if left untreated 1. The most common symptoms of peripheral neuropathy include burning pain, 'electrical shock' type shooting pain, lancinating pain, uncomfortable tingling, and contact pain brought on by touching daytime socks or stockings or bedclothes at night 1. Some key points to consider when evaluating foot tingling include:

• Temporary pressure on nerves when sitting in certain positions for too long can cause tingling, but more concerning causes include peripheral neuropathy from diabetes, vitamin B12 deficiency, or alcoholism 1.
• Tingling may also result from spinal problems, autoimmune conditions like multiple sclerosis, or injuries 1.
• If tingling is persistent, accompanied by weakness, pain, or spreads to other body parts, medical attention is recommended 1.
• Treatment depends on the underlying cause, and may involve addressing diabetes control, supplementing vitamins (particularly B12 at 1000-2000 mcg daily), physical therapy, or medication adjustments 1.
• For temporary tingling, simply changing position, gentle massage, or walking can help restore normal sensation by improving circulation and relieving pressure on nerves 1. It is essential to note that preventive foot care is crucial in people with diabetes, and annual foot examinations can help identify high-risk foot conditions, such as peripheral neuropathy, altered biomechanics, and evidence of increased pressure 1. Additionally, managing high-risk conditions, such as neuropathy, and preventing further complications, such as ulcers and amputations, is critical in reducing morbidity and mortality in diabetic patients 1.

From the Research

Possible Causes of Foot Tingling

• Diabetic peripheral neuropathy, a condition that occurs in up to 50% of patients with diabetes mellitus, can cause foot tingling due to nerve damage 2
• Multiple sclerosis, a chronic and often disabling autoimmune disease, can also cause abnormal sensations, including foot tingling 3
• Neuropathic pain, which can be caused by nerve damage, can manifest as foot tingling or other abnormal sensations 4, 5
• Certain medications, such as gabapentin and pregabalin, which are commonly used to treat neuropathic pain, can cause side effects including dizziness, somnolence, and peripheral edema, which may contribute to foot tingling 4, 6

Underlying Risk Factors

• Poor glycemic control, vitamin B12 deficiency, elevated blood pressure, and obesity can increase the risk of developing neuropathy, which can cause foot tingling 2
• Certain medical conditions, such as multiple sclerosis and diabetes, can increase the risk of developing neuropathic pain and foot tingling 3, 2

Treatment Options

• Medications such as duloxetine, gabapentin, amitriptyline, and pregabalin can be used to treat neuropathic pain and foot tingling, but may have side effects and may not restore sensation to affected extremities 2
• Nondrug therapies, such as exercise and neuromodulation with spinal cord stimulation or transcutaneous electrical nerve stimulation, may also be effective in treating neuropathic pain and foot tingling 2