From the Guidelines
Numbness in toes is most commonly caused by nerve damage (neuropathy), poor circulation, or compression of nerves, with diabetes being a leading cause due to prolonged high blood sugar levels damaging nerves, as supported by the most recent evidence 1. The causes of numbness in toes can be multifactorial, including:
- Nerve damage (neuropathy) due to diabetes, vitamin deficiencies (particularly B12), alcoholism, injuries, infections, autoimmune disorders, and medication side effects
- Poor circulation, which can be a result of peripheral arterial disease (PAD) or other vascular conditions
- Compression of nerves, which can occur due to tight footwear, prolonged sitting or standing, or conditions like Morton's neuroma Treatment depends on the underlying cause and may include:
- Blood sugar management for diabetics
- Vitamin supplements for deficiencies
- Physical therapy
- Medication adjustments For temporary relief, gentle massage, warm foot soaks, and avoiding tight shoes can help. Numbness occurs because sensory nerves in the toes become damaged or compressed, interrupting normal signal transmission to the brain. If toe numbness persists or worsens, medical evaluation is important as it could indicate serious conditions requiring prompt treatment, as highlighted in the standards of care in diabetes-2023 1 and standards of care in diabetes-2025 1. Regular foot examinations, as recommended in the preventive foot care guidelines 1, can help identify high-risk foot conditions and prevent complications. Additionally, the importance of foot monitoring, proper foot care, and selection of appropriate footwear cannot be overstated, as emphasized in the position statement on preventive foot care in people with diabetes 1. Overall, a comprehensive approach to managing numbness in toes involves addressing the underlying cause, providing temporary relief, and preventing future complications, with the most recent and highest quality evidence guiding clinical decision-making 1.
From the Research
Causes of Numbness in Toes
- Numbness in toes can be caused by various factors, including:
- Diabetic peripheral neuropathy, a common complication of diabetes mellitus that can cause nerve damage and numbness in the feet and toes 2
- Peripheral neuropathy, which can be caused by nerve compression or injury, alcohol use, toxin exposure, hereditary diseases, and nutritional deficiencies 3
- Cardiovascular diseases, such as heart failure, myocardial infarction, peripheral vascular disease, stroke, deep venous thrombosis, and pulmonary embolism, which can be associated with the use of certain medications like gabapentin and pregabalin 4
Risk Factors
- Certain risk factors can increase the likelihood of developing numbness in toes, including:
- Poor glycemic control, vitamin B12 deficiency, elevated blood pressure, and obesity, which can contribute to the development of diabetic peripheral neuropathy 2
- Age, with higher rates of peripheral neuropathy among those older than 50 years 3
- Use of certain medications, such as gabapentin and pregabalin, which can cause fluid retention and increase the risk of cardiovascular diseases 4
Diagnosis and Treatment
- Diagnosis of numbness in toes typically involves a comprehensive history, physical examination, and judicious laboratory testing, including electrodiagnostic studies and nerve biopsy 3
- Treatment of numbness in toes focuses on managing the underlying etiology, and may include medications like gabapentin, pregabalin, and duloxetine to alleviate neuropathic pain 2, 5, 6
- Comparative studies have shown that duloxetine and pregabalin are effective in treating diabetic peripheral neuropathy, while gabapentin and oxcarbazepine may have varying degrees of efficacy and safety 5, 6