Why are my toes numb?

You sit cross-legged for too long, and that familiar feeling of pins and needles starts to creep in after your foot falls asleep. But what about a total loss of feeling, like numbness in the toes? Numb toes can happen for a variety of reasons. Sometimes, numbness in your toes is a temporary issue caused by ill-fitting shoes or spending too long out in the cold. But chronic toe numbness can be a sign of an underlying health condition like uncontrolled diabetes, circulatory problems, or nerve or spinal cord issues.

Why are my toes numb?

Toe numbness is a symptom, not a diagnosis. Meaning, there are several different causes.

Sometimes, toe numbness is simply a temporary response to wearing too-tight shoes or being outside in cold, wet weather. Your toes might also feel numb if your foot falls asleep after sitting in the same position for too long. The medical term for a limb “falling asleep” is paresthesia, which occurs when a nerve is compressed. 

Several underlying medical conditions can cause ongoing or frequent toe numbness. These causes typically fall under three general categories, according to Hannah Machemehl, MD, a neuromuscular neurologist with Austin Neuromuscular Center:

• Nerve damage in the feet (peripheral neuropathy)
• Impaired circulation
• Issues with the lower back or spinal cord 

Sometimes, toe numbness can also occur as a result of a nutrient deficiency or an indirect result of lifestyle-related factors such as alcoholism.

Physical causes

Toe numbness can develop in response to physical issues or lifestyle factors such as:

• Frostbite or exposure to extreme cold
• Morton’s neuroma, which is tissue thickening around nerves in the feet that occurs in response to pressure or injury
• Wearing high heels or tight shoes
• Ill-fitting inserts or orthotics
• Broken toe
• Untreated bunions, which are painful, bony bumps on the big toe that could lead to nerve damage

Peripheral neuropathy

Peripheral neuropathy refers to damage to the peripheral nervous system, which comprises the network of nerves outside your brain and spinal cord. It most often affects the peripheral nerves in the feet and legs.

“The number one cause of neuropathy is diabetes,” says Troy S. Watson, MD, founder of The Foot and Ankle Institute and director of The Las Vegas Orthopaedic Foot and Ankle Fellowship.

Diabetic neuropathy usually occurs when blood sugar levels are high for a long time. High blood sugar causes inflammation, which can eventually damage the nerves in your feet and lead to unexplained foot pain or toes that feel numb.

Though diabetes is the most common cause of neuropathy, it’s not the only culprit. For instance, Guillain-Barré syndrome, an autoimmune condition that occurs when the body’s immune system attacks its own nerves, can cause peripheral neuropathy. Causes of neuropathy can also include autoimmune diseases like rheumatoid arthritis, nutrient deficiencies, medication toxicity (such as chemotherapy), genetics, and age-related changes, says Dr. Machemehl.

Circulatory issues

“Toe numbness may also be due to impaired circulation or reduced blood flow to the feet,” Dr. Machemehl explains. Many conditions can cause clogged or impaired blood vessels, including:

• Peripheral artery disease (PAD)
• Peripheral vascular disease
• Raynaud’s phenomenon
• Uncontrolled high blood cholesterol and hypertension (high blood pressure), which can lead to PAD

Nervous system conditions 

Medical conditions that impact the nervous system may damage the nerves in your feet or affect the nerves’ ability to communicate sensation. Multiple sclerosis is a nervous system disorder that often causes toe numbness. 

Issues with the lower back or spinal cord

“The sensation from the feet travels through the spinal cord and back,” says Dr. Machemehl. Thus, problems with the lower back or spinal cord can sometimes lead to numbness in the toes.

These causes can include pinched nerves or narrowing of the bones surrounding the spinal cord and nerve roots (formally known as spinal stenosis). 

Other causes

Sometimes, nutrition deficiencies or hormone imbalances can cause seemingly unrelated symptoms. One of those symptoms is toe numbness. Dr. Watson says other indirect causes of numb toes may include:

• Alcoholism
• Vitamin B12 deficiency
• Folate deficiency
• Thyroid dysfunction 

When should I be worried about numbness in my toes?

“Toe numbness can be serious in some instances or not be a cause for concern in others,” Dr. Machemehl says. So, how do you know if it’s a cause for immediate concern? Both experts agree if you experience the following symptoms, you should seek urgent medical attention:

• Numbness that is severe and comes on suddenly
• Numbness accompanied by pain, redness, ulcerations, swelling, or weakness

Outside of that, if you are experiencing chronic toe numbness, it’s time to make an appointment with your primary healthcare provider or podiatrist. Chronic numbness is most likely linked to neuropathy, according to Dr. Watson. Left untreated, toe neuropathy could lead to undiscovered foot and ankle problems such as sores or burns. 

How is the cause of numb toes diagnosed?

Healthcare providers typically diagnose the cause of numb toes through a physical examination and a review of medical history. If an underlying medical cause is suspected, some testing will also be necessary.

The first step is for your healthcare provider to determine whether your toe numbness is chronic or caused by external factors such as footwear or temperature. Be prepared to answer questions about when the numbness started, whether the onset was gradual or sudden, and how often you notice it. Your healthcare provider will also want to know if your toe numbness is accompanied by any other symptoms of nerve damage or blood supply issues. 

After discussing your symptoms and physically examining your feet, your provider will probably order some tests, which Dr. Machemehl says could include:

• Blood tests
• Ultrasound testing to assess blood flow in the legs
• An MRI
• Electrical testing to measure nerve signals

She adds that depending on other symptoms, your provider may also perform a biopsy or genetic testing.

How long does numbness in the toes last?

How long toe numbness lasts depends on the underlying cause. If numbness is caused by a temporary external factor such as tight shoes or cold temperatures, the sensation should return when the cause is removed. If toe numbness has become a chronic problem, then it’s time to consult with a healthcare provider. It can last until the underlying issue is treated, but not all instances of toe numbness can be reversed.

How to stop numbness in toes

How to treat numb toes will depend on the underlying cause. For instance, Raynaud’s treatment options may include prescription medications like calcium channel blockers, while peripheral diabetic neuropathy treatments may include controlling high blood sugar or taking medication, such as Lyrica (pregabalin) or a serotonin-norepinephrine reuptake inhibitor (SNRI) such as Cymbalta (duloxetine). 

If your symptoms are not caused by an underlying medical condition that requires treatment, potential numb toes treatments include:

• Avoiding extreme cold
• Swapping high heels or tight shoes for well-fitted footwear with cushioning
• Seeing a foot and ankle specialist or physical therapist for an insole fitting

Beyond that, you’ll need to exercise caution with ongoing numbness. “With neuropathy, you cannot feel what a ‘normal’ foot can—this increases your risk of stepping on an item and not realizing it,” Dr. Watson says. He suggests that patients with numb toes take extra special care of their feet to prevent further damage and complications by:

• Wearing shoes whenever possible.
• Examining the bottoms of your feet regularly for new wounds or areas of irritation.
• Checking the water with your hand or a body part with normal sensation before stepping into a bath.

Bottom line: Seek treatment for chronic toe numbness 

Numb toes causes may include ill-fitting shoes, diabetic neuropathy, circulatory issues, nerve compression, and more. The cause of numb toes may resolve on its own without medical treatment. However, if numb toes continue, worsen, or are accompanied by inflammation, swelling, or general weakness, it could be a sign of a more serious condition and require prescription medication treatment. Only your healthcare provider can determine the cause, evaluate for associated serious health conditions, and rule out complications like infection. Visit your healthcare provider to determine the best treatment for numb toes.