Several factors can contribute to burning feet night.
Burning feet is nearly always a nerve problem, but the reason the nerves are affected differs from person to person. The list below runs from the most common explanations to the rarer ones, with the prevalence figures doctors actually use when weighing up the possibilities.
The most common cause of burning feet in Western countries. About a third to a half of people with diabetes develop neuropathy, and the risk rises with how long the diabetes has been present and how well blood sugar is controlled. High glucose damages the tiny blood vessels (vasa nervorum) that supply the nerves, and it triggers chemical stress inside the nerve cells themselves. The feet are affected before the hands because their nerve fibres are the longest in the body. Around half of people with diabetic neuropathy have no symptoms at all, which is why burning or tingling in the feet can be the first clue that blood sugar control has slipped.
Long-term heavy drinking damages nerves in two ways: alcohol is directly toxic to nerve cells, and it interferes with absorption of thiamine (vitamin B1) and other B vitamins that nerves need. Studies put the rate of peripheral neuropathy among chronic heavy drinkers at 25–66%. The burning usually starts in the feet and can spread upward over years. Because this cause is reversible, the single most effective step is stopping or sharply reducing alcohol intake, ideally with medical support.
B12 is essential for the fatty myelin sheath that insulates nerves, and deficiency causes a "dying-back" neuropathy that begins with tingling and burning in the feet. About 6% of people under 60 and up to 20% of people over 60 are deficient. Strict vegans, people with pernicious anaemia, and anyone taking long-term proton-pump inhibitors (acid-reflux drugs) or metformin are at higher risk. B12 deficiency is easily diagnosed with a blood test and responds well to supplements, which is why it is always worth ruling out.
The tibial nerve runs behind the ankle bone and into the sole of the foot through a tight fibro-osseous tunnel. Flat feet, ankle swelling, or a ganglion cyst can compress it, producing burning or tingling on the sole that worsens with prolonged standing or walking and eases with rest and elevation. Unlike most neuropathies it is usually one-sided and confined to the foot, which is a useful clue. Tapping over the nerve (Tinel's sign) often reproduces the burning sensation.
Narrowed arteries from atherosclerosis reduce blood flow to the feet — about 8–12% of adults have PAD, rising to roughly 20% after age 70, and smokers are at markedly higher risk. Nerves are highly sensitive to oxygen shortage, so ischaemia can feel like burning even though the skin feels cool to touch. Classic warning signs are cramping calf pain when walking that eases with rest, and feet that turn pale when raised and red when lowered. PAD matters because it is a marker of heart and stroke risk, not just a foot problem.
An underactive thyroid (hypothyroidism, affecting roughly 5% of the population) slows nerve repair and is a recognised cause of burning feet. Iron-deficiency anaemia reduces oxygen delivery to nerves, and chronic kidney disease allows uraemic toxins to accumulate and poison nerve fibres. All three are picked up easily with blood tests, and treating the underlying condition often improves the burning within weeks to months.
Erythromelalgia (about 1–3 per 100,000 people) causes intense burning, redness, and heat in the feet that is triggered by warmth and relieved by cooling. Small-fibre neuropathy selectively damages the tiny nerve endings that carry pain and temperature signals, producing burning without any visible skin change; it is diagnosed with a skin biopsy that counts nerve endings under the microscope.
The underlying cause determines the treatment. Diabetic neuropathy slows or stops when blood sugar is controlled; B12 deficiency is reversible with supplements; alcohol neuropathy improves with abstinence; and PAD may need medication or vascular procedures. Left untreated, neuropathy can progress from burning to complete numbness, which is dangerous because injuries then go unnoticed and can become infected. Not sure which applies to you? Check the symptoms guide or go straight to when to see a doctor.
Most of the causes above are manageable, but each has a version that should not be waited out:
If any of these fit, use the Doctor page rather than working through the list on your own.