Tingling in the Hands and Feet: What It Means and When to Worry

What tingling is

Tingling, pins and needles, buzzing and prickling — medically, paresthesia — are the sensations produced when a sensory nerve fires abnormally. The nerve may be compressed, short of blood, chemically irritated or damaged. Brief, position-related tingling that resolves within minutes of moving is a normal response to pressure on a nerve and needs no attention. Tingling that is persistent, recurrent or spreading is a symptom with a cause.

Reading the pattern

Where the tingling is, and whether it is symmetrical, is the most useful clue.

Both feet, then legs, then hands — symmetrical

This "stocking and glove" pattern is the signature of peripheral neuropathy: damage to the longest nerve fibres first. The commonest causes are:

• Diabetes and prediabetes — tingling in the toes is often the first sign of diabetic neuropathy, and sometimes the first sign of diabetes itself
• Vitamin B12 deficiency — can produce tingling with unsteadiness and, later, memory problems; easily tested and treated
• Alcohol
• Chemotherapy
• Hypothyroidism, kidney disease
• Medications including some antibiotics and high-dose vitamin B6

One hand — thumb, index and middle fingers

Carpal tunnel syndrome: the median nerve is compressed at the wrist. Tingling and numbness in the thumb, index, middle and half the ring finger, worse at night and with gripping, sometimes with weakness of the thumb. More common in pregnancy, diabetes, hypothyroidism, obesity and with repetitive hand work.

One hand — little finger and ring finger

Ulnar neuropathy at the elbow ("cubitus tunnel"), from leaning on the elbow or a bent-elbow sleeping position, or at the wrist in cyclists.

One foot — top of the foot and outer shin, with foot drop

Peroneal nerve compression at the outside of the knee, from crossing the legs, squatting, a tight cast or rapid weight loss.

Thigh, outer side

Meralgia paraesthetica: compression of a skin nerve at the groin by a belt, tight clothing, pregnancy or weight gain.

Around the mouth and fingertips, with rapid breathing

Hyperventilation from anxiety or panic. Also seen with low calcium (after thyroid surgery, for example), which adds muscle cramps and twitching.

One side of the body, sudden

Tingling or numbness affecting the face, arm and leg on one side, arriving over seconds to minutes, particularly with weakness, facial droop, speech difficulty or visual loss, is a stroke or transient ischaemic attack until proved otherwise. Migraine with aura can cause spreading tingling on one side over 20–30 minutes, usually followed by headache, and is a diagnosis made only after stroke has been excluded the first time.

A band around the trunk, or below a certain level

Suggests a spinal cord problem — compression, inflammation (as in multiple sclerosis), or B12 deficiency affecting the cord — and needs prompt neurological assessment.

Travelling down one arm or leg from the neck or back

A pinched nerve root from a disc prolapse or arthritis in the spine (radiculopathy): pain and tingling following a strip of skin down the limb, often with neck or back pain.

Other causes

Multiple sclerosis (tingling that comes in episodes, often with other neurological symptoms); Raynaud's phenomenon (tingling and colour change in cold fingers); shingles (tingling in a strip of skin before the rash); Guillain-Barré syndrome (tingling in feet and hands followed by ascending weakness over days — an emergency); nerve injury from trauma or surgery; and occasionally, a first sign of Lyme disease, HIV, lupus or Sjögren's syndrome.

What a doctor will do

Take a history of the pattern and timing; examine sensation, strength, reflexes and balance; check blood pressure lying and standing; and order blood tests — usually glucose or A1C, vitamin B12, thyroid function, kidney function and a blood count as a first screen. Nerve conduction studies confirm and localize nerve compression or neuropathy; MRI is used for suspected spinal or brain causes.

What helps

Treatment follows the cause: glucose control, B12 replacement, stopping alcohol or the responsible medication, wrist splints and sometimes surgery for carpal tunnel, avoiding elbow pressure for ulnar neuropathy, and so on. For persistent neuropathic tingling and pain, medications such as duloxetine, pregabalin and amitriptyline help. For anxiety-related tingling, slow breathing resolves the episode and treating the anxiety prevents recurrence.

When to see a doctor

Arrange an appointment for tingling that lasts more than a week or two, keeps returning, spreads, affects both feet, or comes with numbness, weakness or unsteadiness. Seek emergency care for sudden one-sided tingling with weakness, facial droop or speech difficulty; for tingling with rapidly progressive weakness; for tingling below a level on the body with bladder or bowel changes; or for tingling after a head or neck injury.

Frequently asked questions

References