Tingling Feet & Neuropathy in Michigan | Causes & Treatment

Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Tingling, burning, numbness, or electric-shock sensations in the feet are symptoms of peripheral neuropathy — damage or dysfunction of the nerves that supply sensation to the feet and lower legs. These symptoms are not only uncomfortable; they reduce protective sensation, increasing the risk of injury, infection, and, in diabetic patients, limb-threatening ulcers. At Balance Foot & Ankle in Southeast Michigan, Dr. Tom Biernacki evaluates neuropathic foot symptoms comprehensively, identifies the underlying cause when possible, and provides targeted management to reduce symptoms and protect foot health.

What Causes Tingling in the Feet?

The most common cause globally is diabetic peripheral neuropathy (DPN) — affecting approximately 50% of patients with long-standing diabetes. But neuropathy has dozens of causes beyond diabetes. Other common etiologies include: alcohol-related neuropathy (chronic excessive alcohol use damages peripheral axons); vitamin B12 deficiency (especially in elderly patients, those on metformin, and vegans/vegetarians); thyroid disease (hypothyroidism causes a symmetric sensorimotor neuropathy); chronic kidney disease (uremic neuropathy); autoimmune conditions (Sjögren’s syndrome, lupus, rheumatoid arthritis); chemotherapy-induced peripheral neuropathy (paclitaxel, cisplatin, vincristine); hereditary neuropathies (Charcot-Marie-Tooth disease); idiopathic small fiber neuropathy (a significant proportion of neuropathies are idiopathic); and localized nerve compression (tarsal tunnel syndrome — compression of the posterior tibial nerve at the medial ankle — is a surgically correctable cause of unilateral tingling in the foot).

Evaluation at Balance Foot & Ankle

Dr. Biernacki performs sensory screening with a 10-gram Semmes-Weinstein monofilament (loss of protective sensation testing), vibration threshold testing with a 128 Hz tuning fork, and 2-point discrimination. These rapid in-office tests characterize the type and severity of sensory loss. When the pattern or severity suggests a cause beyond routine DPN, appropriate referrals are made — to neurology for electrodiagnostic studies (nerve conduction velocity, EMG), to endocrinology for metabolic contributors, or to vascular surgery for arterial insufficiency evaluation. Tarsal tunnel syndrome, as a compressive cause of unilateral foot neuropathy, is assessed with percussion (Tinel’s sign) at the posterior tibial nerve and may be confirmed with nerve conduction studies or ultrasound of the nerve at the tarsal tunnel.

Treatment Approaches

Treatment targets the underlying cause first: optimizing blood sugar control for DPN, correcting B12 deficiency, treating thyroid disease, addressing alcohol use disorder. Symptomatic treatment for neuropathic pain includes gabapentin (Neurontin), pregabalin (Lyrica), duloxetine (Cymbalta — the only FDA-approved medication specifically for diabetic peripheral neuropathic pain), tricyclic antidepressants (amitriptyline), and topical agents (lidocaine 5% patch, capsaicin 8% patch). Alpha-lipoic acid — a potent antioxidant — has evidence for modest symptomatic benefit in DPN. Tarsal tunnel syndrome from nerve compression responds to steroid injection and, when refractory, surgical tarsal tunnel release. Custom orthotics protect the insensate foot by redistributing pressure and reducing callus formation at high-risk sites.

Frequently Asked Questions

Tingling feet deserve a thorough evaluation to identify and treat the cause. Contact Balance Foot & Ankle to schedule with Dr. Biernacki in Southeast Michigan for a thorough neuropathy assessment.

Differential Diagnosis: What Else Could It Be?

Several conditions share symptoms with Diabetic Neuropathy and are commonly misdiagnosed in the first office visit. Considering these alternatives is part of every Balance Foot & Ankle exam:

• Tarsal tunnel syndrome. Burning radiating into the arch with positive Tinel’s at the medial ankle.
• Peripheral artery disease. Pain with walking that resolves with rest, weak pulses, hair loss on toes.
• Lumbar radiculopathy. Symptoms following a dermatome, often with back pain — MRI of spine, not foot.

If your symptoms don’t fit the textbook pattern, ask your podiatrist which differentials they ruled out — that conversation often shortcuts months of trial-and-error treatment.

Most Common Mistake We See

The most common mistake we see is: Stopping B-vitamin supplementation as soon as symptoms improve. Fix: maintain supplementation for 6-18 months alongside strict glucose control.

Warning Signs That Need Same-Day Care

In-Office Treatment at Balance Foot & Ankle

If home treatment isn’t providing relief for your neuropathy, our podiatry team at Balance Foot & Ankle can help with same-day evaluations and advanced in-office care.

Frequently Asked Questions

When should I see a podiatrist?

If symptoms persist past 2 weeks, affect your normal activity, or are accompanied by red-flag symptoms (warmth, redness, swelling, inability to bear weight).

What does treatment cost?

Most diagnostic visits and conservative treatments are covered by Medicare and major insurers. Out-of-pocket costs vary by your specific plan.

How quickly can I get an appointment?

Most non-urgent cases see us within 5 business days. Urgent cases (sudden pain, possible fracture) typically same or next business day.