Burning feet that flare at night are most often a sign of small fibre neuropathy, in which the thin nerve fibres carrying pain and temperature signals are damaged before the larger fibres. Diabetes and prediabetes are the commonest causes in Las Vegas, followed by vitamin B12 deficiency, thyroid disease, alcohol and certain medications. About a third of cases have no identified cause even after a full workup.
Burning feet that flare at night are most often a sign of small fibre neuropathy, in which the thin nerve fibres carrying pain and temperature signals are damaged before the larger fibres. Diabetes and prediabetes are the commonest causes in Las Vegas, followed by vitamin B12 deficiency, thyroid disease, alcohol and certain medications. About a third of cases have no identified cause even after a full workup.
Three things stack up in the evening. Competing sensation drops away, so a signal that was drowned out by walking, shoes and daytime activity becomes the loudest thing you can feel. Bedding traps heat against the skin, and damaged small fibres misread warmth as burning. Pain thresholds also fall late in the day. None of that means the nerve damage worsens overnight; it means the same damage is easier to notice. Patients often describe it as the feeling arriving the moment they lie still, which is a description of attention, not of progression.
Restless legs feels like an urge to move that eases when you move, which burning neuropathy does not. Tarsal tunnel syndrome burns in one foot along the sole rather than symmetrically in both. Peripheral artery disease causes cramping pain on walking that stops at rest, the reverse of this pattern. Plantar fasciitis hurts on the first steps in the morning. Sorting these out is a clinical job done on history and examination before any test is ordered.
This is the part patients are rarely warned about. EMG and nerve conduction studies measure large myelinated fibres. In pure small fibre neuropathy those fibres are intact, so the study can be entirely normal while the symptoms are real. A normal result is still worth having, because it rules out the large fibre and root problems that need different management, and because it is the study that identifies a treatable entrapment. Both offices run AANEM-accredited electrodiagnostic laboratories, and the neurologist who orders the study is the one who interprets it.
The reason to look for a cause is that several causes are correctable. Blood glucose and HbA1c, vitamin B12 with methylmalonic acid if the level is borderline, thyroid function and a serum protein electrophoresis cover most of the treatable ground. A medication review matters too, since some chemotherapy agents and a handful of common drugs are neurotoxic. Where a cause is found and corrected, progression usually slows; established damage recovers slowly if at all, which is the argument for looking early rather than waiting a year.
Clinical Neurology Specialists has been physician-owned since 1998, when Leo Germin, M.D., FAANEM founded it. Five board-certified neurologists and four advanced practice providers see patients at the Las Vegas and Henderson offices, each with its own AANEM-accredited electrodiagnostic laboratory.
Clinical Neurology Specialists is an adult outpatient neurology practice for patients 18 and older. The practice performs no surgery and operates no imaging suite, infusion suite or interventional pain programme, and provides no emergency or inpatient care.
Physician-reviewed. Reviewed by the physicians of Clinical Neurology Specialists — board-certified neurologists, AANEM-accredited electrodiagnostic laboratories, physician-owned since 1998. Reviewed 1 August 2026. This article is general education for adults 18 and older and is not a substitute for a consultation.
Sources and further reading: MedlinePlus: peripheral nerve disorders; MedlinePlus: numbness and tingling; National Institute of Neurological Disorders and Stroke.
Adults 18 and older, at the Las Vegas and Henderson offices. Call 702-804-1212 or request an appointment online.