Tingling in hands and feet: causes, red flags and when to get it checked

Tingling that affects both hands and both feet suggests the longest nerves are being irritated, as they are most sensitive to metabolic and toxic stresses. This is different from tingling in one hand, which often reflects a pinched nerve at the wrist or neck. A stocking-and-glove pattern is characteristic.

• Diabetes and prediabetes: often starts in the feet, with burning or numbness, and may be present before diabetes is diagnosed.

• Vitamin B12 or folate deficiency: from poor intake, pernicious anaemia, metformin or acid-reducing medicines, with fatigue and sometimes memory changes.

• Alcohol excess and poor nutrition.

• Medicines and toxins: some chemotherapy drugs, nitrofurantoin, amiodarone, isoniazid, and certain statin-related reports; also heavy metal exposure.

• Underactive thyroid and kidney disease.

• Hyperventilation and anxiety, which cause tingling in the hands and around the mouth that comes in episodes.

• Autoimmune and inflammatory neuropathies, including Guillain-Barre syndrome and chronic inflammatory neuropathy.

• Inherited neuropathies, vasculitis, paraproteinaemia and, rarely, spinal cord problems.

Rapid progression over days, weakness or difficulty climbing stairs, loss of balance, bladder or bowel changes, tingling that rises up the trunk, or unexplained weight loss and night sweats need quicker investigation than slowly progressive numbness.

• Call 999 or go to A&E: tingling with weakness spreading rapidly, difficulty breathing or swallowing, new loss of bladder or bowel control, or numbness between the legs.

• Same-day GP or NHS 111: ascending tingling and leg weakness over days, or tingling with sudden facial droop or speech difficulty (call 999 for the latter).

• GP within a week or two: symmetric, progressive tingling lasting more than a few weeks.

• Routine GP: intermittent tingling with anxiety or a clear posture trigger.

Your doctor will ask when it began, which parts are affected, whether it is burning or numb, alcohol intake, diet, medicines, family history and diabetes risk. Examination includes testing light touch, pinprick, vibration and position sense in the feet, ankle reflexes, strength, and balance with eyes closed.

• Blood tests: glucose or HbA1c, vitamin B12 and folate, kidney, liver and thyroid function, full blood count and inflammatory markers.

• Protein electrophoresis: looks for abnormal proteins that can damage nerves.

• Nerve conduction studies and electromyography: show whether the damage is in the nerve or its coating and how severe it is.

• MRI of the spine or lumbar puncture: for suspected spinal or inflammatory causes.

Check your feet daily if you have numbness, wear well-fitting shoes, and avoid very hot water. Cut back alcohol and keep blood sugar well controlled if you have diabetes. Do not self-treat with high-dose supplements without checking levels, because excess vitamin B6 can itself cause neuropathy.

The NHS route is a GP, then neurology for unexplained cases. Private neurology consultations and nerve conduction studies are accessible directly and often shorten the wait for the tests.