Numbness and Tingling

Brief pins and needles from sitting awkwardly is universal and means nothing. Numbness or tingling that persists, spreads, or comes with weakness is a different matter.

The reason it is worth acting on rather than tolerating is specific: some causes of nerve damage — B12 deficiency in particular — are fully reversible early and become permanently less so the longer they continue.

Deficiency — B12 deficiency is the one that matters most. It causes numbness in the hands and feet, a sensation of walking on cotton wool, and balance problems. The neurological damage does not always reverse, which is why finding it early matters. Long-term metformin and omeprazole both deplete B12 and are routinely overlooked as causes.

Diabetes — diabetic neuropathy typically starts in the feet, symmetrically, and is sometimes the first sign of undiagnosed diabetes.

Compression — carpal tunnel syndrome, causing numbness in the thumb and first three fingers, worse at night; ulnar nerve compression at the elbow; sciatica from a disc.

Other — underactive thyroid; alcohol; hyperventilation, which causes tingling around the mouth and in both hands; and less commonly multiple sclerosis, particularly in a younger person with other neurological symptoms.

The distribution is the key question, and it is answerable remotely: both sides or one, hands or feet or both, which fingers specifically, and whether it follows a nerve or a glove-and-stocking pattern. That alone separates carpal tunnel from a peripheral neuropathy from something central.

We arrange B12 and folate — including active B12 where the result is borderline, which resolves a great many uncertain cases — plus HbA1c, thyroid function, full blood count and kidney function.

What we cannot do is test your reflexes, power or sensation. Where the examination would change the answer — and for anything progressive it does — we arrange neurology referral rather than managing it remotely.

Could this be a stroke?

If it came on suddenly and affects one side of the body, treat it as one and call 999. The features are face drooping on one side, arm weakness, and speech that is slurred or muddled — and the crucial point is time, because treatment is far more effective in the first hours.

Numbness that comes on over minutes and resolves within an hour is not "nothing" — that may be a transient ischaemic attack, which carries a high risk of a full stroke in the following days and needs urgent assessment, not relief.

By contrast, numbness developing gradually over weeks, or affecting both sides symmetrically, is not a stroke.

Is it carpal tunnel syndrome?

Likely, if the tingling affects the thumb, index and middle fingers of one hand, wakes you at night, and improves when you shake or hang the hand down. It is caused by compression of a nerve at the wrist and is more common in pregnancy, in an underactive thyroid, and in diabetes.

A wrist splint worn at night resolves it for many people, and a steroid injection or a short day-case operation deals with the rest. It is one of the more satisfying problems in medicine — clearly diagnosed and reliably fixed.

Both my feet are tingling. What does that suggest?

A peripheral neuropathy — nerve damage affecting the longest nerves first, which is why it starts in the feet and creeps upward, often reaching the hands only much later. It is typically symmetrical and gradual.

The commonest causes are diabetes, B12 deficiency, alcohol, thyroid disease and certain medications, and several of them are correctable if caught before the damage becomes fixed — which is the argument for testing sooner rather than later.

Could my metformin or omeprazole be causing it?

Yes — and this is one of the most commonly missed causes of tingling feet. Long-term metformin, and long-term proton pump inhibitors such as omeprazole and lansoprazole, both reduce B12 absorption over years. Neither should be stopped for it; the B12 is simply replaced.

Have your B12 checked before starting any supplement, since taking it first makes the deficiency undetectable while any nerve damage continues.

Could this be MS?

It is a common worry and an uncommon answer. The pattern that raises the question is neurological symptoms that come and go in different parts of the body over time — numbness in one limb lasting weeks then resolving, blurred or painful vision in one eye, balance problems, or symptoms that worsen distinctly in heat.

Tingling in both feet, or in one hand at night, is far more likely to be neuropathy or carpal tunnel. Where the pattern does fit, an MRI and a neurology opinion give a definite answer, and we can arrange both.

What is cauda equina syndrome, and why is it emphasised so strongly?

Because it is the one back-related emergency where hours genuinely matter. It occurs when the nerves at the base of the spine are compressed, and the warning signs are: numbness in the saddle area, difficulty starting or feeling the flow of urine, incontinence of urine or stool, numbness or weakness in both legs, and new loss of sexual sensation.

Any of these means A&E immediately, not an appointment. Delay causes permanent loss of bladder, bowel and sexual function, and it is one of the few situations where being wrong costs you an evening while being right costs you your future.

What tests would you arrange?

HbA1c, B12 and folate, thyroid function, full blood count, kidney and liver function, inflammatory markers and ferritin — which identify most treatable causes. Where a structural cause is likely we arrange an MRI, and nerve conduction studies via neurology referral where the diagnosis needs confirming.

Will the feeling come back?

It depends on cause and duration. Nerve compression released early — carpal tunnel treated, a B12 deficiency corrected — usually recovers well, though nerves regenerate slowly and it can take months. Long-standing neuropathy from years of high blood glucose or alcohol often stabilises rather than reverses, which is precisely why the tests are worth doing early rather than after another year of waiting.