7 Things That Happen To Your Feet When Nerve Pain Keeps You Awake — And What Each One Is Actually Telling You
Number 4 is the one nearly every Australian with burning feet has already tried — and it is the one that was never going to reach them.
You can get through the day. That is the thing nobody outside the house understands about nerve pain in your feet.
You walk, you do the shopping, you mind the grandkids. And then you lie down, and about twenty minutes later your feet start. Burning, or pins and needles, or that sensation people describe as ants, or wire, or standing on hot sand.
So you get up. You walk to the kitchen. You stand on the tiles because they are cold. And somewhere around three you fall asleep in the chair.
Here are seven things that are happening to your feet, in the order most people meet them. Six of them are worth knowing. The seventh is the one underneath all six, and it has a name almost nobody has been given.
Your Feet Burn Worse The Moment You Lie Down
This is the detail that makes people think they are imagining it. All day, nothing much. Lights out, and within half an hour your feet are alight.
It is not in your head and it is not the bed. Two things change when you lie down. There is no longer any pressure, movement or temperature coming up from the floor, so the only signal your brain has left coming out of your feet is the faulty one. And your skin warms up under the covers, which makes a nerve ending that is already firing fire faster.
The reason the cold tiles help is the same reason in reverse. You have not fixed anything. You have turned the volume down for four minutes.
A Bedsheet Starts To Feel Like Sandpaper On Your Feet
A sheet weighs almost nothing. It should register as nothing.
When a nerve ending is already firing, a light touch lands on top of a signal that is running. The doctors have a word for it — allodynia — and all it means is pain from something that should not hurt. A sheet. A sock seam. The dog leaning on your foot.
This is the point where most people stop mentioning it to anyone, because there is no way to say “the sheet hurts” that sounds serious.
It is serious. It is a measure of how much of the signal is already noise.
The Pins And Needles Turn To Numb — And You Think That Is It Improving
This is the one that costs people years, so it is worth being blunt about.
At some point the burning in a patch of your foot fades. Usually the toes first, usually one foot ahead of the other. It feels like the problem is finally settling down, and everyone tells themselves the same sentence: at least it has stopped hurting.
Numbness is not the burning stopping. It is the nerve ending that was doing the burning going dark.
A nerve that has been firing non-stop for years inflames. Inflamed tissue at the end of the longest, thinnest, worst-supplied nerves you own does not get the blood it needs, and a small fibre starved of blood dies back. Quiet does not mean mended. Quiet can mean gone.
It also matters for a plainer reason. A foot you cannot feel is a foot that does not tell you about the tack, the blister or the stone in your shoe — which is the whole reason diabetics are told to check their feet by eye every night.
You Bought Magnesium Tablets, And Almost None Of It Reached Your Feet
This is number 4 and it is the one nearly everybody reading this has already done. There is a tub of magnesium powder or a packet of tablets in the cupboard right now, bought after somebody in a Facebook group said magnesium.
They were right about the mineral and wrong about the route.
A tablet is absorbed through your gut wall into your bloodstream, where it is shared out across everything at once — your heart, your muscles, every nerve in your body. What is left over goes to the very end of the line.
Your feet are the end of the line. They are the furthest point from your heart, on the thinnest capillaries you have, and if you are diabetic that circuit is already the poorest in your body. A supplement designed to lift a number in your blood was never designed to arrive at the nerve endings in your toes.
Nothing about that makes the tablets a con. It makes them the wrong delivery.
Before number 5 — if three of these are already familiar, the rest of the list makes a lot more sense once you know what is sitting at the end of it.
See what it costsLyrica Takes The Edge Off Your Feet And Takes The Rest Of You With It
For a lot of Australians the first thing offered is pregabalin — Lyrica — and for some people it genuinely helps.
What it does is turn down how loudly the signal arrives. It does not do anything at the nerve ending where the signal is being made. That is why the dose so often creeps: nothing underneath has changed.
And the cost is the part people are quietly unhappy about. The fog. The word that will not come. Feeling forty percent present at your own table. Weight, for many. Feet and ankles that swell, which is a special kind of irony when it is your feet you went in about.
Nothing here is a reason to change or stop anything your GP has put you on. A cream you rub into your feet is not an alternative to a script, and that conversation is one to have with the person who wrote it.
Your Cooling Rub Wears Off Long Before Your Feet Let You Sleep
Everybody has one. A blue tub from the chemist, or one of the ones with the horse on the label. You rub it on, it goes cold, and it is genuinely lovely for about twenty minutes.
Then you are awake again.
Menthol and camphor work by giving your brain a different, louder sensation to pay attention to. That is a real effect and it is worth having — twenty minutes of relief at half past one is not nothing.
The problem is that a cooling rub is only the thing on top. There is nothing in it going to the nerve ending, so when the cold fades you are exactly where you started. Most people do not need a different cooling rub. They need something underneath the cooling.
Nobody Told You The Burning Is Your Nerve Firing — Or What Comes After It
Here is the one underneath the other six, and it has a name.
Magnesium is what holds a nerve ending quiet. It sits in the gate on the surface of the nerve — the receptor that decides whether a pain signal gets sent — and it plugs that gate shut. When magnesium runs short, the gate stops closing properly. The nerve fires. And then it keeps firing. That is the burning. What you are feeling at two in the morning is not damage yet. It is a nerve ending stuck in the on position, running all night because there is nothing left to switch it off. Then the second stage, and this is the one nobody explains. A nerve ending that fires continuously inflames. Inflamed tissue in the worst-supplied part of your body starves of blood, and a small nerve fibre starved of blood dies back — patchily at first, then for good. The burning fades. What replaces it is numbness. Numbness is not the problem easing. It is the nerve going dark.
We call it nerve char, because that is the honest description of the sequence: a nerve ending that fires for years, inflames, and then burns out. Not an injury, not something that shows on a scan for a long time. A slow two-stage change at the very ends of the longest nerves you have.
Which is why the answer is magnesium, and why it goes on the foot rather than down your throat. A tablet is absorbed in your gut and shared out across your whole body, and your feet are the last stop on the worst-supplied circuit you have. Rubbed into the skin of the foot, it arrives where the gate is.
That magnesium blocks the NMDA receptor is not a supplement company's claim. It was published in Nature in 1984, and it is in the pharmacology textbooks as the reason that receptor behaves the way it does.
So What Do You Actually Do About Your Feet?
Do the first six anyway. Check your feet by eye at night. Say the sheet sentence to your GP. Keep taking whatever is working.
But if the seventh is the real one — if the problem is a gate that cannot close because there is nothing left to close it — then the thing to change is what is arriving at the nerve ending, and there is only one route to a nerve ending in a foot that does not go through your stomach first.
“Half the people I see have a tub of magnesium in the cupboard and a cooling rub by the bed. They worked out the mineral on their own. Nobody ever told them it had to go on the foot.”
Gavin Rourke, Podiatrist, 22 years — diabetic foot and small-fibre neuropathy
Mantle Nerve Relief Cream is a magnesium chloride cream with MSM, alpha lipoic acid, arnica and B6 in it. A fingertip of cream, morning and night. That is the whole routine.
It cools, because there is menthol in it, and we are not going to pretend that is the clever part — the cool is comfort while you are getting to sleep. The magnesium chloride underneath it is the part doing a job at the nerve ending.
That is the difference between this and the blue tub. Not that the blue tub is a fraud — it is that there is nothing in it once the cold goes away.
Magnesium chloride
The form of magnesium that goes through skin rather than sitting on it. This is the one doing the actual job: putting magnesium back at the nerve ending so the gate can close. Chloride rather than the oxide or citrate on the chemist's shelf, because those are built to be swallowed.
MSM and alpha lipoic acid
Magnesium quiets the firing. These two work on what the firing has already done. MSM is a sulphur compound that has been used on inflamed tissue for decades, and alpha lipoic acid has the longest history of anything in nerve research — it is also the ingredient the big Australian seller charges a premium for.
Arnica, B6 and menthol
Arnica for circulation at the surface, because no cream can help a part of the foot blood is not reaching. B6 because nerves run on it and metformin quietly lowers it. And menthol, which is the cool you feel in the first thirty seconds — that part is comfort, and we would rather say so than pretend it is the medicine.
A 2017 pilot study published in PLOS ONE had participants apply a magnesium cream to the skin daily for two weeks and measured a rise in their magnesium levels — which is the question everybody asks first: does it actually go in.
It is made for Australians, it ships from here with Australia Post tracking, and if it does nothing for you there is 90 days to say so.