Symptoms and causes
Numbness and tingling in hands and feet: what it means
When both hands and both feet are involved, the cause is usually something affecting the whole body rather than a problem in a limb. That narrows the search considerably, and most of the narrowing is done with blood tests.
Written by the Managing Neuropathy editorial team under the direction of Dr. Tom Biernacki, DPM, FACFAS · Clinical review pending · Last updated 24 September 2026
The short answer. Numbness and tingling in both hands and both feet usually means a peripheral neuropathy with a body-wide cause: diabetes or prediabetes, a vitamin B12 deficiency, too much vitamin B6, alcohol, thyroid or kidney disease, a medicine, or an abnormal blood protein. Feet almost always start first, because the longest nerves fail first. Hands and feet becoming numb and weak over hours or days, especially with weakness climbing the legs, is an emergency.
The stocking-glove pattern
Most neuropathies are length-dependent: the far ends of the longest nerves fail first, and the damage works inward. The longest nerves in the body run from the lower spine to the toes, so the feet go first. By the time the numbness has climbed to about the knees, the nerves running to the fingertips are a similar length from the spinal cord, and the hands start too.
That produces the pattern clinicians call stocking-glove: symptoms in the area a sock covers and, later, the area a glove covers. It is worth knowing for two reasons. It is reassuring evidence that the cause is a general one rather than something in your neck, and it tells you roughly how far a neuropathy has advanced. Hands that begin at the same time as the feet, or before them, do not fit the pattern and deserve a closer look.
The causes worth identifying
| Cause | Clues | How it is found |
|---|---|---|
| Diabetes or prediabetes | The commonest cause; gradual, symmetric, feet first | Glucose and HbA1c; a glucose tolerance test where prediabetes is suspected |
| Vitamin B12 deficiency | Can affect hands early; may come with balance trouble or a sore tongue; no anemia needed | B12 level, ideally with methylmalonic acid |
| Too much vitamin B6 | Someone taking a supplement, multivitamin or “nerve” formula containing it | Reading labels; a B6 level |
| Alcohol | Gradual, both feet, often with poor nutrition | History, thiamine status |
| Thyroid or kidney disease | Other symptoms usually present | Thyroid function, kidney function |
| Medicines | Started after a new drug; chemotherapy is the clearest example | Medication review with the prescriber |
| Abnormal blood proteins | Can be the only clue to a treatable cause | Serum protein immunofixation |
| An immune neuropathy | Fast onset, weakness, or a course that does not fit | Neurology assessment, nerve studies |
For symmetric numbness in the hands and feet, an American Academy of Neurology review of the evidence found three screening blood tests with the highest yield: blood glucose, vitamin B12 with methylmalonic acid, and serum protein immunofixation. The American Diabetes Association adds thyroid and kidney disease, alcohol, chemotherapy and other neurotoxic drugs, B12 deficiency in people on long-term metformin, and copper deficiency after weight-loss surgery to the list worth considering.
The deficiencies, and the excess
Vitamin B12
The classic nutritional cause, and the one most worth catching early, because the NIH Office of Dietary Supplements notes that neurological symptoms can appear without anemia and that damage can become irreversible if treatment is delayed. Risk rises with long-term metformin, long-term acid-reducing medicines, vegan diets without supplementation, and any condition affecting absorption.
Thiamine (vitamin B1)
Thiamine deficiency causes beriberi, which the ODS describes as mainly a peripheral neuropathy with wasting. It matters most with heavy alcohol use, after weight-loss surgery, and in older adults with poor intake. Replacement, often by injection at first, works quickly.
Copper
Copper deficiency is rare but worth knowing about, because two of its causes are easy to miss. The NIH lists ataxia, or unsteadiness, among its effects, and notes that high intakes of zinc block copper absorption, whether the zinc comes from supplements or from heavy use of zinc-containing denture cream. The American Diabetes Association separately lists copper deficiency after weight-loss surgery among the causes of neuropathy worth considering.
Folate, and a caution
Folate is worth knowing about for a different reason. Large amounts of folate can correct the anemia of a B12 deficiency while leaving the nerve damage untouched, which can delay the diagnosis that matters. If you take a supplement with folic acid and have numb hands and feet, make sure B12 has been measured properly.
Too much vitamin B6
Vitamin B6 is the exception on this list: the problem is excess, not lack. High doses cause a sensory neuropathy that typically affects the hands and feet. The US upper limit for adults is 100 mg a day, and cases have been reported at lower long-term doses; in 2023 the European Food Safety Authority set its limit at 12 mg a day. B6 appears in multivitamins, B-complex products and many supplements marketed for nerve health, so the total is easy to miss. How to check your labels.
The early signs, and what to do if you have them, are in symptoms of B6 toxicity.
When the hands go first
Hands that start before the feet break the length-dependent rule, and that changes the list.
- Carpal tunnel syndrome is the common explanation, particularly if the numbness spares the little finger, is worse at night, and eases when you shake your hand.
- A neck problem can cause numbness in one arm and hand, usually with neck or shoulder pain.
- Vitamin B12 deficiency is the deficiency most likely to involve the hands early.
- Immune neuropathies, which need a neurologist, often affect the hands early and can be treatable.
If your hands are more affected than your feet, say that clearly to your clinician. It is one of the most useful sentences in the appointment. When the problem is in the feet alone.
Red flags
Get emergency care for:
- numbness and weakness climbing both legs over hours or days, with or without the hands (possible Guillain–Barré syndrome);
- sudden numbness or weakness on one side of the body, or trouble speaking (possible stroke);
- numbness around the groin or bottom, or new bladder or bowel trouble, with back pain or leg weakness.
Arrange an urgent, but not emergency, appointment for numbness that is spreading quickly over weeks, that comes with noticeable weakness, or that is much worse on one side than the other.
The blood tests to ask for
Most causes on this page are found with a short list of tests any primary care clinician can order.
- Blood glucose and HbA1c, with a glucose tolerance test if those are borderline.
- Vitamin B12, ideally with methylmalonic acid, which is the more sensitive marker.
- Thyroid function and kidney function.
- Serum protein immunofixation, to look for an abnormal blood protein.
- A full blood count, and vitamin B6 or copper where the history points that way.
If your evaluation stopped at “it is probably diabetes”, or at a normal B12 with no methylmalonic acid, there is more to do. Which clinician to ask, and when.
What helps
Treatment follows the cause. Correcting a deficiency, stopping an excess, moderating alcohol and getting glucose into range are the steps that change the trajectory, and in the best case reverse some of the damage. What can recover, and how long it takes. Meanwhile, nerve pain has its own treatments, hands and feet both need protecting from unnoticed injury, and balance work is worth starting early.
Common questions
What deficiency causes tingling in hands and feet?
Vitamin B12 is the classic one, and it can cause symptoms before any anemia appears. Thiamine (B1) and copper deficiency can do the same. An excess of vitamin B6, usually from supplements, causes a very similar pattern, so both too little and too much matter.
Is tingling in the hands and feet always neuropathy?
No. Anxiety and overbreathing can cause tingling around the mouth and in both hands, which settles. Low calcium can do the same. But numbness and tingling that persist in both hands and both feet, particularly if the feet started first, is usually a peripheral neuropathy and deserves a workup.
Which doctor should I see?
Start with primary care, which can order the tests that find most causes. A neurologist is the right next step if there is weakness, a fast course, an unusual pattern, or if nothing is found and symptoms continue.
Can anxiety cause numbness in hands and feet?
It can cause tingling, usually in both hands and around the mouth, during periods of rapid breathing, and it settles when breathing does. Persistent numbness that starts in the toes and creeps upward is not explained by anxiety.
Should I take a B-complex supplement for tingling?
Not before testing. B12 replacement helps when you are deficient, and there is no good evidence that it helps when you are not. Many B-complex products contain vitamin B6 at doses that can cause neuropathy over time, so the supplement can become part of the problem.
Related reading
Numb feet · Tingling in the feet · Supplements for neuropathy · Types of neuropathy · Can neuropathy be reversed? · The full symptom list
Sources and further reading: England JD et al., Practice parameter: evaluation of distal symmetric polyneuropathy, the role of laboratory and genetic testing, Neurology 2009, on the highest-yield screening tests. American Diabetes Association Standards of Care in Diabetes—2026, section 12, on other causes to consider, including copper deficiency after metabolic surgery and B12 with metformin. NIH Office of Dietary Supplements, vitamin B12, vitamin B6, thiamin, copper and folate. NINDS, peripheral neuropathy. Emergency signs: NINDS, Guillain–Barré syndrome; CDC, stroke signs.
This page is general education and is not a diagnosis, a treatment plan, or advice to start or stop any supplement. Clinical review by Dr. Biernacki is pending; the review date will be shown here once complete.
For our Michigan neighbors
Hands and feet both
going numb?
The pattern usually points to a body-wide cause, and several are treatable once they are found. Dr. Biernacki’s Michigan practice can start the search.
Everywhere else, take this page to your own clinician.
Dr. Tom Biernacki, DPM, FACFAS is a double board-certified foot and ankle surgeon (ABFAS and ABPM) and a Fellow of the American College of Foot & Ankle Surgeons. He is the founder of Balance Foot & Ankle in Howell and Bloomfield Township, Michigan, where peripheral neuropathy, diabetic foot risk and loss of protective sensation are part of his weekly clinic. His patient education videos have drawn more than 950,000 subscribers on YouTube. Managing Neuropathy is written by its editorial team under his direction, to put the explanation he gives in the exam room in front of the people who cannot get to one — including when a product is worth buying and when it is not.