Burning Feet Syndrome and Vitamin B5

In short: "Burning feet syndrome" is a hot, painful, often worse-at-night burning in the soles. In the 1940s it was tied to severe malnutrition, and some doctors found that pantothenic acid (vitamin B5) helped. Low B5 is a real, documented cause. But it is a rare one, and burning feet is not a sign that points only to B5. Diabetes, vitamin B12 and B1 deficiency, too much vitamin B6, alcohol and several other conditions are far more common causes. This page covers the history, the biology, the full list of causes and where a low-risk B5 trial can sensibly fit.

Table of Contents

  1. What Burning Feet Syndrome Is
  2. A History Written in Prison Camps and Clinics
  3. Why Low B5 Could Make Nerves Burn
  4. Burning Feet Has Many Causes
  5. Where a B5 Trial Reasonably Fits
  6. Food Sources of B5 per Serving
  7. Safety and Red Flags
  8. Key Research Papers
  9. Connections
  10. Featured Videos

What Burning Feet Syndrome Is

Burning feet syndrome is a description, not a single disease. People describe a deep heat or burning in the soles, sometimes with tingling, aching or a "pins and needles" feeling. It usually gets worse at night and in warmth, and many people stick their feet out from under the covers or stand on a cold floor for relief. The skin often looks completely normal.

The syndrome carries two names from medical history. It is often called Grierson-Gopalan syndrome, after a British army surgeon who described burning feet among soldiers in India in the nineteenth century, and after the Indian nutrition scientist C. Gopalan, who wrote about it in 1946. A 2003 clinical review in Australian Family Physician noted that the symptom has been known for almost two centuries. It is common, especially in older adults, and has no single cause: it can turn up alone or as part of many different illnesses. The review also notes how little there usually is to find on examination compared with how much it hurts (review article).

Doctors today mostly see burning feet as a sign that the small nerve fibres are irritated. These are the thinnest nerve endings in the skin, the ones that carry heat and pain. Picture them as the fine twigs at the tip of a tree's branches. They are the longest, thinnest and furthest from the trunk, so they are the first to suffer when the supply line runs short. That is why trouble with nerve fuel, from any cause, tends to show up first in the feet.

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A History Written in Prison Camps and Clinics

Burning feet gets linked to B5 because of three historical episodes. Each one tells us something different, and none of them on its own proves that B5 is the cause.

1942–1945: prisoners of war in the Far East

During the Second World War, prisoners held in Far Eastern camps lived for years on mostly polished rice with very little else. Burning feet affected up to one third of them. In 2017 researchers analysed 54 sets of case notes that an RAF medical officer had secretly written in captivity, the first records of nerve examinations in these patients. Judged by modern criteria, they concluded the syndrome counts as a "possible" neuropathic pain syndrome, meaning genuine nerve-damage pain (historical case series). These men were short of almost everything: thiamin, riboflavin, niacin, protein and calories as well as B5. So the camps show that starvation causes burning feet. They cannot single out which nutrient was missing.

The damage did not always heal. A 1982 study examined 898 former Far East prisoners between 1968 and 1981 and found 49 (5.5%) still had nerve problems dating back to captivity. The most common was peripheral neuropathy, often of the "burning foot" type, and in some men it had lasted up to 36 years (clinical case series). Most recovered soon after release. For a few, a long stretch of severe malnutrition left damage that did not fully reverse.

1946: Gopalan's observations in India

In 1946 C. Gopalan published "The burning-feet syndrome" in the Indian Medical Gazette, describing the condition in poorly nourished patients in South India. His report discussed several B vitamins, including nicotinic acid and riboflavin, as well as calcium pantothenate, the common supplement form of B5. Later writers credit him with observing that many patients improved on calcium pantothenate. That is an important clue, but it came from an uncontrolled clinical observation. There was no placebo group, the patients' diets also changed and burning pain naturally comes and goes. A 1947 American paper called the condition "nutritional melalgia" (literally "limb pain from nutrition"). That label is honest: it ties the syndrome to poor nutrition in general rather than to one vitamin.

1955–58: volunteers made deliberately B5-deficient

The most direct evidence came from a series of experiments in Iowa. Physician-researchers fed healthy male volunteers a purified diet with the pantothenic acid removed, and some volunteers were also given omega-methyl pantothenic acid, a look-alike molecule that blocks the vitamin. Over several weeks the men developed fatigue, poor sleep, irritability, stomach upset, muscle cramps and paraesthesias: numbness, tingling and burning in the hands and feet. They also showed orthostatic (postural) hypotension, a drop in blood pressure on standing that leaves you light-headed (human experimental studies, very small numbers).

One detail is often reported wrongly. A widely viewed online Q&A described these volunteers as having orthostatic hypertension. The original 1958 report describes orthostatic hypotension, which is the opposite: low pressure on standing, not high. It is an easy slip to make, but the direction matters, because the low-pressure finding fits the idea of autonomic nerves being affected along with sensory ones.

Taken together, these experiments show that B5 deficiency alone can produce burning, tingling extremities in humans. That is the solid core of the B5 story. But it took a synthetic diet plus a drug that blocks the vitamin to do it. For the full design of those studies see Human Deficiency Experiments.

A timeline of burning feet syndrome from wartime prison camps in 1942 to 1945, through Gopalan's 1946 report and the 1955 to 1958 induced-deficiency volunteers, to the 1982 follow-up of former prisoners and the 2017 re-analysis, showing that only the volunteer experiments isolated vitamin B5. BURNING FEET AND VITAMIN B5 eighty years of evidence · only one step isolated the vitamin 1942–45 prisoners of war up to one third starved of everything 1955–58 induced B5 deficiency burning, tingling feet postural hypotension 2017 54 camp case notes re-read: "possible" neuropathic pain 1946 Gopalan, India calcium pantothenate no control group 1982 49 of 898 ex-prisoners 5.5% still affected up to 36 years later today AI 5 mg a day deficiency rare only the volunteer experiments removed B5 and nothing else the camps and the clinics saw people short of many nutrients at once, so they show that malnutrition burns the feet — not which vitamin did it. B5 is a proven cause of burning feet, and a rare one.

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Why Low B5 Could Make Nerves Burn

Pantothenic acid has one main job. The body uses it to build coenzyme A (CoA), a molecular "carrying handle" that picks up small carbon pieces and moves them between reactions. A 2020 review counts CoA in more than 100 different reactions, covering the metabolism of fats, carbohydrates, proteins, alcohol and bile acids (review article). For how that build works step by step, see Coenzyme A Synthesis.

Three of those jobs matter for nerves. They come with different levels of certainty, so each one is labelled:

Animals give the clearest picture of nerve damage. A 2026 report described an outbreak of B5 deficiency on a pig farm. Newborn piglets developed unsteadiness, weakness and high death rates. Under the microscope their spinal cord nerve cells were swollen and damaged, and some sciatic nerves showed swollen, broken nerve fibres. Treatment with a B-vitamin complex stopped the outbreak, and the diagnosis was presumptive (animal case report). Livestock studies like this show that B5 deficiency can damage peripheral nerves. They do not tell us how often it happens in people eating ordinary diets, which is very rarely.

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Burning Feet Has Many Causes

A common claim online is that burning feet is "pathognomonic" for B5 deficiency, so if your neuropathy burns, you should "think B5 first". Pathognomonic is a strong word in medicine. It means a sign so specific that it identifies one disease and no other. Burning feet does not meet that bar. The claim gets one thing right: B5 deficiency really is one of the causes, and it is worth knowing about. It gets the order wrong, because in everyday life the common causes far outnumber the rare one.

The evidence against B5 being specific is clear:

The causes, grouped

A differential diagnosis map with burning feet at the centre and five groups of causes around it: metabolic, vitamin deficiency, vitamin excess, toxic and medicines, and other, with vitamin B5 shown as one small branch inside the vitamin deficiency group. WHAT BURNS THE FEET one symptom · many causes · B5 is one branch BURNING FEET METABOLIC diabetes · thyroid kidney disease VITAMIN DEFICIENCY B12 · B1 · B6 · B2 B5 (rare) VITAMIN EXCESS high-dose B6 TOXIC · MEDICINES alcohol · chemotherapy metronidazole · isoniazid OTHER small fiber neuropathy erythromelalgia ankle nerve compression NOT PATHOGNOMONIC riboflavin cured one case 6 mg a day, 1970 — not B5 too much B6 causes it too seven adults, 1983 — better on stopping deficiencies travel together low B5 rarely comes alone check the common causes first: blood sugar, B12, thyroid, kidneys, alcohol and every supplement label.

So where does that leave the quality of the pain? Some writers suggest that "burning" points to B5 while "numbness" points to B12. There is no good evidence for that rule. B12 neuropathy can burn, diabetic neuropathy very often burns, and small fiber neuropathy is defined by burning. How the pain feels tells you that small nerve fibres are involved. It does not tell you why.

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Where a B5 Trial Reasonably Fits

Here is the honest gap. We found no modern randomized controlled trial of pantothenic acid for burning feet in people eating ordinary diets. The evidence for B5 comes from the wartime and 1940s clinic observations and the 1950s induced-deficiency volunteers. So any trial today is a personal experiment, not an evidence-backed treatment. That said, B5 is one of the safest vitamins there is, which makes a sensible trial easy to justify once the basics are covered.

A reasonable order of steps:

  1. Rule out the common causes first. Basic blood tests cover blood sugar (fasting glucose or HbA1c), vitamin B12 (ideally with methylmalonic acid if B12 is borderline), thyroid function, kidney function and a blood count. Bring a list of every medicine and supplement you take.
  2. Check your B6 total. Add up the B6 across every product you take, including the multivitamin, the B-complex, the magnesium blend and the "energy" or sleep formula. B6 excess is a cause of burning feet that you can fix yourself just by stopping. See Vitamin B6 Toxicity.
  3. Consider whether you are at risk of low B5. Heavy alcohol use, very restricted eating, malabsorption, bariatric surgery or long-term dialysis all raise the odds of running low on several B vitamins at once. See Risk Factors and Depleters.
  4. If you want to test it, measure first. Urinary pantothenate excretion is the standard marker of B5 status used in nutrition research. Low output points to low intake. Some commercial "intracellular" or "functional" micronutrient tests use cell-culture methods, but their validation for B5 specifically is limited. See Testing for Vitamin B5.
  5. Then a time-limited trial. Pick a set period, such as six to eight weeks, and score your symptoms before and after. Burning pain naturally waxes and wanes, so without notes it is easy to credit the pill for a good week.

Dose in context. The Adequate Intake for adults is 5 mg a day, and ordinary diets usually provide around that. Supplements commonly contain 100–500 mg of calcium pantothenate per capsule, which is 20 to 100 times the AI. No Tolerable Upper Intake Level has been set, because no clear harm has been found at supplement doses. The one consistent side effect is diarrhea at very large doses, classically around 10 grams a day. If the trial uses a B-complex rather than B5 alone, read the B6 content (step 2). A B5 trial that quietly adds 50–100 mg of B6 a day could, over months, be making burning feet worse. Forms and doses are covered in Dosing and Supplement Forms.

If a well-run trial helps, that is useful information. If it does not, stop it and keep looking for the cause rather than raising the dose.

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Food Sources of B5 per Serving

"Pantothenic" comes from the Greek for "from everywhere", and the name fits: almost every whole food has some. The figures below are per serving, worked out from USDA FoodData Central values (SR Legacy, mg per 100 g multiplied by the serving weight), against the 5 mg Adequate Intake:

A day with eggs at breakfast, an avocado and lentil lunch, and trout with sweet potato and mushrooms at dinner adds up to well over 5 mg without trying. The foods that lose the most B5 are heavily refined ones: white flour, polished grains and many ultra-processed products. For the full list see Vitamin B5 Food Sources.

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Safety and Red Flags

Pantothenic acid itself is about as safe as vitamins get. The real safety risk with burning feet is missing the actual cause while a supplement is tried. Get a prompt medical assessment, not a vitamin trial, if any of these apply:

On supplements: B5 has no set upper limit, and diarrhea is the known effect at gram doses (around 10 g a day). The larger hazard is the company B5 keeps in combination products, B6 above all, as shown by the seven patients in the 1983 report. Read every label in the cabinet, not just the one you are adding. The broader evidence on B5 excess is on Vitamin B5 Toxicity.

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Key Research Papers

  1. Gopalan C (1946). The burning-feet syndrome. Indian Medical Gazette, 81:22–26. — PubMed PMID: 21025573
  2. Glusman M (1947). The syndrome of burning feet (nutritional melalgia) as a manifestation of nutritional deficiency. American Journal of Medicine, 3:211–223. — PubMed PMID: 20253668
  3. Bean WB, Hodges RE, Daum K (1955). Pantothenic acid deficiency induced in human subjects. Journal of Clinical Investigation, 34:1073–1084. — PubMed PMID: 14392222
  4. Hodges RE, Ohlson MA, Bean WB (1958). Pantothenic acid deficiency in man. Journal of Clinical Investigation, 37:1642–1657. — PubMed PMID: 13587673
  5. Lai CS, Ransome GA (1970). Burning-feet syndrome. Case due to malabsorption and responding to riboflavine. British Medical Journal, 2:151–152. — PubMed PMID: 5440597
  6. Gill GV, Bell DR (1982). Persisting nutritional neuropathy amongst former war prisoners. Journal of Neurology, Neurosurgery, and Psychiatry, 45:861–865. — PubMed PMID: 6292369
  7. Schaumburg H, Kaplan J, Windebank A, et al. (1983). Sensory neuropathy from pyridoxine abuse. A new megavitamin syndrome. New England Journal of Medicine, 309:445–448. — PubMed PMID: 6308447
  8. Makkar RP, Arora A, Monga A, et al. (2003). Burning feet syndrome. A clinical review. Australian Family Physician, 32:1006–1009. — PubMed PMID: 14708150
  9. Hammond N, Wang Y, Dimachkie MM, Barohn RJ (2013). Nutritional neuropathies. Neurologic Clinics, 31:477–489. — PubMed PMID: 23642720
  10. Roocroft NT, Mayhew E, Parkes M, et al. (2017). Flight Lieutenant Peach's observations on Burning Feet Syndrome in Far Eastern Prisoners of War 1942-45. QJM, 110:131–139. — PubMed PMID: 28069916
  11. Czumaj A, Szrok-Jurga S, Hebanowska A, et al. (2020). The Pathophysiological Role of CoA. International Journal of Molecular Sciences, 21:9057. — PubMed PMID: 33260564
  12. Ma JE, Lee JUJ, Sartori-Valinotti JC, et al. (2023). Erythromelalgia: A Review of Medical Management Options and Our Approach to Management. Mayo Clinic Proceedings, 98:136–149. — PubMed PMID: 36470753
  13. Kool D, Hoeijmakers JG, Waxman SG, Faber CG (2024). Small fiber neuropathy. International Review of Neurobiology, 179:181–231. — PubMed PMID: 39580213
  14. Loscertales SI, Romagosa A, Martino L, et al. (2026). A pantothenic acid deficiency outbreak causing mortality and neuromuscular disorders in newborn and nursery piglets. Porcine Health Management, 12:47. — PubMed PMID: 42310692

PubMed Topic Searches

  1. PubMed: Burning feet syndrome and pantothenic acid
  2. PubMed: Nutritional neuropathy reviews
  3. PubMed: Causes of small fiber neuropathy

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Connections

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