Sudden pain like pins and needles in the toes is most often neuralgia. It often has no obvious cause, comes on suddenly, and disappears in a few seconds, so care should be taken to identify the cause. The next most common cause is gout. It is especially common in the big toe. These foods tend to increase the blood uric acid in the body, which causes the deposition of blood uric acid in the big toe, resulting in a sudden pain like pins and needles in the toe. This condition is often the beginning of the pain, and the pain becomes more intense afterwards. There is also the problem of a herniated lumbar disc compressing a nerve root, which can cause radiating pain and pins-and-needles pain in the sciatic nerve innervation, sometimes in the toes. There is also the possibility of diabetes causing peripheral vascular disease and diabetic neuropathy. If left untreated, it can easily cause diabetic foot.