There are several conditions and injuries that can cause tingling around the heel and Achilles tendon. The treatments for these differ, so it’s important to get yours diagnosed properly to ensure that your treatment plan is correct. In this article, we’ll list the most common causes of tingling or numbness in the heel area and what treatment may be most appropriate. Remember, if you need more help with an Achilles injury, you're welcome to consult one of our team via video call.
The terms tendinitis, tendonitis, tendinosis, and tendinopathy mean the same thing for all practical purposes, and we use these interchangeably in our articles.
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How can you tell what is causing the tingling in your Achilles or heel?
In most cases, the diagnosis can be made by considering the history of your situation:
How the tingling started
What makes it worse
What makes it better
What other symptoms you may have
What previous injuries or other medical conditions you may have.
Your physio can then confirm their diagnosis by making you perform specific movement tests. In some cases, they may require further imaging (like an MRI scan), but this is not always useful because not all nerve injuries show up on scans. In other cases, they may ask your doctor to investigate further, for example by doing nerve conduction studies or blood tests.
The combination of taking a thorough history and combining it with movement tests is sufficient to diagnose most cases. It is only in a very few cases that imaging and further tests would be useful.
Common causes of tingling around the Achilles tendon
Irritation of a nerve in the area (peripheral nerve)
You have several nerves that run close to your Achilles tendon and heel. When these nerves are irritated or injured, they can cause a tingling sensation or numbness in that area.
The sural neve can cause symptoms over the back of your calf and towards the outside of your ankle. The tibial nerve can cause symptoms over the back of the heel or to the inside of the Achilles tendon.
What can cause these nerves to become injured or irritated?
Overstretch injuries - this can be either due to a sudden movement that forces the nerve in that area to overstretch, or it can be due to excessive stretching during yoga or sport, e.g. long, sustained dorsiflexion stretches (that bend the foot up towards your shin) right at the end of your range of movement.
Direct impact - getting hit on a nerve can sometimes injure it, but it has to be quite a hard knock. Nerves are robust structures that can take a lot of impact.
Tingling can be associated with conditions like Achilles tendinopathy. I’m not 100% sure why this happens, and the research doesn’t offer any answers either. My theory is that the event that injured the tendon also injured the nerve, or that the changes in the tendon structure due to the tendinopathy is irritating the nerve.
Sometimes, tight muscles and structures higher up in the leg can prevent your nerves from sliding freely, which can then cause them to pull tight over the bones lower down in your leg and become irritated. We call this increased neural tension. I’ve put this last in this list, as this is not a very common cause.
How do you treat this?
Nerves recover well if you can reduce the strain on them for a while. Your physio will help you identify the right strategies for you, but some examples include:
Wear shoes that have heel lifts in to take the stretch off your nerves.
Stop doing calf and ankle stretches.
Do your Achilles strengthening exercises on the floor rather than over the side of a step.
Avoid footwear that presses directly on that area.
Ensure good mobility in the rest of your leg.
Referred symptoms from your lower back (spinal nerves)
Numbness around your heel and Achilles tendon can be coming from your lower back even if you don’t have back pain.
How does this work? The nerves that provide sensation around your heel originate in your lower back. If something presses on them or irritates them in the area of your lower back, your brain gets a message that the nerve in your heel is unhappy with life, and it creates a strange sensation that you perceive to be in your heel. Your brain doesn’t realise that the true problem actually lies much higher up. This is similar to someone experiencing phantom pain in a foot or hand after it has been amputated.
Your physio or doctor will know for what nerves to test, depending on where you feel the tingling, because specific spinal nerves supply specific areas of the body. Scientists have mapped those areas and call them dermatomes. The spinal nerves that may cause referred symptoms around the heel and Achilles tendon are L5, S1, and S2.
How do you treat this?
The treatment should be aimed at what is causing the irritation of the nerves in your back. This usually involves doing back exercises, but it may require other interventions. Focusing the treatment on your heel will not work, because that’s not where the problem is.
Peripheral neuropathy – A less common cause of tingling in your heels
This is when the nerves in your feet get damaged by a systemic cause. So, this is different from the stretch or impact injuries I discussed above, where the injury only affects a very specific part of the nerve. When you have peripheral neuropathy, it usually affects several nerves, and the effect is more widespread.
Common causes of peripheral neuropathy include:
Diabetes
Underactive thyroid
Alcohol abuse
Vitamin deficiencies
Mineral deficiencies
Medication
How to treat this
It’s important to consult your doctor, as they have to establish the cause of your neuropathy and treat it accordingly.
How we can help
Need more help with your Achilles injury? You’re welcome to consult one of the team at TMA online via video call for an assessment of your injury and a tailored treatment plan.
We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Treat My Achilles we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.
About the Author
Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Master's Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate.