Heel Numbness: Causes, Treatments, and Prevention
Causes of Foot and Heel Numbness
A 58-year-old female presented with pain and tingling below her left ankle. Walking produced a “zapp” sensation over two toes on her right foot (positive tinel sign).
Numbness and tingling in the feet may be caused by pressure on a nerve. This may occur due to shoe size, improper gait, overpronation, or other causes; or due to an autoimmune disease like Sjogren’s Syndrome or chronic inflammatory demyelinating polyneuropathy.
Causes
Nerves in the feet and legs are designed to convey physical sensation back to the brain, but when these nerves are compromised or damaged they become numb.
Repetitive movements associated with carpal tunnel syndrome may compress the median nerve on the inner wrist causing numbness, tingling, and weakness in that area of the wrist.
Another source of foot numbness may include sitting with crossed legs or wearing tight shoes that squeeze toes.
Simply loosening shoe laces or altering lacing methods often reduces pressure alleviates symptoms and provides respite from foot numbness.
As practitioners must listen closely when patients describe their symptoms and when the pain or numbness first begins, listening closely can provide invaluable clues as to the source.
For instance, hearing that heel pain and numbness get worse with increased activity should prompt practitioners to perform dynamic muscle testing and imaging around the posterior ankle and medial heel, to detect soft tissue masses, accessory flexor tendon stenosis, or tarsal tunnel compression.
Dorsal cutaneous peroneal neuropathy (DCPN), is one of the main sources of heel numbness.
DCPN involves injuries to the dorsal cutaneous peroneal nerve that passes through a small space behind the medial malleolus known as the tarsal tunnel and serves as a passageway for multiple tendons, blood vessels, and nerves; compression of this nerve may result in numbness, tingling or pain on the bottom of your foot.
Diagnosis
A 58-year-old woman complained of paresthesias in her left foot for nine months, describing them as a zapp-like sensation over two of her toes on the dorsum of the foot.
She denied any history of trauma or ankle sprains and denied having a family history of any autoimmune diseases such as Lupus, Sjogren’s Syndrome, or Rheumatoid Arthritis.
History and physical exams are integral in diagnosing heel numbness. Patients should be asked how long the pain has been present and whether it improves with walking.
A foot and ankle specialist should then consider factors like trauma to the feet, systemic arthritis pain, or nerve problems in the lower extremities (i.e. neuropathy) when considering possible causes.
Muscular testing of the foot should involve evaluation of its gastrocnemius tendon, calf muscle, and posterior compartment muscles for contracture, equinus, or instability.
Furthermore, practitioners must test both dorsalis pedis and posterior tibial pulses to ensure adequate vascular supply to support any possible surgical treatments.
Dorsal cutaneous peroneal nerve (DCPN) entrapment is one of the primary causes of heel numbness.
A provocation test, performed by palpating over medial calcaneal nerve(s), usually yields the Tinel sign; however, in cases of more distal entrapments, this sign may not appear at all.
Treatment
The nerves that supply our feet originate as one large nerve running from the lower back through to the buttocks and down the back of a thigh, before splitting and running down front and side legs towards some parts of the foot, others going toward the heel, until reaching their final destination – compression of this nerve can result in numbness in our feet.
Our specialists can assess the source of compression through history review, clinical testing, and nerve conduction studies or other imaging.
Once identified, treatments include shoe modifications, exercises designed to relieve compression, physical therapy, and medications as needed – in extreme cases surgery may even be required.
Morton’s neuroma (benign growth of nerve tissue between the third and fourth toes) requires custom orthotics or surgery to relieve pressure on its associated nerves, while we offer procedures like tendon release to treat other forms of numbness such as hammer toes, claw toes and mallet toes that restrict joint mobility or tightness such as hammertoes or claw toes.
At our clinics in Vancouver and Toronto, we assist people living with nerve damage due to diabetes or other medical conditions like chronic inflammatory demyelinating polyneuropathy by teaching them how to effectively manage their symptoms and prevent further injury.
This involves exercising correctly, limiting repetitive motions, maintaining good body mechanics during prolonged sitting or standing sessions, and encouraging proper body mechanics while sitting or standing for extended periods.
Prevention
Numbness in feet, hands, and fingers may be avoided by keeping muscles active to stimulate blood flow through exercise, massage, or knitting activities that stimulate nerve stimulation and provide preventative benefits.
Numbness in heels may also be avoided by making sure cycling shoes fit well, with no close cleats, and using different lacing methods that decrease pressure on them – these methods could reduce pressure on the heel as well.