Plantar fasciitis (PF) is a common cause of heel pain, stemming from inflammation of the plantar fascia, the thick band of tissue running along the bottom of the foot. When individuals experience tingling, numbness, or a burning sensation in their feet, these specific neurological symptoms, known as paresthesia, are introduced. Paresthesia is not typical of pure plantar fasciitis, but it often occurs alongside it due to the shared biomechanical stresses placed on the foot and ankle.
The Primary Symptoms of Plantar Fasciitis
Plantar fasciitis is characterized by a distinct pattern of pain. The pain is generally sharp and stabbing, located near the heel bone where the plantar fascia attaches to the calcaneus. A hallmark symptom is “first-step pain,” which is the intense discomfort experienced immediately upon waking or after long periods of rest. This phenomenon results from the fascia contracting and stiffening overnight, then being abruptly stretched upon bearing weight.
The pain from PF often lessens as the person moves around and the foot warms up, but it may return or worsen after prolonged standing or high-impact activity. Since PF is an inflammatory condition involving micro-tears in the fascia, the symptoms are localized to the ligament itself or its attachment point on the heel. The pain profile is focused on mechanical stress, not on nerve irritation, which is why tingling is not considered a primary symptom.
Understanding Nerve Entrapment and Paresthesia
Tingling (paresthesia) is a neurological symptom caused by nerve compression or irritation, not the inflamed fascia directly. The physical stresses that lead to PF—such as overpronation, flat feet, or repetitive motion—can also cause nearby nerves to become entrapped. The most common form of this co-occurring issue is Tarsal Tunnel Syndrome (TTS), which involves the posterior tibial nerve. This nerve travels through a narrow space on the inside of the ankle called the tarsal tunnel before branching out into the sole of the foot.
Inflammation and swelling from chronic foot stress can reduce the space within the tarsal tunnel, squeezing the tibial nerve. This compression produces the symptoms of paresthesia, including tingling, burning, or numbness, which often radiate into the arch and toes. Another nerve sometimes involved is Baxter’s nerve, which can become trapped near the heel bone, causing burning pain and tingling that mimics PF. The proximity of these nerves to the plantar fascia explains why PF and nerve symptoms frequently appear together, even though they have distinct causes.
Distinguishing Between PF Pain and Nerve Pain
Differentiating between musculoskeletal PF pain and neurological nerve pain is important because treatment protocols are different for each condition. Plantar fasciitis pain is generally felt as a sharp, localized pain at the heel, which is aggravated by the first steps in the morning. Conversely, nerve-related pain, such as from Tarsal Tunnel Syndrome, is often described as a burning or tingling sensation that may radiate throughout the foot and can sometimes feel worse at night.
The location of tenderness is also a clue; PF tenderness is usually very specific to the bottom of the heel, while nerve pain might present with tenderness along the course of the nerve on the inside of the ankle or arch. A physical examination may include a test called Tinel’s sign, which helps isolate nerve irritation. A practitioner gently taps over the path of the posterior tibial nerve near the ankle; if this action reproduces the tingling sensation, it suggests nerve involvement.
PF symptoms often improve with rest, whereas nerve compression symptoms may persist regardless of activity level. Understanding these distinctions guides practitioners toward the correct diagnosis, especially when standard PF treatments fail to relieve the neurological symptoms.
Seeking Professional Diagnosis and Treatment
If foot pain is accompanied by persistent tingling, numbness, or burning, it is important to seek a professional diagnosis to determine the exact cause of the symptoms. A healthcare provider will perform a thorough physical examination, checking the foot structure and testing for signs of nerve irritation. To rule out other conditions such as stress fractures, X-rays or MRI scans may be ordered.
More specific diagnostic tools, such as Nerve Conduction Studies and electromyography, are used to confirm nerve entrapment. These tests measure how quickly electrical signals travel through the nerves and the electrical activity of muscles, helping to identify the precise location and severity of nerve compression. Accurate diagnosis is necessary because nerve entrapment requires different treatments than standard PF care, which primarily focuses on stretching and orthotics. Treatment for nerve compression may involve nerve gliding exercises, anti-inflammatory medications targeting nerve pain, or specific bracing to relieve pressure on the nerve.