The sensation of tingling in the heel is a common neurological symptom known medically as paresthesia. This feeling indicates that a sensory nerve in the foot or leg is irritated, compressed, or damaged, causing it to send abnormal signals to the brain. While many instances of heel tingling are temporary and resolve quickly, the symptom can also point toward a more chronic issue requiring professional evaluation. Understanding the source of this altered sensation is the first step in addressing the underlying cause, which can range from simple mechanical pressure to systemic disease.
Temporary and Mechanical Causes
The most frequent source of heel tingling involves a brief interruption of nerve function due to external pressure or poor positioning, known as postural compression. Sitting with one’s legs crossed for an extended period or remaining in a single position too long can temporarily compress a nerve, restricting its blood supply and causing the tingling sensation.
This mechanical irritation is usually benign and quickly disappears once the pressure is relieved and normal blood flow resumes. Similarly, wearing footwear that is too tight or ill-fitting can constrict nerves. High-heeled shoes or narrow, rigid boots can place undue pressure on specific nerves, resulting in temporary paresthesia localized to the heel. Changing position or removing the restrictive shoe is typically enough to restore normal sensation.
Local Nerve Compression Syndromes
When heel tingling becomes persistent, a localized nerve entrapment syndrome is often the cause, where a nerve is chronically squeezed within a narrow anatomical space. The most recognized condition affecting the heel is Tarsal Tunnel Syndrome (TTS), which involves the compression of the posterior tibial nerve as it runs through the tarsal tunnel along the inside of the ankle.
Compression occurs when swelling, inflammation, or structural issues physically reduce the space within the tunnel, pressuring the nerve. Common triggers include ankle sprains, which cause localized swelling, or structural deformities like flat feet, which can strain the nerve. Entrapment of the posterior tibial nerve branches, such as the medial plantar and medial calcaneal nerves, can cause tingling and burning sensations directly in the heel and sole of the foot. Abnormal growths like varicose veins, ganglion cysts, or bone spurs can also take up space within the tunnel, leading to chronic nerve impingement.
Systemic Conditions Leading to Neuropathy
A more generalized and chronic form of tingling in the heels often stems from peripheral neuropathy, which is damage to the nerves outside of the brain and spinal cord caused by a systemic condition. Diabetes is the most common systemic cause, leading to Diabetic Neuropathy. Persistently high blood sugar levels damage the tiny blood vessels that supply the nerves, depriving them of oxygen and nutrients over time.
This nerve damage typically progresses gradually and symmetrically, beginning in the longest nerves first, described as a “stocking-glove” pattern. Other metabolic issues, such as hypothyroidism, can cause fluid buildup that leads to nerve compression and resulting paresthesia. Nutritional deficiencies also play a significant role, particularly a lack of Vitamin B12, which is essential for nerve health and maintenance. Chronic alcohol misuse is another factor, as it can be directly toxic to nerve tissue and is often associated with poor nutrient absorption.
When Tingling Requires Medical Attention
While temporary heel tingling is rarely a concern, persistent tingling lasting more than a few days or progressively worsening requires a professional medical evaluation. Seeking care is also recommended if the sensation is accompanied by other neurological symptoms, such as significant pain or muscle weakness.
Immediate attention is necessary if the tingling suddenly spreads rapidly up the leg, or if it is paired with fever, redness, or swelling. The diagnostic process typically begins with a physical examination and medical history, followed by blood tests to check for systemic causes like diabetes or vitamin deficiencies. If nerve damage is suspected, specialized tests like nerve conduction studies or electromyography (EMG) may be used to assess nerve function and pinpoint the exact site of irritation or damage.