Guide · Feel + Move
Restless legs, or a trapped nerve?
Both can make your legs feel wrong at night and push you to get up and move. They start in different places and need different fixes. This guide helps you spot which pattern fits, so the right things get checked.
Audio companion to this guide. Where it and the written guide differ, the written guide has been checked against the sources listed below.
Two problems · the same feeling
One can feel just like the other. They start in different places.
Restless legs syndrome (RLS) comes from the brain and spinal cord, and iron handling in the brain is thought to play a central part. A trapped nerve comes from a single spot where something presses on a nerve in the foot, ankle or leg.[16][10]
Trapped nerve
Entrapment neuropathy- Starts in
- One spot, where a nerve is squeezed by a tight tunnel, swelling, bone, or scar tissue.[10]
- Tell-tale sign
- Sits in one patch of skin, may bring numbness, and can be set off by pressure, shoes or a position.
- Linked to
- Injuries, surgery, repeated ankle sprains, swelling and tight footwear.[10]
- Scar tissue
- A scar can bind a nerve so it can't glide as you move. Not every scar does this, and deep scarring may not show on the skin.
21.5%of people with nerve damage also have RLS
41.8%of people with RLS also have nerve damage
From a 2021 review that pooled many studies. These figures cover nerve damage in general, such as from diabetes, rather than trapped nerves alone. Studies used different criteria, so treat them as a rough guide.[3]
Pattern sorter · ten questions
Which pattern fits your nights?
Doctors diagnose RLS on four core features plus a fifth: nothing else explains it, such as cramps, sitting awkwardly or arthritis. A trapped nerve tends to leave different clues. Tick what is true most of the time. Your answers stay on this page.[1]
RLS features
0 of 4The four core criteria, in plain words
Nerve clues
0 of 6Signs that point to one nerve in one place
RLS features 0 / 4
Nerve clues 0 / 6
Fits the RLS pattern
All four features, few nerve clues
Could be both
All four features, plus nerve clues
Leans to a nerve
Two or more nerve clues stand out
No clear pattern yet
Not enough of either
What to do nextTick what applies and your next step shows here.
This sorts patterns. It can't diagnose. Only a clinician can confirm RLS, because the fifth criterion means ruling out other causes first. Many people have a mix of both.
Foot map · which nerve sits where
Where you feel it is a strong clue.
Each nerve in the foot covers its own patch of skin. Pick an area, or tap the drawing, to see what that nerve does, what can trap it and how it gets checked.[10]
Tibial nerve
Inner ankle- Where
- Feels like
- Can be trapped by
- How it's checked
Outside the foot. The common fibular (peroneal) nerve wraps around the bony bump on the outside of the knee, then splits into the deep and superficial branches. It was released in every patient in the 2026 surgery study below, so that research is about the lower leg as a whole, not foot scars in particular.[5]
Evidence · how sure we are
What's solid, and what's still a hunch.
The idea that a trapped nerve can drive restless legs has some early support. Most of what helps day to day rests on firmer ground.
Solid
RLS is diagnosed on five criteria, and look-alikes must be ruled out.
The fifth criterion was added in 2014 so that cramps, positional discomfort, arthritis and similar problems stop being labelled RLS.[1]
Solid
Iron matters for RLS.
The 2025 US sleep guideline says to check ferritin and transferrin saturation in people with RLS that needs treatment, and to treat low iron.[9]
Solid
Nerves in the foot and ankle can be trapped.
Injury, scarring, fibrosis, swelling and tight tunnels are recognised causes. Care starts with footwear, orthotics and physio, with surgery kept for when those fail.[10][11]
Moderate
RLS and nerve damage often occur together.
A 2021 review found RLS was more common in people with nerve damage than in people without, and the reverse. It shows a link, and can't show that one causes the other.[3]
Early
Releasing nerves in the lower leg lowered RLS scores in 18 adults.
One clinic, no comparison group, and the surgeon who does the operation led the study. Details below.[5]
Early
An earlier look-back at 42 patients reported less burning, tingling and crawling after the same surgery.
It reviewed past records, used the clinic's own 0–10 symptom scales, and did not use the standard RLS rating scale.[4]
Unclear
Magnesium for restless legs.
A 2019 review found one small trial, which showed no benefit, plus case reports. The 2025 guideline makes no recommendation either way.[13][9]
Unproven
A foot scar can cause true RLS.
No study has tested this directly. The research so far looks at nerve damage in general or at lower-leg surgery, not at foot scars.
Up close
The 2026 surgery study
- People
- 30 enrolled, 18 analysed. Five didn't have surgery and seven were lost to follow-up. Average age 59; 10 men, 8 women.
- Diagnosis
- Everyone had nerve damage in the legs. RLS was confirmed by the operating surgeon using the standard criteria.
- Surgery
- Common fibular at the knee (all), superficial fibular (95%), soleal sling (71%), deep fibular (29%), tarsal tunnel (14%).
- Follow-up
- About 18 weeks after surgery.
- Sleep
- Overall sleep quality scores improved. Sleep satisfaction didn't improve by more than chance could explain.
RLS rating scale · average score, 0 to 40
28.8before
17.6after
−11.2
MildMildModerateModSevereSevV. severeV.sev
010203040
11 of 17 people moved down at least one band.[5][6]
How big is an 11-point drop?
About 9–11 points: the smallest change linked to a meaningful improvement in drug trials
Bigger than placebo on average, and still unproven. Without a comparison group, the drop can't be separated from placebo, natural ups and downs, or the care that comes with surgery. No guideline recommends this surgery for RLS.[7][8][9]
Getting checked · in the order it usually goes
Check both. Start with your GP.
In Australia, a GP visit is the first step for restless legs, and blood tests including iron are routine.[17][18] If a podiatrist has raised a nerve problem, look into it alongside the RLS checks, and don't let it replace them.
1
Your story
When it happens, where it starts, whether moving helps, old injuries and scars, family history, and every medicine and supplement you take.
GP · bring the diary2
Foot and nerve exam
Feeling, strength, walking, footwear, and how the scar moves and feels. Tapping over a nerve that sets off tingling along it (Tinel's sign) supports entrapment. It isn't proof.[10]
GP · podiatrist · physio4
Imaging, if a cause is suspected
Ultrasound shows nerves near the surface, scars and neuromas. MRI suits deeper structures. A finding only counts if it matches your symptoms and exam.[10]
Ordered by GP or specialist5
Nerve tests, if still unclear
Nerve conduction studies and EMG help confirm some entrapments. Evidence on their accuracy for tarsal tunnel syndrome is thin, so a normal result doesn't fully rule it out. They also miss the smallest nerve fibres.[12]
Neurologist6
Treat what's found, then review
Give one change a fair trial and track it in the diary. If it doesn't help, go back and question the diagnosis.
GP · specialistIron
The RLS thresholds are higher than most lab ranges.
WhoResultWhat may be offered
AdultsFerritin 75 µg/L or less, or transferrin saturation under 20%Iron by mouth or by drip
AdultsFerritin 75–100 µg/LIron by drip
ChildrenFerritin under 50 µg/LIron by mouth
- Test in the morning, after 24 hours without iron supplements.
- These cut-offs are expert consensus from the 2025 US sleep guideline, not trial results.[9]
- Don't take iron without a test. Your GP will decide the type, dose and how long.
Other blood tests
Not everyone needs every test.
- Ferritin
- Stored iron
- Transferrin saturation
- Iron available in the blood
- Full blood count
- Anaemia
- Vitamin B12
- A cause of nerve damage
- Glucose or HbA1c
- Diabetes, a common cause of nerve damage
- Thyroid function
- When symptoms suggest it
- Kidney function
- Kidney failure is linked to RLS
Symptom diary · one to two weeks
Two weeks of notes beats a guess.
Patterns that are hard to describe in a ten-minute appointment show up over several nights. Log each episode, then copy the summary for your GP or podiatrist.
Your diary
Saved only in this browser on this device. Nothing is sent anywhere.
0episodes logged
0%in the evening or at night
0%eased while moving
Nonemost common area
These are examples. They disappear when you log your first episode.
What helps · treat what's actually there
The fix depends on the cause.
Treatments for a trapped nerve and for RLS are mostly different, which is why sorting the pattern first matters.
If a nerve is trapped
Take the pressure off
First
Footwear changes, orthotics fitted to unload the nerve, physio, and easing off what flares it. A badly placed orthotic can press on the nerve and make things worse.[10]
Next
An image-guided injection around the nerve. Relief from the numbing medicine supports the diagnosis without proving it.
Last
Surgery to free the nerve, when entrapment has been shown, symptoms are disabling and other care has failed. For tarsal tunnel surgery, about 3 in 4 had good or excellent results across mostly low-quality studies. Long-standing symptoms and nerve scarring predicted worse results.[11]
If it's RLS
Iron, triggers, then medicine
First
Correct low iron, and cut back the triggers listed below.[9]
Medicines for adults
The 2025 guideline's strongest recommendations are the gabapentinoids, such as gabapentin and pregabalin, and iron by drip when iron is low. Older dopamine medicines (pramipexole, ropinirole, rotigotine) are now advised against for standard use, because over time they can make RLS worse.[9]
Children
Iron by mouth, when tests show it's needed, is the only treatment with a guideline recommendation.[9]
If it's both
Treat each, one at a time
Plan
Treat both problems, changing one thing at a time so you can tell what helped.
Track
Keep the diary going. A drop in one area, or in night-time episodes, tells you which treatment is working.
Medicines
If you take a dopamine medicine for RLS, don't stop it suddenly. Talk to your doctor about any change.
Things that can make RLS worse
AlcoholCaffeineNicotineShort sleepUntreated sleep apnoeaSome sedating antihistaminesSSRI and SNRI antidepressantsDopamine-blocking anti-nausea and antipsychotic medicines
Don't stop a prescribed medicine on your own. Ask your doctor or pharmacist whether it could be playing a part.[9][16]
Conditions linked to RLS
Iron deficiencyPregnancy, especially lateKidney failure and dialysisNerve damage
They are worth checking for, because treating them can ease RLS.[16]
Children · and when to get help fast
Children describe it differently.
The same two patterns apply, but the words, the checks and the treatment change.
- Use their words. Ask your child to describe the feeling and write down exactly what they say. The children's criteria are built around the child's own description.[2]
- It isn't rare. About 2 in 100 children aged 8 to 17 have RLS.[15]
- A scar alone proves nothing. A past injury or scar doesn't by itself mean a nerve is damaged.
- Treatment differs from adults. Adult medicine recommendations don't carry over. Iron is the one treatment with a recommendation for children, and only when tests show it's needed.[9]
- Ask for the right specialist. A paediatric neurologist, or a foot and ankle specialist who sees children, can help when symptoms persist.
Get help fast
Now · call 000 or go to an emergency department
- Weakness in a leg that comes on suddenly or worsens over hours to days
- New trouble walking
- Numbness or weakness together with new bladder or bowel problems
Soon · see your GP promptly
- Weakness that is slowly getting worse
- Numbness or tingling that keeps spreading
For anyone, child or adult. Adapted from the UK's NICE guidance for children with suspected neurological conditions.[19]
Questions · for your next appointment
Seven questions to take with you.
They aim the next tests at a specific nerve and a specific cause, rather than scanning everything.
- Which nerve could be involved, and where along it?Ankle, arch, forefoot, top of the foot, or higher up the leg.
- What makes you think scar tissue is pressing on it?The exam, my injury history, or something on a scan.
- Would an ultrasound of that area help?It can show a nerve near the surface and the scar beside it.
- Do my symptoms fit RLS, a nerve problem, or both?And should I see a neurologist or sleep specialist?
- Can we check my ferritin and transferrin saturation?Ideally a morning test, with no iron supplements the day before.
- Could any of my medicines be making this worse?Including antihistamines, antidepressants and anti-nausea medicines.
- What do we try first, and when do we judge whether it's working?So there's a clear point to review.
Sources 19
- Allen RP, Picchietti DL, Garcia-Borreguero D, et al. Restless legs syndrome/Willis–Ekbom disease diagnostic criteria: updated IRLSSG consensus criteria. Sleep Medicine, 2014.
- Picchietti DL, Bruni O, de Weerd A, et al. Pediatric restless legs syndrome diagnostic criteria: an update by the IRLSSG. Sleep Medicine, 2013.
- Jiménez-Jiménez FJ, Alonso-Navarro H, García-Martín E, Agúndez JAG. Association between restless legs syndrome and peripheral neuropathy: a systematic review and meta-analysis. European Journal of Neurology, 2021.
- Anderson JC, Fritz ML, Benson JM, Tracy BL. Nerve decompression and restless legs syndrome: a retrospective analysis. Frontiers in Neurology, 2017.
- Anderson JC, Fritz ML, Tracy BL. Improved restless legs syndrome symptoms after lower leg nerve decompression surgery. Discover Medicine, 2026.
- Walters AS, et al. Validation of the International Restless Legs Syndrome Study Group rating scale for restless legs syndrome. Sleep Medicine, 2003.
- Ondo WG, et al. Post hoc analysis of data from two clinical trials evaluating the minimal clinically important change in International RLS Study Group rating scale scores. Journal of Clinical Sleep Medicine, 2016.
- Silva MA, et al. Placebo and nocebo responses in restless legs syndrome: a systematic review and meta-analysis. Neurology, 2017.
- Winkelman JW, Berkowski JA, DelRosso LM, et al. Treatment of restless legs syndrome and periodic limb movement disorder: an American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 2025.
- Bojovic M, Dimitrijevic S, Olory BCR, et al. Overview of nerve entrapment syndromes in the foot and ankle. International Orthopaedics, 2025.
- Haq II, Banerjee AA, Arshad Z, Iqbal AM, Bhatia M. The management of tarsal tunnel syndrome: a scoping review. Journal of Clinical Orthopaedics and Trauma, 2024.
- Patel AT, Gaines K, Malamut R, et al. Usefulness of electrodiagnostic techniques in the evaluation of suspected tarsal tunnel syndrome: an evidence-based review. Muscle & Nerve, 2005; AANEM.
- Marshall NS, Serinel Y, Killick R, et al. Magnesium supplementation for the treatment of restless legs syndrome and periodic limb movement disorder: a systematic review. Sleep Medicine Reviews, 2019.
- Allen RP, et al. Restless legs syndrome prevalence and impact: REST general population study. Archives of Internal Medicine, 2005.
- Picchietti D, et al. Restless legs syndrome: prevalence and impact in children and adolescents. The Peds REST study. Pediatrics, 2007.
- National Institute of Neurological Disorders and Stroke. Restless legs syndrome. Reviewed March 2026.
- Sleep Health Foundation. Restless legs syndrome. February 2026.
- healthdirect Australia. Restless legs syndrome.
- National Institute for Health and Care Excellence (UK). Suspected neurological conditions: recognition and referral (NG127). Updated 2023.
Start tonight
Log the next episode.
Where it was, when it came, and whether moving helped. Two weeks of that gives your GP or podiatrist something real to work with.