Match ends, Everton 1, Tottenham Hotspur 1.
Everton midfielder Andre Gomes suffered a serious ankle injury which left Tottenham's Son Heung-min in tears and overshadowed the home side scoring a 97th-minute equaliser to earn a vital point.
Gomes, 26, was tackled from behind by Son and appeared to be injured by an awkward fall which prompted an anguished reaction from players and fans close to the incident.
Son was sent off by referee Martin Atkinson as Portugal international Gomes received extensive treatment in a lengthy delay and was eventually taken off on a stretcher.
Former Everton winger Pat Nevin, who was the analyst for BBC Radio 5 Live at Goodison Park on Sunday, described the incident as "horrible".
"Players looked devastated and there was utter confusion - players with their heads in their hands," the former Scotland international said.
"Son was distraught before he was sent off, and Serge Aurier couldn't watch and was praying.
"Gomes was led straight to the corner to the ambulance to take him to hospital."
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- Relive the action at Goodison Park
The atmosphere around Goodison Park darkened as the football became secondary to Gomes' plight, until the mood was lifted by substitute Cenk Tosun heading in from close range.
Earlier, Spurs midfielder Dele Alli's clinical finish had livened up a dull game where the video assistant referee again proved a controversial talking point when Everton were denied what looked like a penalty.
Spurs, without a league win on the road since January, seemed set to take all three points when Alli punished a loose pass from Everton's Alex Iwobi to fire in.
Moments later, Alli looked to have handled in the Everton box but, after a three-minute delay peppered with boos from supporters, a penalty was not given by VAR.
Everton eventually equalised deep into the 12 minutes of stoppage time following Gomes' injury, with the draw moving Marco Silva's side three points clear of the relegation zone.
Spurs were set to move eighth with a rare away win, but instead are 11th in the middle of a pack of 13 teams separated by just six points.
Tottenham manager Mauricio Pochettino sent his "best wishes" to Gomes, adding "the most important thing is he recovers quickly".
Son initially looked set to be given a yellow card for the challenge before referee Atkinson changed his mind and reduced Spurs to 10 men for the rest of the match.
Pochettino said it was "not important" whether Son should have been sent off or not, although added he did think his player was given a red card because of the "consequence" of the challenge.
"It was a normal action with the bad luck that Andre was injured," he told BBC Sport.
More VAR confusion leaves everyone baffled
For the first hour of the match, there was very little to talk about as both teams illustrated why they are struggling in the bottom half despite each holding much loftier ambitions.
So it was once again left to the farcical nature of VAR to give fans leaving Goodison Park something to complain about.
Shortly after Alli put Tottenham ahead, the Spurs midfielder looked to have handled in his own box when jumping to challenge Yerry Mina at an Everton corner.
Initially it looked innocuous - and certainly accidental - but replays suggested a penalty would be given as, judging by the letter of the law, his arm was raised above his head.
Loud boos were heard from the Goodison crowd as VAR watched 26 replays in a wait lasting almost three minutes.
Eventually it was decided that the original 'no penalty' decision should stand, leaving the players, managers, supporters at the ground and television viewers alike confused.
Earlier, Son had felt he was fouled by Mina in the Everton box during the first half, leading to another long delay until the system eventually came to the same conclusion of 'no penalty'.
Everton manager Marco Silva said he was "100% sure what happened" in both incidents after needing only a quick look at the same replays seen by VAR.
"I don't know why they needed two or three minutes and then decided what they decided," the Portuguese boss said.
"It is tough for me but tough for the referee as well."
Spurs boss Mauricio Pochettino added he "did not know what is going on".
"It is supposed to be helping the referee but it is creating more confusion," added the Argentine.
Deficiencies of Everton and Spurs still clear
Although the game was ultimately overshadowed, the deficiencies in two teams expecting to be challenging for Champions League qualification - and leaving both managers under differing degrees of pressure - were not masked.
Everton manager Silva badly needed a victory with his side sitting one place above the relegation zone and having earned just three points from their previous six league matches.
That is despite the Toffees spending almost £120m this summer in a bid to close the gap on the Premier League's 'top six'.
Both sides played with a lethargy in a first half which saw neither team pressing quickly, leading to a dearth of attacking pressure and just one shot on target - when Everton forward Richarlison turned and shot weakly at Spurs keeper Paulo Gazzaniga - between them.
Everton improved with their numerical advantage and left Silva claiming his team could have won.
"We showed a fantastic spirit. Even after that tough moment we had to keep focus and get a result. We deserved more than just a draw," he said.
"The first half was tough, we had problems to press a little more and even though they didn't create anything we didn't create either.
"In the second half we made some steps forward and started to press a little more. In my opinion we controlled the game until they scored through our mistake.
"Of course we reacted and after that tough moment we showed a reaction and could have won 2-1."
Everton's late equaliser means Tottenham, who were without striker Harry Kane through illness, have won just twice in their past 10 matches in all competitions.
"We were playing well but it's difficult to assess the last 10 minutes," Pochettino said.
"Talking only about football, it was a very difficult game. We were good but the game changed after the incident."
Man of the match - Dele Alli (Tottenham)
Spurs' struggles on the road continue - the stats
- Tottenham Hotspur are winless in their last 12 Premier League away games, drawing three and losing nine, and last beating Fulham 2-1 on 20 January.
- Cenk Tosun's goal for Everton after 96 minutes and 57 seconds is the latest goal scored in a Premier League game since Alexis Sanchez scored for Arsenal against Burnley in January 2017 after 97 minutes and 14 seconds.
- Spurs avoided a goalless draw for an 82nd consecutive Premier League game, the only two sides to go on longer runs are Ipswich Town (87 between Aug 1994 and May 2001) and Manchester United (114 between May 1999 and May 2002).
- Everton's Jordan Pickford became only the 22nd player in Premier League history to appear in 100 consecutive matches and the first since Darren Fletcher.
- Spurs' Dele Alli has not lost any of the 39 Premier League games he has scored in; only Darius Vassell (46) and James Milner (53) have scored in more games without finishing on the losing side.
- The match lasted 104 minutes and 52 seconds, making it four minutes longer than any other Premier League match this season.
Everton go to fellow strugglers Southampton on Saturday (15:00 GMT) in what is surely a must-win game for under-pressure manager Marco Silva.
Tottenham switch their attention back to the Champions League, when they face Red Star Belgrade in the Serbian capital on Wednesday (20:00 GMT), before returning to Premier League action at home to sixth-placed Sheffield United on Saturday (15:00 GMT).
- 11WalcottBooked at 30minsSubstituted forTosunat 68'minutes
- 26DaviesSubstituted forCalvert-Lewinat 83'minutes
- 21André GomesSubstituted forG Sigurdssonat 84'minutes
- 10G Sigurdsson
- 24AurierSubstituted forFoythat 88'minutes
- 6D Sánchez
- 28NdombeleBooked at 65minsSubstituted forLo Celsoat 73'minutes
- 7Son Heung-MinBooked at 79mins
- 23EriksenBooked at 31minsSubstituted forR Sessegnonat 90+12'minutes
- 27Lucas Moura
- 18Lo Celso
- 19R Sessegnon
- Martin Atkinson
- Shots on Target
Second Half ends, Everton 1, Tottenham Hotspur 1.
Substitution, Tottenham Hotspur. Ryan Sessegnon replaces Christian Eriksen.
Foul by Giovani Lo Celso (Tottenham Hotspur).
Fabian Delph (Everton) wins a free kick in the attacking half.
VAR Decision: Other Decision Confirmed.
Goal! Everton 1, Tottenham Hotspur 1. Cenk Tosun (Everton) header from the centre of the box to the bottom left corner. Assisted by Lucas Digne with a cross.
Offside, Tottenham Hotspur. Toby Alderweireld tries a through ball, but Christian Eriksen is caught offside.
Giovani Lo Celso (Tottenham Hotspur) wins a free kick in the defensive half.
Foul by Fabian Delph (Everton).
Juan Foyth (Tottenham Hotspur) wins a free kick in the defensive half.
Foul by Dominic Calvert-Lewin (Everton).
Substitution, Tottenham Hotspur. Juan Foyth replaces Serge Aurier.
Attempt missed. Dominic Calvert-Lewin (Everton) header from the left side of the six yard box is just a bit too high.
Substitution, Everton. Gylfi Sigurdsson replaces André Gomes because of an injury.
Substitution, Everton. Dominic Calvert-Lewin replaces Tom Davies.
Son Heung-Min (Tottenham Hotspur) is shown the red card.
Foul by Son Heung-Min (Tottenham Hotspur).
André Gomes (Everton) wins a free kick on the left wing.
Substitution, Tottenham Hotspur. Giovani Lo Celso replaces Tanguy Ndombele.