Plantar fasciitis is the most common cause of chronic heel pain. However, not all cases of heel pain are due to plantar fasciitis. Other causes of heel pain include stress fracture, joint inflammation, and nerve trapping. Baxter’s nerve entrapment causes up to 20% of cases of chronic heel pain. But it is a frequently overlooked cause of heel pain. So, how do you diagnose Baxter’s entrapment and how do you treat it?
What is Baxter’s nerve?
Baxter’s nerve is a tiny nerve coming from a larger plantar nerve on the inside of the ankle. This tiny nerve supplies the small muscles of the foot and sensation to the heel.
What causes Baxter’s nerve entrapment?
We don’t know the answer exactly. However, we think the nerve might become trapped from pressure due to reduced movement of the ankle joint, flattened feet, and pressure from a heel spur or plantar fasciitis. Often, Baxter’s nerve entrapment occurs together with plantar fasciitis.
Diagnosis of Baxter’s nerve entrapment
Baxter’s neuritis vs Plantar fasciitis
This condition often presents similar to plantar fasciitis. Baxter’s neuropathy symptoms are similar, but there are a few differences. Firstly, people describe sharp or burning pain on the inside of the heel. Sometimes, the pain moves to the arch of the foot. In rare cases, you feel pins and needles in the heel. Unlike plantar fasciitis, you often don’t feel morning stiffness or pain. Finally, tenderness is a little closer to the arch of the foot than plantar fasciitis. Nevertheless, baxters entrapment is confused with plantar fasciitis often delaying the diagnosis.
In general, imaging such as ultrasound or MRI can give clues to the diagnosis. Sometimes, you can see the thickening of the small Baxter’s nerve on the inside of the heel. Other times, you might see a normal scan increasing suspicion of nerve trapping as the cause of pain. In severe cases, nerve trapping can cause the shrinking of the muscles on the outside of the foot seen on MRI.
Can plantar fasciitis cause neuropathy?
Yes. We think that thickening of the plantar fascia close to the attachment to the heel bone can trap the small Baxter’s nerve. So, in some cases of plantar fasciitis, we think that pain can come from the thickened plantar fascia or the trapped Baxter’s nerve.
Relief for Baxter’s nerve entrapment
Often, we start with simple treatments such as taping or orthotics, stretching, and foot strengthening.
In cases that prove difficult, Baxter’s nerve injection of cortisone can be helpful. Importantly, we do Baxter’s nerve injection with ultrasound to make sure we target the correct site of Baxter’s nerve trapping. Usually, the exact site of injection is different from a plantar fasciitis injection. Also, ultrasound helps avoid injecting arteries or veins close to the nerve. It is vital that an injection is followed by further rehab to ensure the pain does not return.
Finally, in some cases, Baxter’s nerve surgery might be needed.
Final word from Sportdoctorlondon about Baxter’s neuritis
Baxter’s nerve entrapment is often misdiagnosed as plantar fasciitis. The biggest clue to possible nerve trapping is when the plantar fascia is a normal appearance on imaging. Generally, we try simple treatment first followed and ultrasound-guided injection.
Other related foot and ankle conditions: