Plantar fasciitis is the most common cause of chronic heel pain — but not the only one. Baxter’s nerve entrapment causes up to 20% of chronic heel pain, yet it’s frequently overlooked, leaving people treated for plantar fasciitis that they don’t have. Dr Masci diagnoses and treats Baxter’s neuropathy at his London clinics with ultrasound-guided assessment and injection.
So how do you diagnose Baxter’s nerve entrapment, and how do you treat it?
What is Baxter’s nerve?
Baxter’s nerve is a tiny branch of a larger plantar nerve inside the ankle. It supplies the small muscles of the foot and sensation to the heel.
What causes Baxter’s nerve entrapment?
The exact cause is unclear. The nerve likely becomes trapped by pressure — from reduced ankle movement, flattened feet, or a heel spur and thickened plantar fascia. Baxter’s nerve entrapment frequently occurs alongside plantar fasciitis, which is part of why it gets missed.
Baxter’s neuropathy vs plantar fasciitis: how to tell the difference
The two look alike, but the clues differ:
- Pain type: Baxter’s causes sharp or burning pain inside the heel, sometimes spreading into the arch; plantar fasciitis is more of a throbbing ache
- A numb heel or pins and needles: points to Baxter’s, not plantar fasciitis
- Morning pain: classic for plantar fasciitis, usually absent in Baxter’s
- Tenderness location: slightly closer to the arch in Baxter’s than in plantar fasciitis
The biggest clue of all: a normal plantar fascia on imaging. If the fascia looks normal but the heel still hurts, suspect the nerve.
Imaging helps. Ultrasound or MRI can show thickening of the small Baxter’s nerve; a normal scan raises suspicion of nerve trapping; and in severe cases, MRI reveals wasting of the muscles on the outside of the foot that the nerve supplies.
What nerve causes a numb heel?
Baxter’s nerve entrapment can cause a numb heel alongside the pain. But a numb heel can also come from a pinched nerve in the lower lumbar spine, which usually adds leg pain or weakness — worth excluding.
Can plantar fasciitis cause Baxter’s nerve entrapment?
Yes. Thickening of the plantar fascia near the heel can trap the small Baxter’s nerve. So in some “plantar fasciitis” cases, the pain comes from the thickened fascia, the trapped nerve, or both — which changes the treatment.
Treatment for Baxter’s nerve entrapment
Start simple: taping or orthotics, stretching, and foot strengthening. Low-dye strapping often helps, and a hole cut in the orthotic at the tender spot can offload the nerve.
For stubborn cases, a Baxter’s nerve injection of cortisone helps — but only if placed precisely. Dr Masci performs every Baxter’s neuropathy injection under ultrasound guidance, because the target sits in a different spot from a plantar fasciitis injection, and ultrasound also avoids the arteries and veins beside the nerve. Rehab must follow to stop the pain returning.
Where scar tissue or adhesions bind the nerve, Dr Masci uses nerve hydrodissection — an advanced ultrasound-guided technique that floats the nerve free from the surrounding tissue. He teaches this technique to doctors across the UK and Europe. Surgery is reserved for cases that fail everything else.
Does a plantar fasciitis injection also treat Baxter’s nerve?
No. Baxter’s nerve can be trapped at two sites, and a standard plantar fasciitis injection targets only one location — neither of which may be the trapped nerve. This is precisely why an accurate, ultrasound-guided diagnosis matters before any injection.
Frequently asked questions about Baxter’s nerve entrapment
Why has my “plantar fasciitis” not responded to treatment?
Persistent heel pain that ignores plantar fasciitis treatment is a red flag for a different diagnosis — Baxter’s nerve entrapment being a common culprit, especially if your plantar fascia scanned normal. Many people are treated for plantar fasciitis for years before the nerve is identified.
Does Baxter’s nerve entrapment show on a scan?
Sometimes. Ultrasound or MRI may show the thickened nerve or, in advanced cases, wasting of the foot muscles it supplies. Often the scan looks normal — and a normal scan, in the face of ongoing heel pain, actually supports the diagnosis.
Can Baxter’s nerve entrapment be cured without surgery?
Usually, yes. Most cases settle with offloading (strapping, orthotics with a relief hole), strengthening, and an ultrasound-guided injection or nerve hydrodissection. Surgery is a last resort for the minority who don’t respond.
Final word from Sport Doctor London about Baxter’s nerve entrapment
Baxter’s nerve entrapment is commonly misdiagnosed as plantar fasciitis. The strongest clue is a normal plantar fascia on imaging with ongoing heel pain — often with a numb heel or burning rather than morning stiffness. Simple treatment comes first, then a precisely placed, ultrasound-guided injection or hydrodissection.
To book a one-stop heel pain assessment with Dr Masci in London, contact his team here or call +44 (0) 203 488 0350.
The information has surely helped me as I am a Physiotherapy student at Mulago paramedical school
This was very helpful,i.ll try,to get some physical therapy and sleep if would me out
I’m thinking maybe this is what’s wrong with me, fist they thought it was plantar fascists got the injection, and therapy at the end they said I’d wasn’t that that it’s from my back maybe a pinch nerve? This is so painful and it stops me from doing anything. It’s painful even when I’m sitting or laying.i can’t stand up to walk. This has really helped me I will ask my Dr boutthis.
I have the same thing as you. Did the same
With injections Threpy nothing works. I think I need surgery
I was treated for years for plantar fasciitis and saw many doctors. I had new orthotics, cortisone shots, physiotherapy ,and surgery. I had to quit working because I couldn’t stand long enough. Finally a doctor suggested it could be Baxter’s nerve entrapment. He told me to get a hole cut in the heel of my orthotics, right where the pain was. Such a simple thing made things much better.
That’s a great outcome. yes, nerve entrapment can be tricky.
I have had pain in my heel like this for 7 years. Constantly diagnosed as plantars fasciitis but no treatment worked. No pain in the morning, discomfort comes later in the work day. I have very little discomfort when I’m moving quickly but during periods of sustained standing it becomes almost unbearably uncomfortable in my heel/arch area. When I nap and when I stretch my calves the discomfort abates (napping works the best strangely). I’ve given up on treatments and assumed this is untreatable. Arch supports provide modest relief.
Hi Jordan, yes, you could have nerve-related pain like Baxter’s nerve entrapment. Other possibilities include referred pain from the spine (entrapment of the nerves arising from the lumbar spine. The likelihood of nerve-related pain increases if imaging shows a normal plantar fascia (making plantar fasciitis less likely). Cases like yours can be tricky.
LM
Thanks for your article! Can you point me to good instructions for kinesio taping for Baxter’s nerve entrapment?
I’m guessing I may have Baxter’s nerve entrapment. My podiatrist appointment is still months away, but I’ve had plantar foot pain with an approximately dime-sized extremely tender spot on the distal (arch) side of calcaneus for over six months now. Heel spur was ruled out by x-rays a couple months ago.
There are several possible causes, but the most obvious was two-to-three weeks of irrigating in May/June – stomping on a shovel in flexible-soled muck boots (mostly with that foot) for many hours per day. I also had had an achilles strain about 18 months before (don’t remember which foot, though) and had started dance classes in the spring (stopped in May) and changed my walking/hiking posture including more toe push-off.
I definitely noticed some soreness after the first week or so of irrigating. I initially suspected that my cracked insoles (Superfeet green) were causing the pain, but new ones didn’t provide much relief. A new job in June had me on my feet on hard floors for 12-14 hrs per day, and many days I’d be hobbling the last several hours. After a couple months, I cut back my hours drastically because of the foot pain. It almost goes away when I can keep a really light schedule for a few weeks, but comes back with a vengeance when I increase use to 6-8 hrs.
I suspect there may initially have been plantar faciitis, too (I have some history with it), but now passive dorsiflexion doesn’t cause pain – only pressing on that spot in front of my heel does. I wear mostly western boots, hiking boots, running shoes, and non-slip nurse’s shoes – all with Superfeet green insoles and compression socks – and haven’t noticed much difference in the pain between them. I tried icing (rolling arch with frozen water bottle) for a few days with little relief. I haven’t yet tried targeted stretches or exercises.
I welcome any suggestions while I await my podiatrist appointment. (Oh, I’m ~50 yr old female, ~140 lbs and fairly fit/active, though not like I used to be!) Thanks again for your site!
Many thanks for your email.
You need to see a professional – either doctor or podiatrist = to confirm the diagnosis of Baxter’s nerve entrapment. You may still have plantar fasciitis.
Generally, I recommend low dye strapping for baxter’s nerve entrapment (you can google).
All the best
Lorenzo
Same here almost exactly. Been 10 years for me. Did physical therapy, cortisol injections, costume orthodics, etc. like you mentioned napping/sleep helps and actually a message gun helps a lot too. Also same with walking being less painful then standing still.
Thank you for posting this information. Gotta love it when I have to do my own medical research to find out what’s really wrong with me, when the 2 so-called doctors I’ve seen so far blithely dismiss my concerns & pain because they think it’s due to me being overweight.