Plantar fasciitis or heel spurs are 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. Baxters nerve entrapment causes up to 20% of cases of chronic heel pain. However, it is a frequently overlooked cause of heel pain and numbness. So, how do you diagnose Baxter’s entrapment, and how do you treat it? 

What is Baxter’s nerve?

Baxters nerve is a tiny nerve from a larger plantar nerve inside the ankle. This little nerve supplies the foot’s small muscles and sensation to the heel.

 

baxters nerve

What causes Baxter’s nerve entrapment?  

We don’t know the answer exactly. However, we think the nerve might become trapped by pressure due to reduced movement of the ankle joint, flattened feet, and pressure from a heel spur or plantar fasciitis. Often, Baxters nerve entrapment occurs together with plantar fasciitis.

Diagnosis of Baxter’s neuropathy 

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 inside the heel. Sometimes, the pain moves to the arch of the foot. You rarely feel pins and needles and have a numb heel. Unlike plantar fasciitis, you often don’t feel morning stiffness or pain. Finally, tenderness is slightly closer to the foot’s arch than plantar fasciitis. Nevertheless, Baxter’s neuropathy 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, as seen on MRI.

Can plantar fasciitis cause Baxter’s neuropathy?

Yes. We think the 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 pain can come from the thickened plantar fascia or the trapped Baxter’s nerve.

Relief for Baxter’s nerve entrapment

baxter's nerve injection

 

Often, we start with simple treatments such as taping or orthotics, stretching, and foot strengthening.

Baxter’s nerve injection of cortisone can be helpful in cases that prove challenging. Importantly, we do Baxter’s neuropathy injection with ultrasound to ensure we target the correct site of Baxter’s nerve trapping. Usually, the exact location of the injection is different from a plantar fasciitis injection. Also, ultrasound helps avoid injecting arteries or veins close to the nerve. Further rehab must follow the injection to ensure the pain does not return.

Finally, in some cases, Baxter’s nerve surgery might be needed.

Does a plantar fasciitis injection also target Baxter’s nerve? 

Not always. We think Baxter’s nerve entrapment occurs at two sites, and only one place is targeted with a typical plantar fasciitis injection.

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 normal on imaging. Generally, we try simple treatment first, followed by an ultrasound-guided injection.

Other related foot and ankle conditions:

Dr. Masci is a specialist sport doctor in London. 

He specialises in muscle, tendon and joint injuries.