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 neuropathy 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.
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
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. Sometimes, we use an advanced nerve hydrodissection to separate the nerve from surrounding scar tissue or adhesions.
Finally, in some cases, 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 a typical plantar fasciitis injection targets only one place.
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.
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.