What is Baxter’s nerve entrapment?
Baxter’s nerve entrapment is a heel pain condition caused by entrapment of the inferior calcaneal nerve, also commonly known as “Baxter’s nerve”. Baxter’s nerve entrapment causes up to 20% of cases of chronic heel pain. However, it’s an often-overlooked source of heel pain. Baxter’s nerve also known as the inferior calcaneal nerve is the first branch of the lateral plantar nerve arising within the tarsal tunnel.
Baxter’s nerve is vulnerable to entrapment because of its course. The most common location is the tight fascia of the abductor hallucis and the medial aspect of the quadrates Plantae muscle. Common causes include:
Poor foot mechanics or excess foot pronation (rolling inwards of the foot).
Compression from poor footwear or poorly prescribed orthotics.
Heel pad atrophy.
An acute injury to the foot that results in swelling around the inside or underneath the heel.
Repetitive overuse or trauma to the nerve during certain activities e.g. running.
Heel pain, that may have radiated laterally.
The patient may not be able to abduct the fifth digit
Symptoms increase with continuous activity.
Chronic pain on the inside (medial aspect) of the heel.
A radiating or burning pain under the heel.
In long-standing cases, there can be numbness in the outside (lateral) part of the heel or foot.
Tenderness at the inside of the heel.
Pain with walking and placing your foot on the floor after a period of rest
Plantar fascial massage with bottle or roller.
Stretching of Achilles tendon, soleus, and gastrocnemius muscle.
Ultrasound therapy and heat
ultrasound-guided corticosteroid injection
Surgical release of the nerve has been found to be effective management.
Ultrasound-Guided Hydrodissection injection
An ultrasound-guided anesthetic injection may also be used for diagnostic and therapeutic purposes.