Baxters-neuritis (Calcaneal Nerve Entrapment)

What is Baxter’s neuritis?

Also known as calcaneal nerve entrapment, Baxter’s neuritis occurs when a branch of the tarsal tunnel nerves becomes trapped or scarred. Baxter's nerve (inferior calcaneal nerve) is actually the first branch of the lateral plantar nerve before it continues through the arch of the foot. This small nerve can become pinched between muscles in the ankle. The quadratus plantae muscles and the abductor hallucis muscle, are often the ones that trap or pinch the small Baxter’s nerve.

Baxter's neuropathy can be overlooked as a cause of heel pain because so many other issues can cause similar pain. About 20% of the time, patients come to us having been misdiagnosed with plantar fasciitis. Chronic heel pain can also be misattributed to heel spurs, Morton’s neuroma, flat feet, or an injury to the heel bone (calcaneus).

What are the symptoms of Baxter's neuritis?

When the Baxter's nerve is pinched, there is often pain and discomfort. Other Baxter's nerve entrapment symptoms can include:

• Sharp medial-plantar heel pain
• A burning sensation around the inner ankle and heel
• Loss of feeling or pins and needles (paresthesia) on the base of the foot or under the heel
• Pain during weight-bearing activities
• Pain first thing in the morning when getting out of bed or after being at rest
• Sensitivity to touch the inside of the heel

What causes Baxter's nerve entrapment?

So far, a single cause of Baxter’s nerve entrapment hasn’t been determined. It can develop over time, regardless of age or gender. In some cases, it may result from an injury to the foot or ankle. Over-pronation (rolling your foot inwards when walking), obesity, and flat feet may increase your risk of developing nerve entrapment. 

Overly-tight footwear and improperly fitting orthotics can also increase your risk.

How is Baxter's nerve compression diagnosed? 

Because heel pain can have so many possible causes, it’s essential to see a foot and ankle specialist for a proper diagnosis. The podiatrists at University Foot & Ankle Institute have access to imaging technology and neurosensory testing to rule out bone spurs, stress fractures, and problems with the muscles, ligaments, and tendons.

Imaging such as X-rays and MRIs also let us see where the nerve is being pinched. 

Conservative treatment options for calcaneal nerve entrapment 

Non-surgical treatment options focus on pain relief and reducing inflammation and swelling that can further irritate the nerve. Conservative treatment will often include corticosteroid injections near the nerve. Steroid injections can be especially helpful when over-the-counter NSAIDs aren't working. Physical therapy, taping, and possible bracing for some time may also be suggested. Custom insoles called orthotics may be used to relieve chronic pain along the problematic nerve.

Cryotherapy, an outpatient treatment method using extreme cold to remove Baxter's nerve, is sometimes used as a treatment to improve nerve pain symptoms without surgical treatment. A 2-millimeter incision is made, and the cryoprobe is used to freeze the damaged nerve under local anesthetic. You can return to regular shoes after about three days, and full activity after about two weeks. 

In about 30% of cases, it may be necessary to repeat the procedure to achieve an ideal outcome.

What are the surgical options for treatment for Baxter's nerve entrapment? 

Decompression — surgical release of the nerve — may be necessary if pain does not resolve with conservative treatment options. Done in an outpatient setting, this procedure boasts a fairly rapid recovery. Generally, the nerve is freed as part of a more comprehensive fascia and ligament nerve release. It can be needed in cases when innervation to the abductor digiti minimi muscle is necessary to restore the feeling and function of the little toe as well as to prevent atrophy.

Patients are not allowed to put weight on the foot for about two weeks, after which they’ll start physical therapy to rebuild strength and flexibility.

UFAI doctors have experience with Baxter nerve pain 

The physicians at the University Foot and Ankle Institute have decades of combined experience treating all forms of adult foot and ankle concerns. Our podiatry clinics use the latest technologies available to successfully diagnose and treat Baxter's neuropathy. 

New patients or individuals concerned about foot or toe pain in the greater Los Angeles area are encouraged to call or schedule a consultation; please call (877) 736-6001 or make an appointment now.

University Foot and Ankle Institute is conveniently located throughout Southern California and the Los Angeles area. Our foot and ankle surgeons are available at locations in or near Santa Monica, Beverly Hills, West Los Angeles, Sherman Oaks, the San Fernando Valley, El Segundo, the South Bay, LAX, Calabasas, Agoura Hills, Westlake Village, Valencia, Santa Clarita, and Santa Barbara.

 

 

Baxter's neuritis FAQ’s

 

What does Baxter’s nerve pain feel like? 

Baxter’s nerve pain is commonly described as a sharp or burning pain. It can also cause loss of feeling, numbness, and pins and needles.

 

What are the best shoes for Baxter’s nerve entrapment? 

Shoes with good arch support and shock absorption can help with Baxter’s nerve entrapment. Orthotics designed for your foot mechanics and shape may also be beneficial.

 

Baxter’s nerve entrapment vs. plantar fasciitis 

It can be challenging to tell plantar fasciitis and Baxter’s neuropathy apart. However, plantar fasciitis pain commonly presents where the plantar fascia attaches to the heel while Baxter’s nerve entrapment can produce symptoms further away from the heel and toward the inner ankle.