The Center for Podiatric Care and Sports Medicine

Baxter Entrapped My Nerve

Posted by on Thursday, August 9th, 2012

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Oh, heels. Just when we have come to understand the crankiness of plantar fasciitis and all the heel pain fun that comes with that very common ailment, we are reminded that not all heel pain is pure PF. Sometimes it is something sneaky, like a nerve entrapment. A Baxter’s nerve entrapment.

What is a Baxter’s nerve entrapment? Anatomy time! (Don’t give me that face, you’re going to love this.) The posterior tibial nerve runs down your lower leg, swinging around to the inward facing area of your ankle. When it gets down there, it , it divides into three branches. If one of those branches, the lateral plantar branch, is trapped or pinched by the heel bone, then it creates the painful condition known as Baxter’s nerve entrapment.

You mentioned plantar fasciitis. What does this Baxter’s nerve entrapment have to do with plantar fasciitis? It’s often found in people who have plantar fasciitis. It’s  difficult to diagnose, though, because it’s easy to think that the heel pain you’re feeling is just related to your plantar fasciitis.

So how do you tell the difference? They seem similar but if you think about the pain you’re feeling, you’ll see that a Baxter’s nerve entrapment is really just hiding in plain sight. Here are some tips to help you differentiate between the two conditions: the heel pain from plantar fasciitis is worst first thing in the morning or when you get up after sitting for a long time; pain from a Baxter’s nerve entrapment isn’t as noticeable on the “first step,” but gets worse as you put weight on your foot, and throughout the day. Heel pain from plantar fasciitis will die down when you take weight off your foot; you’ll still feel pain from a Baxter’s nerve entrapment even when you’re off your feet.

Those are just hints, though. The only way to absolutely diagnose a Baxter’s nerve entrapment is for a podiatrist at The Center for Podiatric Care and Sports Medicine (212.996.1900) to examine your foot and run tests to determine whether a nerve entrapment is really the problem. The most important thing for you to do is really think about when you’re feeling the pain in your heel, and accurately describe that to your podiatrist.

Okay, imagine that my intrepid, thoughtful podiatrist saw through the plantar fasciitis forest and has diagnosed me with a Baxter’s nerve entrapment. What’s the treatment? Steroidal injections may help with the inflammation caused by the irritated nerve. Orthotics can correct overpronation that may be contributing to the entrapment of the nerve.

However, in many cases, the best solution is surgery. The most common procedure is external neurolysis, where the podiatric surgeon finds the area of the nerve that’s being pinched and releases it. Cryosurgical neurolysis, where the painful nerve is essentially frozen, is also considered to be a successful method of treatment. Your podiatrist can discuss the various procedures available and determine which one is right for you.

Any other questions about Baxter’s nerve entrapments?

Yes. Who is Baxter? I’m glad you asked! The Baxter in question is Dr. Donald Baxter, a Houston orthopedist who described the condition around 1984. So next time you have any heel pain, don’t just think about your plantar fascia–think about Dr. Baxter as well.

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If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.