What is Baxter's Nerve Entrapment?
Baxter’s nerve entrapment is a condition that causes heel pain in up to 20%1 of the population suffering from heel pain. It occurs when the inferior calcaneal nerve is entrapped between the heel bone and the surrounding muscles of the foot. This condition is often overlooked and many patients have been misdiagnosed with plantar fasciitis. Pain caused by Baxter’s nerve entrapment usually presents with other neurological symptoms such as burning, numbness and tingling sensation.
Causes of Baxter's Nerve Entrapment
The Baxter’s nerve is the first calcaneal (heel bone) branch of the lateral plantar nerve and provides sensory feedback for the heel. It courses through several musculotendinous structures in the heel such as the plantar fascia, abductor hallucis muscles, and quadratus plantae muscles. Baxter’s nerve entrapment occurs when the space between these muscles and the heel bone reduces. The 2 common causes are thickened plantar fascia and pronation.
A thickened plantar fascia, as seen in cases of plantar fasciitis, is due to degeneration of the plantar fascia. The thickened plantar fascia occupy space and adds pressure to Baxter’s nerve around the medial (inner side) heel. Swelling and inflammation around the area causes more compression and lead to the increased risk of Baxter’s nerve entrapment.
Pronation, in cases of flat feet, causes the plantar fascia and the abductor hallucis muscles around the medial heel to stretch when weight-bearing. This along with the collapsed heel bone creates compression on Baxter’s nerve, leading to Baxter’s nerve entrapment.
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Signs and symptoms of Baxter's Nerve Entrapment
Signs and symptoms of Baxter’s nerve entrapment include:
- Sharp pain at the inner side of the heel, occasionally radiating to the outside heel
- Burning sensation after prolonged periods of standing o walking
- Associated numbness and tingling may be present
- Pain relieves at rest
Baxter's Nerve Entrapment Management
Management of Baxter’s nerve entrapment involves addressing the condition’s causative factors and treating any inflamed structures around Baxter’s never, such as the plantar fascia.
Management options for Baxter’s nerve entrapment include:
- Calf and plantar fascia stretches
- Customised foot orthoses to address foot posture, has to be prescribed correctly or risk causing more compression
- Extracorporeal shockwave therapy and magnetotransduction therapy to reduce pain and inflammation
