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Baxter’s nerve entrapment
What is Baxter’s nerve entrapment?
Baxter’s nerve entrapment is a cause of heel pain that is less common compared to plantar fasciitis. It accounts for approximately 20% of the cases of chronic heel pain. Baxter’s nerve is a small nerve that arises from a larger nerve (called the lateral plantar nerve) at the inner aspect of the ankle. It supplies the small muscles of the foot and sensation to the heel. The exact cause of nerve entrapment is not clear. It can happen as the nerve passes between the foot's small muscles or due to pressure from an adjacent bony heel spur or plantar fasciitis.
What are the clinical symptoms of Baxter’s nerve entrapment?
This condition usually presents very similar to plantar fasciitis with pain at the inside of the heel. However, there are a few differentiating features. The pain is more burning in nature and at the inside of the heel. Sometimes, you feel pain in the arch of the foot.
How to diagnose Baxter's nerve entrapment?
Ultrasound and MRI are useful tests to assess the heel when there is suspicion of Baxter’s nerve entrapment or Plantar fasciitis. It can identify the nerve thickening but most of the time the nerve will demonstrate normal appearance. However, imaging is very valuable in ruling out plantar fasciitis which will show a normal appearance on imaging in patients with Baxter’s nerve entrapment.
Ultrasound guided tarsal sinus syndrome steroid injection
Initial treatment consists of exercises to strengthen the foot musculature, taping and orthotics. Ultrasound guided steroid injections can be useful in managing Baxter’s nerve entrapment. Ultrasound guidance will make sure to target the exact area around the nerve. Sometimes, an injection of local anaesthetic only (numbing medication) can be performed under ultrasound guidance. This will be a test to see if this would help alleviate the symptoms to confirm the diagnosis of Baxter’s nerve entrapment.
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