What is Baxter’s nerve entrapment?

When a tiny nerve (known as Baxter’s nerve or, more precisely, the first branch of the lateral plantar nerve) becomes pinched (impeded) between two muscles of the inner foot, it is known as Baxter’s nerve entrapment. When this tiny nerve on the inside of the heel is impinged, it creates an intense, burning pain that is typically accompanied by numbness and pins and needles around the heel. Baxter’s nerve entrapment can happen after an injury to your ankle or heel, although it usually happens gradually and is neither gender or age specific.

What are the symptoms of Baxter’s nerve entrapment?


The following are common symptoms of Baxter’s nerve entrapment.

  • Pins and needles, especially when the nerve is struck or tapped, around the inner aspect or under the heel.
  • Touching the inside of the heel causes pain.
  • After a time of relaxation, you may experience difficulty walking and placing your foot on the floor (getting out of bed in the morning).
  • A strong, scorching pain radiates from the inside of the heel.

What are some additional conditions that mimic Baxter’s nerve entrapment?

  • Bursitis of the heel
  • Morton’s neuroma
  • Osteoarthritis of the midfoot
  • Plantar fasciitis

Baxter’s nerve entrapment vs plantar fasciitis

Plantar fasciitis and Baxter’s nerve entrapment have a lot in common. Both usually begin slowly and without shock or injury. Both cause discomfort on the inside of the heel and affect men and women of all ages. It can be difficult to tell the difference between these two states.
The type of pain and the location of the symptoms can have a modest difference. Plantar fascia discomfort is primarily felt under the heel, whereas Baxter’s nerve entrapment is primarily felt on the heel and medial arch of the foot, with numbness or pins and needles as well.
A diagnostic ultrasound scan is required to ensure a precise diagnosis and, as a result, the most effective treatment.

What is Baxter’s nerve entrapment?

The Baxter’s nerve, also known as the first branch of the lateral plantar nerve, is a tiny nerve that runs along the inside of the heel (under 1mm in diameter). It’s a rare cause of heel pain, but it’s one to investigate if your discomfort isn’t going away, especially if you’ve been diagnosed with plantarfasciitis. The quadratus plantae, abductor digiti minimi, and flexor digitorum brevis are three little muscles in the foot that are controlled by this tiny nerve. It also gives the calcaneus (heel bone) sensation (Presley et al., 2013).

The Baxter’s nerve is a branch of the tibial nerve, which is a bigger nerve. The tibial nerve gives muscle control and sensation to the calf muscles.

What is the definition of neuropathy?

A neuropathy is a nerve inflammation. Neuropathies can affect any part of the body and commonly manifest as:

  • Weakness
  • Numbness
  • Tingling sensations (pins and needles)
  • a burning sensation
  • The agony is shooting.
  • Loss of equilibrium

Neuropathy can be caused by a number of factors, including:

  • Trauma — for example, after an ankle sprai
  • Nerve entrapment occurs when the nerve is squeezed by other tissues such as tight muscles.
  • Infection
  • Viruses that cause diabetes, such as shingles
  • Neuropathy is a side effect of some drugs.

Symptoms of Baxter’s nerve entrapment?

The following are some of the signs and symptoms of Baxter’s neuropathy:

  • Sharp or searing pain that travels up the inside of the heel bone (calcaneus) and into the arch of the foot.
  • Tenderness on the inside of the heel nerve
  • When the nerve is tapped, it causes pins and needles. Tinel’s Sign is the act of ‘tapping’ the nerve to mimic the symptoms. Your physiotherapist will take care of this.
  • Plantarfasciitis can generate symptoms that are remarkably similar to those of plantarfasciitis (the most common cause of heel pain).
  • Baxter’s neuropathy is caused by a variety of factors.
  • Nerve entrapment is the most common cause of Baxter’s neuropathy. It happens when the Baxter’s nerve is pinched or imprisoned as it goes beneath the heel (see below) between the quadratus plantae and the abductor hallucis, two inner foot muscles.

How do we diagnose Baxter’s nerve entrapment?

Heel discomfort can be caused by Baxter’s neuropathy, which is a rare condition. It’s been estimated that up to 20% of all chronic heel pain cases are caused by it (Presley et al., 2013). It’s difficult to get an exact diagnosis, and it’s frequently mistaken for chronic plantarfasciitis. A delay in diagnosis can lead to poor therapy, frustration, and discomfort for long periods of time.

An correct diagnosis is necessary for the development of an effective treatment strategy. An in-depth clinical interview, clinical testing, and a diagnostic ultrasonography scan are all used to make a diagnosis. The following items will be covered during your first visit to Joint Injection:

Clinical interview

A clinical interview is the first step in your evaluation. Your doctor will carefully listen to your injury history and ask you specific questions such as when your pain began, if you’ve had any previous treatment, what has helped you, and what has been particularly tough for you. At this stage, a complete medical history is also requested. This helps to rule out the presence of any other medical disorders that could be causing your symptoms.

Clinical trials
You will be required to complete a series of physical challenges following the interview. Your foot, ankle, and lower leg will also be palpated by your doctor. It’s possible that some of these duties will be painful. Pain associated with specific tasks can be a useful indicator, leading to a more accurate diagnosis. Your doctor will also palpate the nerve to see if it is the source of any of your pain or symptoms.

Diagnostic Ultrasound
The presence of a Baxter’s neuropathy cannot be formally confirmed by a clinical examination alone. Only medical imaging procedures such as diagnostic ultrasound can confirm the presence of a Baxter’s neuropathy. The use of diagnostic ultrasound to visualise the Baxter’s nerve has been found to be quite helpful (Presley et al., 2013). To confirm the diagnosis, an ultrasound-guided injection of local anaesthetic nerve block may be required. This includes injecting a little quantity of local anaesthesia around the nerve while utilising ultrasonography to visualise and guide the process.

How do you treat Baxter’s nerve neuropathy?
The first course of treatment is often conservative, consisting of a physiotherapist-led rehabilitation programme supplemented with manual therapy (hands-on treatment) approaches. The following will be included in the physiotherapy treatment:

  • Suggestions for pain management
  • Techniques for reducing nerve irritation in particular
  • A strengthening routine that is tailored to the individual.
  • Stretches that are specific.
  • Techniques for soft tissue massage
  • Acupuncture.
  • Taping.
  • Orthotics are a type of footwear that is worn (inner soles for your shoes).
  • Advice on how to get back into shape.

What if conventional treatment fails?
Injections guided by ultrasound
Baxter’s neuropathy is difficult to treat, and conservative therapy methods alone do not usually work. If this is the case, an ultrasound-guided steroid injection may be a good option for you. The accuracy of ultrasound guided steroid injections in targeting the Baxter’s nerve has been verified (Presley et al., 2013). Non-guided (blind) steroid injections are not indicated due to the size and depth of the Baxter’s nerve, as well as its proximity to a number of arteries that supply the inner heel. The needle must be guided directly to the nerve to guarantee a safe and effective injection. This can only be done by employing an ultrasound scanner to visualise the injection in real time.

A combination of a steroid (anti-inflammatory drug) and a local anaesthetic (short-term numbing agent) is injected into the nerve during a guided injection. By lowering inflammation, this decreases the pain associated with the.

Although an ultrasound-guided steroid injection can help with pain and inflammation, it should not be used as a stand-alone treatment. It is critical that you begin a physiotherapy programme after your injection to guarantee that the pain does not recur. Physiotherapy seeks to enhance the biomechanics of your foot, particularly your foot arches, by strengthening your foot and calf musculature.

Fully qualified sonographers, independent medical prescribers, and injection therapists make up joint injections clinicians. If an ultrasound guided steroid injection is clinically indicated and you want one, your physician will be able to prescribe the most effective drug and conduct the procedure within the same visit. You do not need a reference from your doctor because of the one-stop service. You can simply walk into one of our clinics and recommend yourself

Joint Injection’s experts are dual-trained, highly specialised physiotherapists and musculoskeletal sonographers with extensive experience diagnosing all foot and ankle disorders. We provide a ‘one-stop’ clinic, which means you’ll get an examination, a diagnostic ultrasound, and, if necessary, an ultrasound-guided injection.