Baxter's Neuritis
Entrapment of the lateral plantar nerve is also commonly referred to as Baxter's Neuritis. This entrapment is a cause of chronic heel pain for many patients. This pain may be similar to pain caused from plantar fasciitis. However, the pain is usually felt when the heel is palpated medially instead of plantarly (from the bottom of the heel). Patients with nerve entrapment also show a limited response to NSAIDs and injections, which is different from the usual relief that patients with plantar fasciitis receive from these therapies.
Symptoms:
Specific symptoms for Baxter’s neuritis include:
• No morning pain but pain towards the end of the day
• Paresthesias (numbness, tingling) across the plantar aspect of the heel laterally
• Pain on palpation of the medial heel along the course of the nerve between the abductor hallucis and quadratus plantae muscles
Diagnosis:
One can most accurately confirm this diagnosis through magnetic resonance imaging (MRI).
Non-Surgical (Conservative) Intervention and Treatment Options:
• Chemical neurolysis - low risk
• Radiofrequency ablation - high level of accuracy
Surgical Intervention and Treatment Options:
• Decompression of the nerve
References
1. Baxter DE, Pfeffer GB. Treatment of chronic heel pain by surgical release of the first branch of the lateral plantar nerve. Clin Orthop Relat Res. 1992; (279):229-36.
2. A Closer Look at Heel Pain and Baxter's Neuritis. DeHeer, P. Podiatry Today. 2013.