Do you suffer from Chronic Heel Pain?

Sufferers of chronic heel pain often are often diagnosed with Plantar fasciitis, however not all cases of heel pain are due to this. Other causes include nerve trapping, joint inflammation, stress fracture and Baxter’s nerve entrapment. In fact, Baxter’s nerve entrapment can cause up to 20% of cases of chronic heel pain.

So, what is Baxter’s nerve?

Baxter’s nerve is a tiny nerve coming from the larger plantar nerve on the inside of the ankle. It supplies the small muscles of the foot and sensation to the heel. When the nerve becomes impinged it causes a sharp, burning pain, often associated with pins and needles and numbness and pins around the heel.

What causes Baxter’s nerve entrapment?

Baxter’s nerve entrapment can occur after injuring your ankle or heel, but more commonly, it develops slowly, without injury. It is unclear how it happens but there are theories that the nerve might become trapped from pressure, due to reduced movement of the ankle joint, flattened feet, and/or a pressure from a heel spur or plantar fasciitis. It can happen to anyone and doesn’t appear to be gender or age specific.

What are the symptoms and diagnosis

Symptoms often include:

• Pain when you touch the inside of the heel

• A sharp/burning pain around the inside aspect of the heel

• Pain when walking and placing your foot on the floor after a period of rest

• Some people may suffer from pins and needles around the inner aspect of under the heel. Especially when the nerve is knocked or trapped.

Although Baxter’s nerve entrapment presents very similarly to plantar fasciitis, there is a subtle difference in where the pain is felt and some of the symptoms. Baxter’s nerve entrapment is felt on the heel and the medial arch of the foot, whereas Plantar fasciitis is more concentrated just on the heel. As noted above Baxter’s nerve entrapment can also include a sensation of numbness or pins and needles.

Imaging such as ultrasound or MRI can help with diagnosis. You might see thickening of the small Baxter’s nerve on the inside of the heel, or if your scan appears normal this increases suspicion of nerve trapping as the cause of pain. In severe cases, nerve trapping can cause shrinking of the muscles on the outside of the foot which will be seen on MRI.

What is the treatment of Baxter’s nerve entrapment?

Often, we would start with simple, gentle treatments, such as taping and orthotics (inner soles for your shoes), stretching and foot strengthening. We would give an individual strengthening routine and specific stretches to work on at home. Sometimes an injection of cortisone can be helpful, this would be done with ultrasound to ensure we target the correct site of Baxter’s nerve trapping. Finally, in some cases, surgery to release the Baxter’s entrapment might be needed.

If you are suffering from any form of heel pain, get in touch with the team today and see what we can do to help you.

Blog post by James Dodd