Baxter's Nerve Entrapment
Baxter’s nerve entrapment is a possible cause of pain underneath the heel. It can produce symptoms that are similar to plantar fasciitis, which means that the two conditions can sometimes be difficult to distinguish without a thorough assessment.
Baxter’s nerve is a small nerve in the heel and foot. When the nerve becomes irritated or compressed, it can cause pain around the underside and inner aspect of the heel.
At MK Orthotics in Milton Keynes, we can assess your foot and lower-limb mechanics and consider whether the pattern of your symptoms may be consistent with Baxter’s nerve entrapment or another cause of heel pain.
What is Baxter’s nerve entrapment?
Baxter’s nerve is also known as the inferior calcaneal nerve or the first branch of the lateral plantar nerve.
It passes through the soft tissues around the inside and underside of the heel. If the nerve becomes irritated or compressed, it can cause pain in the heel.
Baxter’s nerve entrapment is sometimes referred to as Baxter’s neuropathy.
It is important to remember that heel pain can have several different causes. Symptoms alone do not necessarily establish the cause, so an appropriate assessment is important.
What does Baxter’s nerve entrapment feel like?
Symptoms can vary between individuals. They may include:
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Pain underneath the heel
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Pain around the inner or medial side of the heel
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Burning or nerve-like pain
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Sharp or shooting pain
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Persistent heel pain
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Pain that becomes worse with prolonged standing or walking
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Pain associated with activity
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Tenderness around the heel
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Occasionally, altered sensation such as tingling or numbness
The exact pattern of symptoms can be different from one person to another.
One feature that may help distinguish Baxter’s nerve entrapment from plantar fasciitis is the timing of the pain.
With plantar fasciitis, pain is commonly worse with the first few steps after getting out of bed or after a period of rest. Baxter’s nerve entrapment does not typically produce this same classic first-step pattern.
However, this difference alone cannot confirm the diagnosis.
Baxter’s nerve entrapment and plantar fasciitis
Because both conditions can cause pain underneath the heel, Baxter’s nerve entrapment can sometimes be mistaken for plantar fasciitis.
Plantar fasciitis commonly causes pain around the inner or central underside of the heel and is often particularly noticeable with the first steps after rest.
Baxter’s nerve entrapment is a nerve-related problem and may instead produce a more persistent, burning, sharp or aching pattern of heel pain.
It is also possible for more than one problem to be contributing to heel pain at the same time.
If heel pain is continuing despite treatment for plantar fasciitis, it may therefore be appropriate to reassess the diagnosis and consider other possible causes.
What can contribute to Baxter’s nerve entrapment?
Nerve entrapment occurs when a nerve is exposed to pressure or irritation.
The structures around the heel and foot can influence the amount of space and pressure around the nerve. Foot posture, movement and the way load is transferred through the foot may therefore be relevant when assessing an individual.
Other factors may also contribute to symptoms.
This is why the assessment should look at the foot and lower limb as a whole rather than assuming that the painful area alone explains the problem.
Foot mechanics and Baxter’s nerve pain
The way your foot functions during standing and walking can affect how forces are distributed through the foot.
Your assessment may therefore consider:
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Foot posture
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The movement of your foot and ankle
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Joint range of movement
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Muscle function
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Walking mechanics
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Lower-limb alignment
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Your footwear
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Your normal activities and exercise
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Previous injuries
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Where and when your symptoms occur
A video gait analysis may also be used where appropriate to look at how your feet and lower limbs move during walking.
The purpose is not to assume that your foot posture needs correcting, but to determine whether any particular features may be relevant to your symptoms.
Could orthotics help?
Orthotics are not automatically required for Baxter’s nerve entrapment.
If your assessment suggests that the way your foot is functioning or loading is contributing to irritation around the heel, an orthotic may sometimes be considered as part of an individual management plan.
The design would depend on your particular symptoms and assessment findings.
The aim may be to alter pressure distribution or the way load is transferred through the foot rather than simply providing an arch support.
Orthotics will not be appropriate for every person with heel pain, and they do not replace appropriate medical investigation where a nerve problem or another underlying condition needs further assessment.
Other treatment approaches
Management will depend on the suspected cause of your symptoms and how severe or persistent they are.
Depending on your individual circumstances, management may include:
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Reviewing your footwear
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Modifying activities that aggravate your symptoms
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Exercises or rehabilitation
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Advice about load management
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Foot mobilisation where appropriate
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Taping or other supportive approaches
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An orthotic if this is considered appropriate
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Referral for further medical assessment where required
If your symptoms suggest significant nerve involvement or another condition that requires investigation, you may be advised to seek assessment from an appropriate healthcare professional.
How we assess heel pain
At MK Orthotics, the assessment starts with understanding your symptoms and how they affect your everyday life.
We may discuss:
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When your heel pain started
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Exactly where you feel the pain
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Whether it is burning, sharp, aching or shooting
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Whether you experience tingling or numbness
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Whether symptoms are worse with your first steps in the morning
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What happens during prolonged standing or walking
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Your footwear
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Your work and daily activities
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Exercise and sporting activities
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Previous injuries or treatment
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Any orthotics or supports you have already tried
We can then assess your feet and lower limbs, including movement and function.
Where appropriate, video gait analysis can be used to look at your walking pattern in more detail.
The initial consultation is approximately 90 minutes, allowing time for a detailed assessment and discussion of the findings.
When should heel pain be assessed?
Consider arranging an assessment if:
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Your heel pain has persisted despite rest or changes to activity
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You have ongoing pain after being treated for plantar fasciitis
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Your heel pain feels burning, sharp or nerve-like
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You experience tingling or altered sensation
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Your symptoms are affecting your walking, work or exercise
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Heel pain keeps returning
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You have tried orthotics but your symptoms have not improved
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You are unsure what is causing your heel pain
Persistent or significant heel pain should not automatically be assumed to be plantar fasciitis. There are several possible causes of heel pain, and further medical assessment may sometimes be appropriate.
Related conditions
You may also find these pages useful:
Baxter’s nerve entrapment assessment in Milton Keynes
If you have persistent or unexplained pain underneath your heel, a detailed assessment can help determine what may be contributing to your symptoms.
At MK Orthotics in Blakelands, Milton Keynes, we assess the foot and lower limb as a whole rather than assuming that every case of heel pain requires an orthotic.
If an orthotic is considered appropriate, we can explain how it may be used as part of your individual management plan.