by Last updated on February 2nd, 2023 at 12:32 pm
The prevalence of heel-related pain in adults is approximately 15%. About 20% of heel pain complaint is Baxter’s nerve entrapment (Hornick & Amabile, 2018). These two pathologies are often confused and can pose difficulty for clinicians to diagnose. While both are relatively common in the population, plantar fasciitis is more prevalent at 9.6% (Nice, 2020). This article will look at Baxter’s nerve entrapment vs plantar fasciitis in terms of what they are, what causes them, their symptoms, their diagnosis, risk factors, how they are treated and their prognosis. Read on to find out more!
What is Baxter’s nerve entrapment?
The Baxter’s nerve is a branch of the lateral plantar nerve. The posterior tibial nerve runs downwards behind the medial malleolus inside the ankle. It gives rise to various branches. The Baxter’s nerve is the first branch. Anatomical variations have been reported in the literature. As such, the nerve may not be in the area described. Baxter’s nerve is predisposed to compressive neuritis, which can be painful to walk on.
Causes of Baxter’s nerve entrapment
Anything that causes compression to the nerve can lead to entrapment syndrome. Any increase in tissue volume or viscosity in the area can cause compression to the nerve. The pathology is also associated with atrophy to the abductor digiti quinti muscle, which it innervates. Nevertheless, chronic plantar fasciitis and viscosities are generally associated with Baxter’s nerve entrapment.
Additionally, the heel spur, which the nerve passes anteriorly, can also cause compression. Excessive pronation and trauma are also contributing factors. Medial and lateral ankle ligament injuries, tendinopathy, and tarsal tunnel syndrome further put the individual at risk. Poor footwear should not be ruled out as a potential cause. All the problems listed in one way or another can result in pressure on the Baxter’s nerve.
Symptoms of Baxter’s nerve entrapment
The symptoms generally include chronic pain at the medial plantar heel. There is pain on palpation, which can radiate to other areas. Since the pain is nerve-related other symptoms such as burning, tingling, shooting, or numbing sensations will be experienced. These neurological symptoms are the major differences when considering Baxter’s nerve entrapment vs plantar fasciitis. Note that the two can occur together.
Risk factors for Baxter’s neuritis
Comparatively speaking, females are approximately 78% more likely to develop the pathology. There was also a strong correlation with atrophy of the abductor digiti quniti muscle, which was more prevalent in females. It is not entirely clear why this disparity exists between males and females. Some have postulated that it could be due to the type of shoes ladies generally wear.
Baxter’s entrapment diagnosis
Your clinicians will take a thorough medical history. In this interview, they will ask subjective and objective questions. They will palpate the area to identify where the pain is coming from and determine its type. An MRI may be ordered as it gives good images of the tissue under the skin. It is more sensitive when compared with other imaging methods. However, it can be expensive. Diagnostic ultrasound is also good at highlighting the Baxter’s nerve. Many clinicians have one in their surgery, making it a less expensive option.
Treatment options for Baxter’s Nerve entrapment
Conservative treatment should involve resting the area where that is possible. Appropriate footwear and anti-inflammatories (NSAIDs) will be advised on. Note that for NSAIDs like ibuprofen can irritate the stomach, and the gel alternative is indicated. If a biomechanical of the foot is the cause, your clinician may prescribe orthotics to help with the correction. The cortico-steriods injection can be very effective in treating Baxter’s neuritis. However, it is an option that should be used with caution as it can damage underlying tissue if miss used.
If conservative treatment fails, surgical decompression of the nerve should be considered. The techniques used will depend on the clinician’s experience. They would typically do open surgery, an endoscopic approach or a radiofrequency ablation technique.
What is plantar fasciitis?
The plantar fascia is a thick, strong fibre that runs the entire span of the bottom of the foot. It attaches to the heel bone and the base of the toes. This gives the foot dynamic stability, and it also aids in shock absorption. It is avascular (poor blood supply) and can take long to heal when injured.
Causes of plantar fasciitis
The leading cause of plantar fasciitis is tight calf muscles. The calf muscles attach to the Achilles tendon, which attaches to the plantar fasciitis. They all work together as an effective mechanism during gait. Tightness in the calf translates to the tendon and plantar fascia and can eventually lead to tendinopathy or plantar fasciitis. Poor footwear, high BMI, trauma, overuse, type of terrain for walking or training and sports participation are also causative factors.
Symptoms of plantar fasciitis
The main giveaway that the medial heel pain is plantar fasciitis is pain on the first step in the mornings or after rest, which eases with activity. It is essential to note that the pain can become chronic with a long-standing pathology. The pain can affect the entire foot and interfere with daily activities. It is not generally associated with swelling or bruising in my experience. Again, it may be due to the relatively avascular nature of the plantar fascia itself.
Risk factors for plantar fasciitis
Population over 40 years of age with high BMI are at greater risk of developing plantar fasciitis. The literature has highlighted the pathology in younger populations, but it is associated with those participating in sports. As mentioned earlier, tight calf muscles and shoes with too firm a sole are also risk factors. It is worth knowing that hormonal changes later in life may predispose females to the conditions. It is acknowledged that a reduction in estrogen production can negatively affect collagen production.
Plantar fasciitis diagnosis
Plantar fasciitis can be diagnosed in the clinic through a thorough medical history. The giveaway is a pain in the morning and after rest. Your clinician may use an ultrasound machine to look at the tissue to see the extent of the damage or do a guided injection. Furthermore, they may also use it to help with differential diagnosis.
Treatment options for plantar fasciitis
As with most musculoskeletal injuries, rest, ice, and elevation should be initiated. Again NSAIDs can be used to help with inflammation. Footwear with a rocker bottom is perfect for offloading pressure. Daily stretching exercises for the calf muscles are necessary. Orthotics are prescribed to put the foot into an advantageous biomechanical position and offload the area of the plantar fascia that’s painful.
Shockwave has shown promising clinical outcomes and is a treatment option recommended by (NICE, 2009). Injection therapy such as steroids or autologous platelet-rich plasma (PRP) should also be considered. Surgery is generally considered chronic and will not respond to conservative treatment. Open or endoscopic plantar fasciotomy is the go-to procedure. After which physiotherapy rehabilitation can commence.
Prognosis
With care and early treatment, the prognosis of both Baxter’s nerve entrapment and plantar fasciitis can have good outcomes. However, the patient must comply with their treatment regime to achieve this clinical goal.
Final thoughts on Baxter’s nerve entrapment vs plantar pasciitis
After reading this article, you should better grasp Baxter’s nerve entrapment vs plantar fasciitis. It is not recommended to treat these pathologies yourself. See your care provider for diagnosis and a treatment plan. Early intervention can minimise risks. In the meantime, you can use the RICE protocol to get things going with treating your heel pain. Your health is your wealth!
