Abstract

Case Report

Baxter’s nerve injury: an often overlooked cause of chronic heel pain: a case report

Anand Prem* and Suwarna Anand

Published: 07 February, 2023 | Volume 7 - Issue 1 | Pages: 003-004

Chronic foot and heel pain is a clinical dilemma that Pain Physicians often encounter in their daily practice. In the younger active patients, this is often attributed to plantar fasciitis but other rarer etiologies should also be considered. In patients who present with pain over the medial calcaneus, entrapment neuropathy of the inferior calcaneal nerve, the first branch of the lateral plantar nerve (FBLPN), also known as “Baxter’s nerve” must be considered [1,2]. Initially described in 1984 by Baxter and Thigpen, it is often overlooked as a cause of medial heel pain, particularly in athletes, where it may coexist with plantar fasciitis [3]. The nerve has a tortuous course in the foot and can be entrapped as it passes through the fascia of the abductor hallucis, travels in close proximity to a plantar spur or the medial calcaneal tuberosity, or gets enmeshed in scar tissue from prior surgery [1,3].

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References

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  2. Presley JC, Maida E, Pawlina W, Murthy N, Ryssman DB, Smith J. Sonographic visualization of the first branch of the lateral plantar nerve (baxter nerve): technique and validation using perineural injections in a cadaveric model. J Ultrasound Med. 2013 Sep;32(9):1643-52. doi: 10.7863/ultra.32.9.1643. PMID: 23980227.
  3. Baxter DE. Release of the nerve to the abductor digiti minimi. In: Kitaoka HB, ed. Master techniques in orthopedic surgery of the foot and ankle. Philadelphia, PA: Lippincott Williams and Wilkins; 2002: 359.
  4. Beltran LS, Bencardino J, Ghazikhanian V, Beltran J. Entrapment neuropathies III: lower limb. Semin Musculoskelet Radiol. 2010 Nov;14(5):501-11. doi: 10.1055/s-0030-1268070. Epub 2010 Nov 11. PMID: 21072728.
  5. Allam AE, Chang KV. Plantar Heel Pain. 2022 Sep 5. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022 Jan. PMID: 29763043.
  6. Lareau CR, Sawyer GA, Wang JH, DiGiovanni CW. Plantar and medial heel pain: diagnosis and management. J Am Acad Orthop Surg. 2014 Jun;22(6):372-80. doi: 10.5435/JAAOS-22-06-372. PMID: 24860133.

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