Treating Heel Pain: Baxter’s Nerve Entrapment
If distinguishing between all of these possible injuries to the heel isn’t perplexing enough, consider Baxter’s Nerve Entrapment. This tricky injury affects the outside part of the posterior tibial nerve as the nerve snakes around the bottom of the foot. When this nerve is compressed or pinched, the heel will be in pain and the bottom of the foot will be numb. Feet with Baxter’s Nerve Entrapment will become increasingly painful throughout the day, and can be aggravated by pronation.
Part of the reason why Baxter’s Nerve Entrapment is so difficult to diagnose is because of the complexity of the foot’s structure; Baxter’s Nerve Entrapment occurs in an intersection for multiple nerves, not to mention other surrounding tissues. It also occurs in a specific part of the posterior tibial nerve, after this nerve divides into two branches on the inside of the ankle. On top of that, this part of the foot is close to the bottom of the calcaneus where heel spurs may form, providing further opportunity to aggravate the nerve.
There are limited treatments for Baxter’s nerve entrapments. Over the counter or custom orthotics can be helpful in controlling pronation, flatfeet and other biomechanical issues. If surgery is a viable option, a procedure to surgically release the nerve, called external neurolysis, will often be conducted. Neurolysis identifies the physical irritation of the nerve, releases the strictures and allows the nerve to return to normal function. Dr. Murray and Dr. Chang have found success through conducting cryosurgical neurolysis, which is an out patient method using cold to ablate the Baxter’s nerve. Be sure to discuss the pros and cons of your this procedure with your podiatrist.