What Is the Calcaneal Nerve Entrapment (Baxter’s Neuritis)?

Calcaneal nerve entrapment is a condition that can commonly mimic plantar fasciitis. However, this condition has slight differences that can be missed, and unfortunately often patients will be misdagnosed. Calcaneal nerve entrapment mainly occurs as a muscle compresses the nerve against the heel bone. Patients don’t typically have morning pain and don't responding to the normal plantar fascial treatments. 

Causes

The nerve is compressed and you begin to experience the signs and symptoms of calcaneal nerve entrapment/Baxter’s neuritis. There are many possible causes, but a few of the most common include:

• Flat feet and fallen arches

• Bone spurs and plantar fasciitis

• Systemic conditions like diabetes or rheumatoid arthritis

Symptoms

Patients typically experience one or more of the following symptoms:

• An ache that progressese to a burning, tingling or electric-type pain

• Numb toes or numbness around the heel

• Pain, especially shooting pain or pins and needles

The symptoms are usually around the inside of the foot or heel. However, some people will experience pain along the bottom of the foot or along fifth toe. Symptoms may arise suddenly, or sometimes get worse with time.

It is very important to seek help from your foot and ankle doctor early to minimize long-term complications like permanent numbness or loss of function.

Diagnosis

The foot and ankle doctor will examine your foot and ankle and pertinent medical issues. Often times one can strike the nerve and recreate the sensations. Further medical imaging or testing can be ordered, such as nerve conduction studies or an MRI. Even a local injection to numb the nerve and see if symptoms resolve can help with the diagnosis.

Non-Surgical Treatment

A variety of treatment options, often used in combination, are available to treat calcaneal nerve entrapments/Baxter’s neuritis. These include:

• Rest. Staying off the foot prevents further injury and encourages healing.

• Ice. Apply an ice pack to the affected area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.

• Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.

• Immobilization. Restricting movement of the foot by wearing a cast is sometimes necessary to enable the nerve and surrounding tissue to heal.

• Physical therapy. Ultrasound therapy, exercises, and other physical therapy modalities may be prescribed to reduce symptoms.

• Injection therapy. Injections of a local anesthetic provide pain relief, and an injected corticosteroid may be useful in treating the inflammation.

• Custom orthotic devices. Custom shoe inserts may be prescribed to help maintain the arch and limit excessive motion that can cause compression of the nerve.

• Bracing. Patients can find relief with specific braces. 

When is Surgery Needed?

Sometimes surgery is the best option for treating calcaneal nerve entrapment/Baxter’s neuritis syndrome. The foot and ankle surgeon will determine if surgery is necessary and will select the appropriate procedure or procedures based on the cause of the condition.