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Baxter's Nerve Entrapment - Causes and Treatment

By Steven Gershman DPM / Feb 06, 2024

This blog will explain what Baxter's nerve is, what an entrapment is, what causes it and how to treat it. 

What is Baxter's nerve entrapment? 

Baxter's nerve is a branch of a larger nerve known as the Posterior Tibial Nerve. It is situated in the tarsal tunnel, located just below the medial or inner ankle bone. The formal name is the Inferior Calcaneal Nerve, as it travels under the foot to reach the bottom of the heel or calcaneus bone.

It is both a sensory and motor nerve. In other words it feels the sensations on the heel and along its course, and moves small muscles to the little toe and the outside of the foot.   

Baxter's nerve entrapment causes

Due to the way the nerve travels to the heel, it has to pass under a muscle (abductor hallucis)  and turn to run down to the heel. If the muscle is too large from overuse, swelling, or abnormal shape, the nerve can be compressed, squeezed, or entrapped. 

Entrapment means too much pressure on the nerve, causing it to malfunction. If you ever had your arm fall asleep from lying on it too long, you know what an entrapment is and how it can feel.

Symptoms of Baxter's nerve entrapment can include sharp burning pain on the inside of the foot just below the ankle, pins and needles on the side of the foot in the same area, numbness on the inside of the foot under the ankle, and pain on the bottom of the heel. The pain is usually worse after being on it for a while or walking or running, and gets worse the more time is spent on the foot. Tapping on the inside of the foot, below the ankle, will often cause pins and needles.

How to tell the difference between plantar fasciitis and nerve damage?

Baxter's nerve entrapment can be difficult to differentiate from plantar fasciitis, which also causes pain on the bottom of the heel in the same area. One difference between the two is that plantar fasciitis often hurts worse when first getting up from sitting or lying down and can improve after a while on it, while Baxter's is worse later after being on it. 

Diagnosing Baxter's entrapment requires a good exam and sometimes an ultrasound or an MRI. It can fool even an experienced practitioner at times. In some cases, plantar fasciitis can exist with Baxter's nerve entrapment. 

Baxter's nerve entrapment treatment

Treatment can and should start with proper shoe wear and possibly inserts or orthotics. A common cause of Baxter's nerve entrapment is overpronation of the foot. This is where the foot rolls in and the arch usually lowers significantly. 

Overpronation can enlarge or swell the abductor muscle which entraps the nerve. Also, it can compress the heel where the nerve ends up squeezing it. Reducing pronation is critical to helping treat this problem and the subsequent pain. 

The role of footwear in managing Baxter's nerve entrapment

Baxter's nerve entrapment shoes should have a solid heel counter and extra depth to handle inserts or orthotics, and reduce abnormal motion, and a low heel, wide roomy toe box and a stable midsole for motion control. Orthofeet has many shoes that are appropriate for these criteria.

In addition, inserts or even orthotics are often required to go with the shoes. Pronation control often requires a combination of proper shoes and inserts. Orthofeet has a well-made basic insert in all its shoes and if more support is required, Orthofeet’s BioSole Gel Sport non-custom orthotic is well made for reducing pronation and controlling motion issues. It is very comfortable, as are all Orthofeet shoes. 

Baxter's nerve entrapment can be painful and challenging to treat. In some cases, injections,  immobilization and surgery may be required. Prevention is always a better way to go. Proper shoes are a good way to head off this painful condition.

Try Orthofeet shoes, as they are comfortable and give your feet a chance to reduce the risk of developing this condition.